Background: Insomnia and sleep disturbance are pervasive and debilitating conditions affecting up to 40% of adolescents. Women and girls are at greater risk of insomnia, yet differences in treatment responsiveness between genders have not been adequately investigated. Additionally, while women report greater symptom severity and burden of illness than men, this discrepancy requires further examination in adolescents.
Objective: The purpose of this study was to examine gender differences in sleep symptom profiles and treatment response in adolescents.
Methods: Digital cognitive behavioral therapy for insomnia (CBT-I) treatment responsiveness, as indexed by changes in Insomnia Severity Index (ISI) and Global Pittsburgh Sleep Quality Index (PSQI) scores, was compared in boys and girls (aged 12-16 years; N=49) who participated in a pilot evaluation of the Sleep Ninja smartphone app. Gender differences in self-reported baseline insomnia symptom severity (ISI), sleep quality (PSQI), and sleep characteristics derived from sleep diaries were also examined.
Results: Compared with boys, we found that girls reported greater symptom severity (P=.04) and nighttime wakefulness (P=.01 and P=.04) and reduced sleep duration (P=.02) and efficiency (P=.03), but not poorer sleep quality (P=.07), more nighttime awakenings (P=.16), or longer time to get to sleep (P=.21). However, gender differences in symptom severity and sleep duration were accounted for by boys being marginally younger in age. Treatment response to CBT-I was equivalent between boys and girls when comparing reductions in symptom severity (P=.32); there was a trend showing gender differences in improvements in sleep quality, but this was not statistically significant (P=.07).
Conclusions: These results demonstrate the presence of gender differences in insomnia symptoms and severity in adolescents and suggest further research is required to understand gender differences in insomnia symptom profiles to inform the development of gender-specific digital interventions delivered to adolescents.
Insomnia, defined as difficulty initiating or maintaining sleep with an associated impairment in daytime functioning , is a pervasive problem affecting 4%-18.5% of adolescents, in addition to 40% experiencing subthreshold symptoms and insufficient sleep [ - ]. Insomnia and disturbed and insufficient sleep impact adolescents’ academic, social, emotional, and behavioral development [ ]. Difficulties with sleep also often accompany mental health disorders, such as depression, and contribute to their maintenance and burden of illness [ ]. Moreover, there is a well-established link between sleep disturbance and the onset of depression in adolescents, emphasizing the need for effective interventions to ensure adequate sleep duration and quality in this population [ - ].
The exact cause of insomnia has not yet been identified but is likely to involve complex interactions between genetic, neurological, behavioral, cognitive, and emotional factors (eg, [, ], particularly during adolescence [ ]. One factor identified to be a likely contributing candidate is gender. Girls and women are 50% more likely to develop insomnia [ , ] compared with adolescent boys and men. One recent large-scale study examining insomnia symptoms in boys and girls aged 6-17 years found that pubertal maturation in girls was associated with increased prevalence and severity of insomnia symptoms, indicating that gender discrepancies in insomnia emerge at puberty [ ]. Women also report greater symptom severity and perceived burden of illness [ ] and more difficulty falling asleep and nighttime wakefulness than men [ ]. Only one study has investigated gender discrepancies in sleep characteristics in adolescents. This study recruited a large cohort of more than 10,000 Norwegian adolescents with a mean age of 17 years and found that girls reported taking longer to get to sleep (sleep onset latency [SOL]: 51 minutes vs 43 minutes), experienced greater durations of wakefulness after sleep onset (wake after sleep onset [WASO]: 17 minutes