Sleep and insomnia symptoms in adolescence

Insufficient sleep, sleep problems and insomnia are common in adolescents, and insomnia and insufficient sleep are public health concerns that can impact adolescents’ mental and physical health. There are several different treatments for sleep problems and insomnia, and there is a great focus on the problem when it has already arisen. However, since this is a public health problem, it is important to shed light on it at an early stage, and to inform about adolescents’ sleep problems and insomnia symptoms. This, in hope to help the adolescents’, adults in their environment and professionals in school health care. Aim and methods: The overall aim of this doctoral thesis was to contribute with knowledge about possible factors influencing sleep and insomnia symptoms among adolescents. Paper I investigated adolescents’ experiences regarding what they perceived as facilitators and barriers for a good night´s sleep. This study has a qualitative design, focus groups interviews were performed and analysed with qualitative content analysis. Paper II investigated the associations between insomnia symptoms, academic performance, self-reported health, physical activity, school start time, and substance use in adolescents. This paper was a cross-sectional survey and analysed with descriptive and analytic statistics. Paper III aimed to test the measurement properties of the Minimal Insomnia Symptom Scale (MISS) together with an additional item focusing on daytime functioning, Minimal Insomnia Symptom Scale-Revised (MISS-R) among adolescents. This study has cross-sectional design and data was analysed with Rash measurement model. Paper IV aimed to investigate whether sleep duration, difficulties waking up, tiredness in school, and family financial situation among school-aged girls and boys (aged 6-10 years) can predict insomnia symptoms among female and male adolescents (aged 14-16 years). This was a longitudinal design and was analysed with descriptive and analytic statistics.Results: From paper I emerge that the adolescents were aware of the importance of sleep for managing during the day. However, there were both facilitators and barriers for achieving a good night sleep. Three categories were identified: striving for a sense of well-being, tiring yourself out and regulating electronic media. Paper II highlights that insomnia was associated with poor self-reported health, failed school courses, and use of alcohol and/or cigarettes. When the combined effect of self-reported health and physical activity were investigated, a combination of low physical activity and poor self-reported health was strongly associated with insomnia. Paper III showed that both MISS and MISS-R had good measurement properties, regarding targeting, items tended to represent more severe levels of insomnia symptoms than reported by the adolescents. Older adolescents were more likely to score higher than younger adolescents in the items concerning “problems with not being rested by sleep”, and “problems with daytime disturbance”. Paper IV showed different factors in childhood that predicted insomnia symptoms in adolescence. These factors differed between sex. Perceived quite bad/very bad family financial situation, and short sleep duration at baseline was associated with insomnia symptoms among female adolescents. However, problems waking up at baseline was associated with insomnia symptoms among male adolescents.Conclusions: This thesis shows that the adolescents want to talk about sleep problems and insomnia symptoms with adults in their environment. One instrument that professionals in school health care can have benefit of in the conversation with the adolescents, are MISS-R. MISS-R seem to be a reliable screening instrument for insomnia symptoms among adolescents. The adolescents need support from adults to facilitate a good night sleep