Specific evidence-based recommendat

Specific evidence-based recommendations for management of insomnia and other sleep disorders in special populations and conditions are as follows

•After menopause, the incidence of sleep-disordered breathing increases, and the clinical presentation is different in women vs men and often includes insomnia. Informed, individualized treatment of symptoms is needed for use of hormone therapy, considering risks and benefits clarified in recent studies.


•Behavioral strategies are recommended for children with disturbed sleep (level of evidence, A). In children with attention-deficit/hyperactive disorder not treated with stimulant drugs, melatonin administration may help advance sleep onset to normal values (level of evidence, A).


•For children and adults with learning disabilities, clinical evaluation should describe the sleep disturbance and triggering and exacerbating factors (level of evidence, A). Recommended first-line therapy includes environmental, behavioral, and educational strategies (level of evidence, A). Melatonin is effective in improving sleep (level of evidence, A). The treatment plan should be based on a capacity/best-interests framework.


•For management of circadian rhythm disorders, clinical evaluation is essential in delayed sleep-phase syndrome and free-running disorder (level of evidence, A/B). In delayed sleep-phase syndrome, free-running disorder, and jet lag, melatonin may be useful (level of evidence, A), but other strategies such as behavioral regimens and scheduled light exposure (in sighted individuals) can also be used (level of evidence, B/C).