The University of Texas System

CPAN Case of the Month – May 2024

Each month, PCPs call CPAN with a wide variety of mental health questions. Find out how CPAN helped a pediatrician during this consultation.

Patient: Adolescent

Reason for CPAN Consultation: To receive support with medication and treatment

Explanation of the Case and Outcome of the Call:

A PCP called asking for help with an adolescent struggling with insomnia complicated by anxiety and depression. After an unsuccessful trial of sertraline, escitalopram was started with minimal improvements. Targeted trazodone led to nightmares and switching to doxylamine (Unisom) was ineffective. CBT additionally provided some benefits, but insomnia persisted. As we reviewed the teen’s daily schedule, issues with increased sleep latency became apparent. His daily routine included football practice, having to stay up to finish up his homework, and going to bed after 10:30 p.m.  

Insomnia is a common issue during childhood and adolescence. A complete differential diagnostic review of issues causing insomnia was done during this consultation. Based on that review, the likely culprits were the intensive evening exercise and homework less than an hour before bedtime. These activities were contributing to increased sleep latency and the resultant poor sleep quality. While a wide array of medications was reviewed, the primary recommendation was CBT for insomnia to be incorporated into their current therapy and schedule modifications, as possible, to address the insomnia.