For example, insomnia symptoms were associated with greater consumption of energy drinks and alcohol in boys only whereas insomnia symptoms were associated with self-reported poorer emotional and behavioral wellbeing in girls only. While some relationships were common in both boys and girls, interactions with sex were also found. Our previous study has explored the associations of insomnia symptoms with lifestyle, and emotional and behavioral problems in females and males. Several social and biological changes occur during puberty that are sexually differentiated, such as higher stress level and greater stress reactivity in females and differential changes in sex steroids associated with increased neuroendocrine sensitivity, which may increase risk for both depression and insomnia. In part, the sexual dimorphism in the prevalence of insomnia in adolescence could relate to the higher prevalence of depression in females, which also emerges after puberty. There is an emerging sex difference in the prevalence of insomnia and depression in adolescents. On the other hand, adolescent insomnia and depression share many common features, both at the symptom level and at the disease level. There was a significant interaction between sex and puberty in the prevalence of insomnia symptoms (p<0.001) with the emergence of female preponderance at Tanner stage 4 even after controlling for age, family income, and school start time. By using a large-scale school-based survey, we found that the prevalence of insomnia symptoms progressively increased from 3.4% to 12.2% in girls (3.6-fold) and from 4.3% to 9.1% in boys (2.1-fold). found that the onset of menses was a critical phase with an increased risk of developing insomnia in adolescent girls but pubertal maturation was not associated with increased prevalence of insomnia in adolescent boys. Several studies have explored the timing of sex differences in insomnia. Indeed, puberty is accompanied by a series of factors that may contribute to the development of insomnia, such as decreased homeostatic sleep drive and delayed circadian phase leading to a mismatch with social activity. Thus, puberty has been postulated as a critical stage for the development of insomnia and the emergence of the sex differences in insomnia. Interestingly, most studies did not find any sex differences in insomnia in children. Keywords: Insomnia, Depressive symptoms, Cognitive behavioral therapy for insomnia, Adolescents INTRODUCTION INTRODUCTION Epidemiology of insomnia in adolescents Epidemiology of insomnia in adolescents However, there is still unknown whether CBT-I may treat depression in adolescents with both disorders or whether CBT-I may prevent depression in those adolescents with insomnia who are at-risk of depression. This finding suggest that CBT-I is not only beneficial to sleep quality but also improve mental health. There is evidence to show that CBT-I can reduce depressive symptoms in adolescents with insomnia. Four studies have been found to meet the inclusion criteria in this review. This narrative review aimed to examine whether CBT for insomnia (CBT-I) can improve depressive symptoms in adolescents who experience both insomnia and depressive symptoms. Many studies have suggested or illustrated that adolescents and families strongly favor cognitive behavioral therapy (CBT) and other psychotherapies over pharmacotherapy. Psychological and pharmacological treatments for insomnia in adolescents have been associated with reduced insomnia symptoms and improved psychological wellbeing.
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