Systematic Review and Meta-analysis of Adolescent Cognitive–Behavioral Sleep Interventions

“Additionally, all trials were assessed for publication bias using funnel plots and the Egger test (Egger et al. 1997; Higgins et al. 2003).”

“A systematic review and meta-analysis was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines (Moher et al. 2015).”

“9.8 (Viechtbauer 2010), inR software v 3.3.1 (RCore Team2015).”

“Because comorbidity is the norm (Kessler et al. 2005, 2007), clinicians are often faced with the dilemma of which disorder/ disorders to prioritize for treatment.”

“Empirical evidence shows that lack of reporting of blinding is associated with biased estimates of treatment effect and more positive outcomes (Boutron et al. 2008; Higgins and Green 2011; Moher et al. 2012).”

“Mindfulness can be defined as ‘‘the awareness that emerges through paying attention on purpose, in the present moment, and non-judgmentally to the unfolding of experience’’ and is considered a ‘‘third-wave’’ cognitive– behavioral therapy (Kabat-Zinn 2003, p. 145).”

“To conduct an appraisal of the studies’ methodological quality, each of the trials was evaluated according to the quality index for randomized and non-randomized studies proposed by Downs and Black (1998).”

“The American Academy of Sleep Medicine, the National Sleep Foundation, and the American Center for Disease Control and Prevention have suggested that adolescents optimally require between 8 and 10 h of sleep per night (Hirshkowitz et al. 2015; Paruthi et al. 2016).”

“It has been recommended as a strong instrument for assessing the methodological quality of interventions (Deeks et al. 2003; Higgins and Green 2011).”

“…that sleep and mental health problems in youth share common etiological underpinnings, early treatment programs for sleep problems might reduce the risk of developing mental health problems and can be considered a helpful general preventive strategy (Baglioni et al. 2011; Dahl and Harvey 2007).”

“On the other hand, if nonsignificant results are found, the outcome could be due to an ineffective treatment or a lack of treatment fidelity (Bellg et al. 2004).”

“Treatment mechanism research can lead to a number of positive outcomes, including clarifying the nature and etiology of disorders, elucidating the processes leading to therapeutic change, identifying active treatment components, and refining current treatment protocols (Kazdin 2007; Kraemer et al. 2002).”

“Treatment mechanism research can lead to a number of positive outcomes, including clarifying the nature and etiology of disorders, elucidating the processes leading to therapeutic change, identifying active treatment components, and refining current treatment protocols (Kazdin 2007; Kraemer et al. 2002).”

“Beliefs and expectations about behavioral and psychological treatments play an important role in determining experiences and outcomes of treatment (Devilly and Borkovec 2000).”

“Empirical evidence shows that lack of reporting of blinding is associated with biased estimates of treatment effect and more positive outcomes (Boutron et al. 2008; Higgins and Green 2011; Moher et al. 2012).”

“The American College of Physicians recently recommended that all adult patients should receive CBT-I as an initial treatment for chronic insomnia (Qaseem et al. 2016).”

“Between 40 and 92% of all cases of insomnia occur in the context of psychiatric disorders (Breslau et al. 1996; Kessler et al. 2012).”

“However, the publication bias results should be interpreted with caution, as funnel plots require a considerable number of studies, generally at least 30 (Cuijpers 2016; Lau et al. 2006).”

“Sixty-five percent of adolescents report sleep onset latencies exceeding 30 min (Hysing et al. 2013), more than half report the need for more sleep (Wolfson and Carskadon 1998), and most (59”

“The American Academy of Sleep Medicine, the National Sleep Foundation, and the American Center for Disease Control and Prevention have suggested that adolescents optimally require between 8 and 10 h of sleep per night (Hirshkowitz et al. 2015; Paruthi et al. 2016).”

“Finally, electronic devices have a deleterious impact on sleep in adolescence, including delaying sleep onset and reducing sleep duration (Bartel et al. 2015; Hale and Guan 2015).”

“Eleventh, studies are needed that examine mechanisms of change during adolescent cognitive–behavioral sleep interventions (Morin et al. 2006; Schwartz and Carney 2012; Vitiello et al. 2013).”

“Sleep diaries are considered the gold standard of subjective self-report (Buysse et al. 2006; Morin and Espie 2003) but are vulnerable to poor compliance (missing data and entry errors), and all subjective measures of sleep are subject to the limits of introspection and memory bias.”

“However, recent systematic reviews and meta-analyses have demonstrated that many adolescents obtain insufficient sleep (i.e., \8 h), especially on school nights (Gradisar et al. 2011b).”

