What Should Psychiatrists Know About Pediatric Sleep Apnea and Insomnia Treatment?

Carol Rosen, MD, discussed unmet needs and evolving priorities in pediatric sleep medicine, with particular emphasis on the bidirectional relationship between sleep and mental health and on her field's growing reliance on behavioral, rather than pharmacologic, treatment of pediatric insomnia.

Rosen noted that insomnia, behavioral sleep problems, and circadian disorders account for an increasing proportion of new referrals to pediatric sleep medicine specialists. She emphasized that pediatric sleep medicine is intrinsically multidisciplinary, working closely with psychiatrists, psychologists, neurologists, pulmonologists, otolaryngologists, and dentists, and identified the underresourcing of behavioral sleep medicine psychologists—who she described as central to clinical practice.

Rosen addressed the bidirectional relationship between sleep and mental health, noting that disrupted or insufficient sleep is often the earliest observable sign that a child's mental health is deteriorating, and that irregular sleep can itself precipitate mood and behavioral disturbance. She also discussed obstructive sleep apnea, explaining that fragmentation of sleep and intermittent hypoxia exert measurable effects on learning, behavior, mood, and emotional regulation, underscoring the importance of recognition and treatment.¹ Rosen reflected on her field's evolving relationship with psychiatry, recalling that 10 years earlier her primary educational message to psychiatric colleagues was to recognize narcolepsy, given its tendency to be misattributed to depression. She characterized the present relationship as a genuine bidirectional partnership.

A central theme was Rosen's emphasis that pharmacologic sedation is not an effective long-term strategy for pediatric insomnia, and that behavioral approaches—targeting sleep habits, behaviors, and beliefs—represent the more robust, durable treatment.² She noted encouraging movement among psychiatric colleagues toward recognizing this distinction, treating the underlying mental health condition pharmacologically while addressing comorbid insomnia behaviorally. Rosen also expressed cautious optimism regarding ambient artificial intelligence scribes, suggesting they may restore more direct clinician-patient engagement during visits. Finally, she cautioned against the increasing use of medical cannabis for sleep, noting that despite its sedating and relaxing effects, evidence does not support its use as a durable insomnia treatment and that it should not substitute for first-line cognitive behavioral therapy.

Dr Rosen is professor emerita in the department of pediatrics at Case Western Reserve University School of Medicine.

References

1. Hunter SJ, Gozal D, Smith DL, et al. Effect of sleep-disordered breathing severity on cognitive performance measures in a large community cohort of young school-aged children. Am J Respir Crit Care Med. 2016;194(6):739–747.

2. de Bruin EJ, Bögels SM, Oort FJ, et al. Efficacy of cognitive behavioral therapy for insomnia in adolescents: a randomized controlled trial with internet therapy, group therapy and a waiting list condition. Sleep. 2015;38(12):1913–1926.