“Melatonin is released later in the evening among adolescents than children, which also delays the onset of evening sleepiness (Carskadon et al. 1993).”

“Between 40 and 92% of all cases of insomnia occur in the context of psychiatric disorders (Breslau et al. 1996; Kessler et al. 2012).”

“These physiological maturational processes and social and cultural factors have been described as a ‘‘perfect storm’’ of factors in adolescence (Carskadon 2011), so that reduced sleep propensity in the late evening becomes permissive of continued waking activities and delayed bedtimes (Carskadon 2011; Jenni and LeBour…”

“…of psychological interventions for sleep problems have suggested that individual and group treatments are equally effective (Murtagh and Greenwood 1995; Trauer et al. 2015; van Straten et al. 2017), while another indicated that individual treatment is most effective (Morin et al. 1994).”

“…recent reviews suggesting that targeted interventions are more effective than universal interventions in preventing child and adolescent depression (Horowitz and Garber 2006; Rohde 2015), and that simple sleep hygiene education does not guarantee positive outcomes in adults (Irish et al. 2015).”

“Along with timed melatonin administration, timed light exposure and chronotherapy are recommended as effective therapies for DSPD by the Standards of Practice Committee of the American Academy of Sleep Medicine (Morgenthaler et al. 2006), based on a systematic review of the literature (Sack et al. 2007).”

“These findings are consistent with recent reviews suggesting that targeted interventions are more effective than universal interventions in preventing child and adolescent depression (Horowitz and Garber 2006; Rohde 2015), and that simple sleep hygiene education does not guarantee positive outcomes in adults (Irish et…”

“There is strong evidence from multiple systematic reviews and meta-analyses that CBT-I improves sleep in adults, usually with medium–large effect sizes (Koffel et al. 2015; Murtagh and Greenwood 1995; Morin et al. 1994; Trauer et al. 2015; van Straten et al. 2017).”

“While wrist actigraphy shows high sensitivity (to detect sleep), it demonstrates lower specificity (to detect wakefulness in bed; Meltzer et al. 2012).”

“Cognitive–Behavioral Therapies for DSPD Finally, there is accumulating evidence that DSPD can be treated successfully using cognitive–behavioral therapies.”

“Indeed, there is emerging evidence that sleep may qualify as a transdiagnostic process (Harvey 2015; Harvey et al. 2011).”

“Sleep problems are a highly relevant ‘‘bridge symptom’’ (Baglioni et al. 2014) and share the highest percentage of connected symptoms within all symptoms in the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association 1994; Borsboom et al. 2011).”

“Recent evidence suggests that sleep problems, particularly wakefulness in bed (e.g., prolonged sleep onset latency and poor sleep efficiency), precede the development of anxiety and depression in adolescence more than the reverse (Lovato and Gradisar 2014; McMakin and Alfano 2015).”

“However, different to hypnotics, CBT-I effects are likely to continue after treatment cessation (Sivertsen et al. 2006) and to have fewer side effects, such as adverse effects and rebound insomnia after discontinuation (Buscemi et al. 2007; Kales et al. 1991).”

“Finally, electronic devices have a deleterious impact on sleep in adolescence, including delaying sleep onset and reducing sleep duration (Bartel et al. 2015; Hale and Guan 2015).”

“…with timed melatonin administration, timed light exposure and chronotherapy are recommended as effective therapies for DSPD by the Standards of Practice Committee of the American Academy of Sleep Medicine (Morgenthaler et al. 2006), based on a systematic review of the literature (Sack et al. 2007).”

“It is generally accepted that for a trial to achieve a high standard of evidence, it must include adequate statistical power to detect significant effects and an active control condition or psychological placebo (Furukawa et al. 2014).”

“Future adolescent cognitive–behavioral sleep intervention trials should recruit larger sample sizes and use high-quality active control conditions (Morin et al. 2006; Riemann and Perlis 2009; Vitiello et al. 2013).”

“Because comorbidity is the norm (Kessler et al. 2005, 2007), clinicians are often faced with the dilemma of which disorder/ disorders to prioritize for treatment.”

“Along with timed melatonin administration, timed light exposure and chronotherapy are recommended as effective therapies for DSPD by the Standards of Practice Committee of the American Academy of Sleep Medicine (Morgenthaler et al. 2006), based on a systematic review of the literature (Sack et al. 2007).”

“adolescence is affected by physiological development (Colrain and Baker 2011).”

“The effect sizes were similar in size to those seen in meta-analyses of hypnotics, such as benzodiazepines (Huedo-Medina et al. 2012; Nowell et al. 1997).”

“2006) and to have fewer side effects, such as adverse effects and rebound insomnia after discontinuation (Buscemi et al. 2007; Kales et al. 1991).”

“A systematic review of daily sleep variability among adults found that higher variability in sleep is associated with sleep and mental health problems (including insomnia, depression, anxiety), and that CBT-I reduces such variability (Bei et al. 2016).”

“Fourth, adolescents develop responsibilities and social interests (e.g., homework, employment, friendships) that encourage remaining awake later into the evening (Adam et al. 2007; Maume 2013).”

“Sixty-five percent of adolescents report sleep onset latencies exceeding 30 min (Hysing et al. 2013), more than half report the need for more sleep (Wolfson and Carskadon 1998), and most (59”

“Sleep diaries are considered the gold standard of subjective self-report (Buysse et al. 2006; Morin and Espie 2003) but are vulnerable to poor compliance (missing data and entry errors), and all subjective measures of sleep are subject to the limits of introspection and memory bias.”

“…Royal Children’s Hospital, Flemington Road, Parkville, VIC 3052, Australia 5 Department of Psychology, University of Oregon, Eugene, OR 97403-1227, USA (Adolescent Sleep Working Group 2014; American Medical Association 2010; Millman 2005; Office of Disease Prevention and Health Promotion 2011).”

“Patient adherence to online interventions also represents a major challenge, as indicated by the 50% completion rate for computerized CBT-I in two recent studies (Lancee et al. 2016; Christensen et al. 2016).”

“Studies that have assessed mental health have tended to use generic measures of emotional distress (Bootzin and Stevens 2005; Schlarb et al. 2011) or have not examined heterogeneous anxiety and depressive symptoms (Blake et al. 2016; Clarke et al. 2015; Gradisar et al. 2011a), limiting specificity…”

“50)] relative to control conditions (Taylor and Pruiksma 2014).”

“There is strong evidence from multiple systematic reviews and meta-analyses that CBT-I improves sleep in adults, usually with medium–large effect sizes (Koffel et al. 2015; Murtagh and Greenwood 1995; Morin et al. 1994; Trauer et al. 2015; van Straten et al. 2017).”

“Chronotherapy (Czeisler et al. 1981) involves a prescribed progressive delay in the schedule of sleep time until the desired sleep schedule is reached.”

“…processes may reduce the burden on clinicians, who are often required to learn multiple disorder-focused protocols (e.g., CBT-I, mindfulness-based sleep interventions, bright light therapy, and chronotherapy), with shared theoretical underpinnings (Harvey 2004, 2015; Mansell et al. 2009).”

“Insomnia is the most prevalent sleep disorder among adolescents (Johnson et al. 2006; Roberts et al. 2009).”

“Adult CBT-I is usually conducted over the course of four to eight sessions (Edinger and Means 2005), and a recent meta-analysis found that adult CBT-I delivered on at least four occasions is more effective than CBT-I delivered on fewer occasions (van Straten et al.”

“, anxiety-/ depression-specific components, bright light therapy), were not excluded, as adult studies suggest the efficacy of such combined approaches (Britton et al. 2010, 2012; Garland et al. 2014; Gross et al. 2011; Ong et al. 2014), and the aim of the review was to evaluate the broad-based and transdiagnostic eff…”

“Several RCTs have evaluated in person mindfulness-based therapies in adults with sleep problems (Britton et al. 2010, 2012; Garland et al. 2014; Gross et al. 2011; Ong et al. 2014) and have found significant improvements within active treatment conditions for subjective and objective measures of…”

“(2011a) evaluated adolescents with DSPD, which is a low prevalence disorder (between 1 and 7%; Johnson et al. 2006; Ohayon et al. 2000; Pelayo et al. 1988).”

“The effect sizes were similar in size to those seen in meta-analyses of hypnotics, such as benzodiazepines (Huedo-Medina et al. 2012; Nowell et al. 1997).”

“Adolescence is also associated with a delay in the timing of sleep, which is related to a lengthening of the intrinsic period of the endogenous circadian oscillator (Carskadon et al. 2004).”

“…with insomnia diverge from healthy control participants in subjectively assessed TST, SOL, and SE by around 95 min, 23 min, and 16%, respectively (Buysse et al. 2007), and Scholle et al. (2011) found that normal polysomnography assessed TST, SOL, and SE among adolescents are around 473 min, 24…”

“…barriers to sleep intervention in adolescence, including powerful physiological and social/cultural factors that combine to delay sleep onset and restrict sleep opportunities (Adam et al. 2007; Carskadon et al. 2004; Feinberg and Campbell 2010; Hale and Guan 2015; Maume 2013; Short et al. 2011).”

“First, children and adolescents are subject to the same physiological susceptibilities and psychological and environmental vulnerabilities that cause insomnia in adults (Keller & El-Sheikh 2011), such as predisposition to cognitive–emotional hyperarousal (Fernandez-Mendoza et al. 2011).”

“…stimulus control therapy, and cognitive–behavioral therapy, is a common goal of sleep interventions, and regularity and variability of sleep behaviors have been recommended as measures of treatment adherence and non-adherence, respectively, in behavioral insomnia treatments (Buysse et al. 2010).”

“Several RCTs have evaluated in person mindfulness-based therapies in adults with sleep problems (Britton et al. 2010, 2012; Garland et al. 2014; Gross et al. 2011; Ong et al. 2014) and have found significant improvements within active treatment conditions for subjective and objective measures of…”

“On the other hand, it is also possible that transdiagnostic approaches may solve the ‘‘too many empirically supported treatments problem’’ that can impede the dissemination and uptake of treatments (Weisz et al. 2014, p. 68).”

“Two of the studies found that both forms of CBT-I were equally effective at improving sleep (Bastien et al. 2004; Verbeek et al. 2006), while the third study found that individual CBT-I resulted in greater improvement on several sleep variables compared to group CBT-I, including SOL and sleep…”

“Third, parental control over bedtime lessens during adolescence (Short et al. 2011).”

“The findings are also consistent with large epidemiologic studies showing that in adolescents, evening chronotype and increased daytime sleepiness are associated with deficits in self-regulation, while short sleep duration is not (Anderson et al. 2009; Owens et al. 2016; Perez-Lloret et al. 2013).”

“Trials among adolescents experiencing subclinical and generalized levels of sleep and mental health problems are needed (Chase and Pincus 2011; Johnson et al. 2000; Moore et al. 2009; Warner et al. 2008).”

“Recent evidence suggests that sleep problems, particularly wakefulness in bed (e.g., prolonged sleep onset latency and poor sleep efficiency), precede the development of anxiety and depression in adolescence more than the reverse (Lovato and Gradisar 2014; McMakin and Alfano 2015).”

“However, no adolescent studies have compared the efficacy of different treatment components using dismantling designs (Harvey et al. 2014).”

“…reporting Other issues Summary assessment Blake et al. (2016) Low Low Low Low Low Low Low Clarke et al. (2015) Low Low Low Low Unclear Low Low De Bruin et al. (2015) Low Low High Low Unclear Low High Gradisar et al. (2011a) Low Low High High Unclear Low High Summary assessment Low Low High Low…”

“There is also emerging evidence that CBT-I leads to improvements in physical and mental health symptoms, including reductions in anxiety and depression, with small– medium effect sizes (Ballesio et al. 2017; Belleville et al. 2011; Taylor and Pruiksma 2014).”

“Seventeen percent of adolescents report difficulties falling asleep before 2 a.m. at least three times per week (Saxvig et al. 2012).”

“, CBT-I, mindfulness-based sleep interventions, bright light therapy, and chronotherapy), and that are delivered to students who are already experiencing early signs of sleep and/or mental health problems, may be more effective (Wensing et al. 2010).”

“…Low Low High High Unclear Low High Summary assessment Low Low High Low Unclear Low High Assessed using the Cochrane risk-of-bias instrument consistent indicator of current and future internalizing problems (Alfano et al. 2013; Forbes et al. 2009; Lovato and Gradisar 2014; McMakin and Alfano 2015).”

“…predictors of treatment adherence (e.g., baseline symptoms (short sleep duration, anxiety, depression), self-efficacy, and attitude to treatment; Matthews et al. 2013), dose–response relationships (i.e., highvs. low-intensity treatments), and temporal relations between variables (Morin et al.…”

“With respect to adolescents, a number of studies have found that variability in sleep schedules is associated with poor functional outcomes among adolescents, including anxiety, depression, daytime sleepiness, behavioral problems, and poor school performance (Biggs et al. 2011; Fuligni and Hardway 2006; Pasch et al. 2…”

“must not only demonstrate that it is effective, but also show that the intervention works via its purportedly active mechanism (Garratt et al. 2007; Insel 2015).”

“The index was adapted to be consistent with a procedure used by Blunden et al. (2012) in their review of school-based sleep education programs.”

“…healthy control participants in subjectively assessed TST, SOL, and SE by around 95 min, 23 min, and 16%, respectively (Buysse et al. 2007), and Scholle et al. (2011) found that normal polysomnography assessed TST, SOL, and SE among adolescents are around 473 min, 24 min, and 89%, respectively.”

“Patient adherence to online interventions also represents a major challenge, as indicated by the 50% completion rate for computerized CBT-I in two recent studies (Lancee et al. 2016; Christensen et al. 2016).”

“There is also emerging evidence that CBT-I leads to improvements in physical and mental health symptoms, including reductions in anxiety and depression, with small– medium effect sizes (Ballesio et al. 2017; Belleville et al. 2011; Taylor and Pruiksma 2014).”

“Morin (2003) has suggested that it is critical to document efficacy beyond the simple reduction of insomnia symptoms in CBT-I trials and to incorporate additional indicators of efficacy, such as daytime functioning, fatigue, mood, anxiety, quality of life, school attendance, academic performance,…”

“…processes and social and cultural factors have been described as a ‘‘perfect storm’’ of factors in adolescence (Carskadon 2011), so that reduced sleep propensity in the late evening becomes permissive of continued waking activities and delayed bedtimes (Carskadon 2011; Jenni and LeBourgeois 2006).”

“must not only demonstrate that it is effective, but also show that the intervention works via its purportedly active mechanism (Garratt et al. 2007; Insel 2015).”

“2010; Wolfson and Carskadon 1998), as well as altered brain development (Telzer et al. 2015).”

“…assessors Incomplete outcome data Selective outcome reporting Other issues Summary assessment Blake et al. (2016) Low Low Low Low Low Low Low Clarke et al. (2015) Low Low Low Low Unclear Low Low De Bruin et al. (2015) Low Low High Low Unclear Low High Gradisar et al. (2011a) Low Low High…”

“The findings are also consistent with large epidemiologic studies showing that in adolescents, evening chronotype and increased daytime sleepiness are associated with deficits in self-regulation, while short sleep duration is not (Anderson et al. 2009; Owens et al. 2016; Perez-Lloret et al. 2013).”

“Trials among adolescents experiencing subclinical and generalized levels of sleep and mental health problems are needed (Chase and Pincus 2011; Johnson et al. 2000; Moore et al. 2009; Warner et al. 2008).”

“Eleventh, studies are needed that examine mechanisms of change during adolescent cognitive–behavioral sleep interventions (Morin et al. 2006; Schwartz and Carney 2012; Vitiello et al. 2013).”

“Two articles (Bootzin and Stevens 2005; Britton et al. 2010) reported data from the same trial (pre- and post-intervention and follow-up).”

“…that sleep and mental health problems in youth share common etiological underpinnings, early treatment programs for sleep problems might reduce the risk of developing mental health problems and can be considered a helpful general preventive strategy (Baglioni et al. 2011; Dahl and Harvey 2007).”

“Trials among adolescents experiencing subclinical and generalized levels of sleep and mental health problems are needed (Chase and Pincus 2011; Johnson et al. 2000; Moore et al. 2009; Warner et al. 2008).”

“With respect to adolescents, a number of studies have found that variability in sleep schedules is associated with poor functional outcomes among adolescents, including anxiety, depression, daytime sleepiness, behavioral problems, and poor school performance (Biggs et al. 2011; Fuligni and Hardway 2006; Pasch et al. 2…”

“Sleep education (Bei et al. 2013; Blake et al. 2016; Schlarb et al. 2011), sleep scheduling (Bei et al. 2013; Blake et al. 2016), personalized bedtimes (De Bruin et al. 2014), relaxation (De Bruin et al. 2014), and mindfulness (Blake et al. 2016) were rated as the most helpful components.”

“…RCTs have found that while these psychoeducational programs are effective in increasing students’ knowledge about sleep and insomnia, they are less effective in improving sleep behavior or mental health (Blunden et al. 2012; Blunden and Rigney 2015; Gruber 2016; Kira et al. 2014; Wing et al. 2015).”

“Adolescence is associated with a progressive reduction in the accumulation of homeostatic sleep pressure during wakefulness, which leads to a reduction in sleep drive (Feinberg et al. 2006).”

“For all analyses, we calculated effects based on an assumed correlation between measurements over time of r = 0.5, which was based on results obtained in Blake et al. (2016).”

“Trials among adolescents experiencing subclinical and generalized levels of sleep and mental health problems are needed (Chase and Pincus 2011; Johnson et al. 2000; Moore et al. 2009; Warner et al. 2008).”

“Fourth, adolescents develop responsibilities and social interests (e.g., homework, employment, friendships) that encourage remaining awake later into the evening (Adam et al. 2007; Maume 2013).”

“…Low Low High High Unclear Low High Summary assessment Low Low High Low Unclear Low High Assessed using the Cochrane risk-of-bias instrument consistent indicator of current and future internalizing problems (Alfano et al. 2013; Forbes et al. 2009; Lovato and Gradisar 2014; McMakin and Alfano 2015).”

“…RCTs have found that while these psychoeducational programs are effective in increasing students’ knowledge about sleep and insomnia, they are less effective in improving sleep behavior or mental health (Blunden et al. 2012; Blunden and Rigney 2015; Gruber 2016; Kira et al. 2014; Wing et al. 2015).”

“Furthermore, between 1 and 7% of adolescent’s meet diagnostic criteria for DSPD (Johnson et al. 2006; Ohayon et al. 2000; Pelayo et al. 1988), with the majority (51”

“Sleep education (Bei et al. 2013; Blake et al. 2016; Schlarb et al. 2011), sleep scheduling (Bei et al. 2013; Blake et al. 2016), personalized bedtimes (De Bruin et al. 2014), relaxation (De Bruin et al. 2014), and mindfulness (Blake et al. 2016) were rated as the most helpful components.”

“This delay in sleep onset may lead to significant difficulty in rising for school in the morning, school non-attendance, daytime sleepiness, chronic sleep reduction, and poor school performance (Gradisar and Crowley 2013).”

“…processes may reduce the burden on clinicians, who are often required to learn multiple disorder-focused protocols (e.g., CBT-I, mindfulness-based sleep interventions, bright light therapy, and chronotherapy), with shared theoretical underpinnings (Harvey 2004, 2015; Mansell et al. 2009).”

“…RCTs have found that while these psychoeducational programs are effective in increasing students’ knowledge about sleep and insomnia, they are less effective in improving sleep behavior or mental health (Blunden et al. 2012; Blunden and Rigney 2015; Gruber 2016; Kira et al. 2014; Wing et al. 2015).”

“The findings are also consistent with large epidemiologic studies showing that in adolescents, evening chronotype and increased daytime sleepiness are associated with deficits in self-regulation, while short sleep duration is not (Anderson et al. 2009; Owens et al. 2016; Perez-Lloret et al. 2013).”

“First, children and adolescents are subject to the same physiological susceptibilities and psychological and environmental vulnerabilities that cause insomnia in adults (Keller & El-Sheikh 2011), such as predisposition to cognitive–emotional hyperarousal (Fernandez-Mendoza et al. 2011).”

“Reporting and publishing trial protocol papers prior to the commencement of interventions is an important step in increasing the transparency of research and the reliability of outcome papers (Cybulski et al. 2016).”

“2006) and to have fewer side effects, such as adverse effects and rebound insomnia after discontinuation (Buscemi et al. 2007; Kales et al. 1991).”

“…RCTs have found that while these psychoeducational programs are effective in increasing students’ knowledge about sleep and insomnia, they are less effective in improving sleep behavior or mental health (Blunden et al. 2012; Blunden and Rigney 2015; Gruber 2016; Kira et al. 2014; Wing et al. 2015).”

“There is strong evidence that adolescent sleep is characterized by sleep restriction and high sleep drive during the school week and sleep saturation and lower sleep drive during vacation periods (Bei et al. 2014).”

“Studies that have assessed mental health have tended to use generic measures of emotional distress (Bootzin and Stevens 2005; Schlarb et al. 2011) or have not examined heterogeneous anxiety and depressive symptoms (Blake et al. 2016; Clarke et al. 2015; Gradisar et al. 2011a), limiting specificity…”

“Approximately 8–11% of young people meet diagnostic criteria for insomnia at any one time (Dohnt et al. 2012), which tends to persist over time (Roberts et al.”

“Several RCTs have evaluated in person mindfulness-based therapies in adults with sleep problems (Britton et al. 2010, 2012; Garland et al. 2014; Gross et al. 2011; Ong et al. 2014) and have found significant improvements within active treatment conditions for subjective and objective measures of…”

“%) reporting at least one symptom (Lovato et al. 2013).”

“determine whether cognitive–behavioral sleep interventions can be delivered prophylactically to at-risk, pre-insomniac psychiatric populations (Vitiello et al. 2013).”

“low-intensity treatments), and temporal relations between variables (Morin et al. 2014).”

“Bright light therapy (Lewy and Sack 1996) consists of scheduled natural sunlight and/or broad-spectrum white light from a specialized lamp at usual wake time, while incrementally advancing light exposure each day.”

“Two of the studies found that both forms of CBT-I were equally effective at improving sleep (Bastien et al. 2004; Verbeek et al. 2006), while the third study found that individual CBT-I resulted in greater improvement on several sleep variables compared to group CBT-I, including SOL and sleep…”

“…both forms of CBT-I were equally effective at improving sleep (Bastien et al. 2004; Verbeek et al. 2006), while the third study found that individual CBT-I resulted in greater improvement on several sleep variables compared to group CBT-I, including SOL and sleep quality (Yamadera et al. 2013).”

“…trials were large-scale RCT’s (Blake et al. 2016; De Bruin et al. 2015; Gradisar et al. 2011a), one was a prospective RCT (Clarke et al. 2015), and five were uncontrolled feasibility trials (Bei et al. 2013; Bootzin and Stevens 2005; De Bruin et al. 2014; Roeser et al. 2016; Schlarb et al. 2011).”

“Fourth, we limited analyses to studies that incorporated sleep restriction because this may be among the most effective component of CBT-I (Fernando et al. 2013).”

“In particular, several modifiable risk mechanisms appear to underlie the relationship between sleep disturbance and internalizing problems, including stress/ arousal, emotion processing, and cognitive factors (Cowie et al. 2014).”

“Sleep problems are a highly relevant ‘‘bridge symptom’’ (Baglioni et al. 2014) and share the highest percentage of connected symptoms within all symptoms in the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association 1994; Borsboom et al. 2011).”

“As described by Gradisar and Richardson (2015), ‘‘the list of research questions is extensive and highlights that our field has only begun to evaluate treatment for adolescent sleep disturbance, which may or may not present and respond to treatment like adult insomnia’’ (p. 1841).”

“These findings are consistent with recent reviews suggesting that targeted interventions are more effective than universal interventions in preventing child and adolescent depression (Horowitz and Garber 2006; Rohde 2015), and that simple sleep hygiene education does not guarantee positive outcomes in adults (Irish et…”

“CBT-I modifies the patterns of thinking and behavior underlying sleep disturbances, such as poor sleep hygiene, irregular sleep–wake schedules, delayed bedtimes, pre-sleep hyperarousal, and maladaptive sleep-related cognitions [122].”

“Adolescent Cognitive Behavioral Therapy for Insomnia (ACBT-I) (63), has been shown to be moderately effective, with medium to large effect sizes depending on the outcome measured.”

“In the adolescent population, CBT-I delivered in person one-on-one [72] as well as in a group setting and through specific internet-based programing has been shown to be effective for the treatment of insomnia [73].”

“By including recently published RCTs and evaluating between-group comparisons, the findings provide an updated estimate of the treatment effect with less risk of bias as compared to previous meta-analyses 33,34 of uncontrolled effect sizes.”

“0) 6 (60) 0 (0) 5 (63) 0 (0) Subthreshold insomnia (8-14) 2 (17) 3 (25) 3 (30) 7 (64) 2 (25) 7 (64) Moderate insomnia (15-21) 8 (67) 8 (67) 1 (10) 4 (36) 1 (13) 4 (36) Severe insomnia (22-28) 2 (17) 1 (8) 0 (0) 0 (0) 0 (0) 0 (0)”

“Strong empirical evidence exists for the efficacy of cognitive and behavioral interventions for treating pediatric insomnia [59, 128, 129].”

“Current theory and research have already pointed to interventions to improve sleep and mitigate the risk of deleterious outcomes (Blake et al., 2017).”

“Commonly used treatment options for child and adolescent sleep problems include cognitive behavior therapy (Blake et al. 2017), bedtime fading, chronotherapy, graduated extinction, and response cost procedures (Meltzer and McLaughlin Crabtree 2015; Perlis et al.”

“Though trials of cognitive-behavioral sleep interventions in adolescents provide promising findings (Blake et al., 2017), they have typically excluded adolescents with psychiatric problems (de Bruin et al., 2015; Gradisar et al., 2011; Schlarb et al., 2011) or specifically recruited adolescents…”

“Three previous systematic reviews have addressed behavioral sleep interventions [14, 15, 16]; adolescents were included in one of the reviews [14], whereas adults and adolescents were included in the other two [15, 16].”

“In addition to their impact on insomnia severity, sleep treatments, like CBT-I, have been found to also reduce mental health symptoms related to STBs (e.g., anxiety, depression) in youth (Blake et al., 2017a).”

“In contrast, sleep problems can be effectively treated in adolescents (Blake et al., 2017), which appear to also confer reductions in depressive symptoms.”

“cognitive components (Blake et al., 2017), in a study which compared ‘behavioural therapy’, ‘cognitive therapy’ and ‘Wait List Control’, behavioural therapy was included in the meta-analysis.”

“A consensus is emerging that “early treatment of sleep problems might reduce the risk of developing mental health problems and can be considered a helpful preventive strategy” (10).”

“…disseminate mindfulness exercise decreased SOL comparably more than previous multi-component studies (19 min decrease, Bei et al., 2013; 31 min in the present study among treatment completers with long baseline SOL; 10– 15 min difference between control and intervention groups, Blake et al., 2016).”

“However, despite the effectiveness of CBT-I in reducing depressive symptoms in adult and youth populations [7–9], only a few studies with adequate statistical power examined the effects of CBT-I on preventing new-onset depression at disorder level, but with mixed findings [10].”

“Some studies have indicated a positive effect of cognitive and behavioral interventions for adolescent insomnia as well (Blake et al., 2017).”

“Furthermore, subjective global sleep quality, daytime sleepiness, depression, and anxiety also improved.(8)”

“This finding is consistent with previous research reporting that stimulus control, the element of CBT for insomnia from which this TranS-C element was adapted, has been well-accepted by adolescents participating in randomized controlled trials (Blake et al., 2017).”

“However, the RCTs had several limitations, such as a small sample size, a short follow-up, and the exclusion of adolescents with comorbid physical and mental health conditions [73].”

“These findings are compatible with previous meta-analyses showing the significant therapeutic effect of CBT-I on anxiety and depressive symptoms (Ballesio et al., 2018; Belleville et al., 2011; Blake et al., 2017; Gebara et al., 2018; Gee et al., 2019; Taylor & Pruiksma, 2014).”

“Regarding adolescents, several studies have also demonstrated the effectiveness of these therapies in the management of insomnia disorders, which suggests that CBT for insomnia may be a first-line treatment in this particular subpopulation 50,51 .”

“Meta-analyses confirm these findings (Blake et al., 2017).”

“This study adds to the growing literature on the long-term benefits of cognitive and behavioral treatments for adolescent sleep problems (Blake et al., 2017, 2016; De Bruin et al., 2018).”

“15,19 Disrupted sleep has been negatively associated with multiple other areas of functioning in youth, 20 and these associated problems can overlap considerably with the effects often reported from concussion.”

“In addition to educating parents/caregivers, sleep hygiene education programs for adolescents themselves may also be beneficial (Blake et al., 2017; Gruber, 2017; Noland et al., 2009).”

“Thus, it is likely that the adolescents assessed in the present study would benefit from later SSTs. Alternatively, or concomitantly, cognitive– behavioural strategies and parental involvement may help to reduce the chronic sleep deprivation of adolescents (Blake et al., 2017; Short et al., 2011).”

“As sleep problems are a highly modifiable intervention target that can improve mental health symptoms (Blake & Allen, 2020; Blake et al., 2017), this study reinforces the importance of clinicians targeting sleep problems when treating adolescents with mental health difficulties, regardless of whether ADHD is present o…”

“Of particular note are cognitive-behavioural based sleep interventions that have been shown to improve sleep and also have beneficial effects on mental health outcomes in adults and adolescents (Blake et al., 2017; Blake & Allen, 2020).”

“Finally, sleep problems have been shown to be modifiable via cognitive-behavioral treatment among youth in HICs [20], even when delivered via low-cost, digital platforms [21].”

“During education on sleep hygiene, users learn about healthy sleep habits, which is a first-line intervention for promoting sleep health [26,28].”

“In adults, CBTi is highly efficacious in reducing insomnia symptoms ( g = 0.98), improving subjective sleep quality ( g = 0.65) and sleep metrics, including sleep efficiency (SE%; g = 0.71), total sleep time (TST; g = 0.16), wake after sleep onset (WASO; g = 0.63), sleep-onset latency (SOL; g = 0.57) and number of noc…”

“…parents as active participants (e.g. parental sleep education through workshops, consultations and pamphlets; Hiscock et al., 2015; Jones et al., 2013), by adolescence, most sleep interventions tend to involve the adolescent directly, through individual and group therapy (Blake et al., 2017).”

“…there is strong evidence that interventions that do include a specific focus on behavior change and overcoming barriers to change, such as cognitive-behavioral sleep intervention programs with motivational interviewing elements, are more effective (M. Blake et al., 2017; M. J. Blake et al., 2016).”

“Notably, evidence suggests that behavioral sleep interventions may not only improve sleep, but also reduce anxiety, in pediatric samples [33, 34].”

“So far, three randomized controlled trials showed the effectiveness of either face-to-face or online CBT-I for insomnia in adolescents [30, 31].”