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Media Use and Sleep
Abstract
Statistics show that sleep has become a problematic health issue, with significant proportions of the population coping with insufficient sleep, having trouble falling asleep, or suffering from clinical sleep disturbances. One of the factors contributing to the sleep loss epidemic appears to be electronic media use. Increases in media uses go hand in hand with declines in various sleep outcomes such as later bedtimes, shorter sleep, disturbed sleeping patterns, and increased daytime fatigue. Scholars have become invested in uncovering the underlying mechanisms of this association, and findings have spurred the development of preventative strategies. This entry reviews the most important conclusions in this area of research and highlights next steps for future research.
Das Smartphone spielt als permanenter Begleiter im Alltag vieler Menschen eine wesentliche Rolle – auch wenn es um die abendliche Routine vor dem Einschlafen geht. Das ist das Ergebnis einer Querschnittsstudie der Universität Hohenheim, die erstmalig aussagekräftige Daten zur Nutzung des Mobiltelefons beim abendlichen Zubettgehen und Einschlafen der Bevölkerung im Alter zwischen 18 und 49 Jahren in Deutschland gewonnen hat. Demnach gab rund jede vierte befragte Person an, das Mobiltelefon auf dem Weg ins Bett mit in das Badezimmer zu nehmen. Über drei Viertel der Befragten berichteten, das Mobiltelefon mit ins Schlafzimmer zu nehmen – davon gaben wiederum fast alle an, im Bett vor dem Einschlafen noch einmal zum Mobiltelefon zu greifen. Die häufigsten Aktivitäten in diesem Zusammenhang waren das Prüfen neuer Nachrichten in Messengerdiensten, das Herumsurfen im Internet und das Stellen des Weckers. Die Nutzung von Social- Media-Apps – dabei insbesondere WhatsApp, Instagram und Facebook – zählte mit Abstand zu den häufigsten Aktivitäten der Mobiltelefonnutzung vor dem Einschlafen. Aber auch das Anschauen von Filmen oder Serien und Musikhören gehörten dazu. Für fast die Hälfte der Befragten fühlte sich die Nutzung des Mobiltelefons vor dem Einschlafen laut Selbstauskunft so an, als würden sie noch einmal nach dem Rechten sehen oder es vermittelte ihnen ein beruhigendes Gefühl.
Zukünftig werden komplexe Mehrmethodenstudien nötig sein, damit die Medienforschung ein komplettes und valides Bild der Rolle von Medien in spezifischen Nutzungssituationen – wie beispielsweise beim Zubettgehen und Einschlafen, aber auch in den Morgenstunden oder zur Überbrückung von Wartezeiten – zeichnen kann. Da die Nutzung von Streamingdiensten laut der vorliegenden Studie eine besondere Rolle vor dem Einschlafen spielt, wird es unabdingbar sein, in künftigen Studien die Vielzahl möglicher Endgeräte – wie Tablet, Laptop, Smart-TV usw. – zum Abspielen von Streaminginhalten im Abfragemodell zu berücksichtigen. Aber auch die Rolle des Buches sollte bei künftigen Nutzungsstudien zur Rolle von Medien beim Einschlafen nicht aus dem Blick verloren werden.
Purpose of Review
The screen-based media landscape has changed markedly during the last decade, with 95% of American teens owning or having access to a smartphone. Coinciding with the rise in digital media devices, researchers have noted a high prevalence of insufficient sleep among youth. In this article, we review recent literature about adolescents’ screen use behaviors and sleep health outcomes published between 2015 and 2019.
Recent Findings
Overall, we found a high level of screen use and poor sleep health (i.e., short duration, poor quality, late timing) among adolescents. The great majority of recent observational studies demonstrated a robust inverse association between screen media device use and sleep outcomes among adolescents all over the world. Screen-based media use has also been linked to a series of adverse psychosocial and behavioral outcomes, partially if not fully mediated through impaired sleep health. Experimental data, however, offer mixed findings on the causal relationship between teen media use and sleep. In addition, there is uncertainty as to the relative roles of the proposed mechanisms underlying those relationships, whether driven by the light emitted by devices, time displacement, or the media content affecting psychological state (e.g., fear of missing out, anxiety).
Summary
Current empirical research demonstrates that screen-based digital media use is closely associated with sleep duration and sleep quality among teens; however, limited data show a direct causal effect of screen-based media use on adolescent sleep health. With very few studies demonstrating easy-to-implement and effective interventions, we argue that more basic, translational, and clinical research is necessary.
Sleep experts have raised concern over the effects of electronic media use on sleep. To date, few studies have looked beyond the effects of duration and frequency of media exposure or examined the underlying mechanisms of this association. As procrastinatory media use has been related to lower well-being, we used data from two survey studies (N1= 821, N2 = 584) to investigate (1) predictors of procrastinatory TV viewing and (2) the link between procrastinatory TV viewing and sleep quality. Findings from both studies indicate that those with a stronger viewing habit, higher TV involvement, and an eveningness preference reported more procrastinatory TV viewing. Procrastinatory TV viewing was related to subjective sleep quality, sleep latency, sleep efficiency, and daytime dysfunction. This association was fully mediated by perceived stress. As sleep is key for the replenishment of self-control, procrastinators may be setting themselves up to fail at self-regulating, a situation exacerbated by the omnipresence of media in today’s society.
Objective: Sleep insufficiency has been related to self-control failure: people fail to go to bed in time and end up sleep deprived. The role of state self-control in predicting bedtime and sleep duration has not yet been investigated. Based on an overlap between depleted self-control resources and fatigue, self-control depletion may foster earlier bedtimes. Conversely, self-control depletion also increases the propensity to procrastinate bedtime by giving in to the immediate gratification of late night entertainment. This study looked at procrastinatory television viewing, and its intermediary role in the association between state self-control and bedtime. The implications for sleep duration are examined.
Design: First year students participated in an online survey (N=234). Using Day Reconstruction Method, they charted their activities and experiences during the preceding day and subsequent bedtime behavior.
Results: Self-control depletion was directly related to earlier bedtimes, which we explained by its overlap with fatigue. This was associated with longer sleep duration. Self-control depletion was indirectly related to later bedtimes because it increased the propensity to procrastinate by watching television. This was associated with shorter sleep duration.
Conclusion: This study exposes a dual pathway between self-control depletion and sleep duration, whereby procrastinatory television viewing may reduce sleep duration.
Mobile phone use is often blamed for adolescent sleeping difficulties in the popular and scientific literature, with correlations observed between adolescents’ mobile phone use and their bedtime. We aimed to obtain experimental evidence to support these causal claims. A within-subjects experiment (baseline, intervention) was conducted in adolescents’ homes, to determine the effect of restricting adolescents’ pre-bed mobile phone use on school night sleep habits. Following a baseline week, adolescents were given individualized phone stop times, 1 hour before bed for one school week. An online sleep diary was used to monitor bedtime, lights out time, sleep latency and total sleep. Sixty three adolescents (age range 14–18, M = 16.3, SD = 0.93yrs; 17%male) provided data. During one week of phone restriction, adolescents stopped using their phones earlier (80 min, p < .001), turned their lights off earlier (17 min, p = .01), and slept longer (21 min, p = .01). Participant recruitment was low (26%), indicating many adolescents lack motivation to negotiate changes to their evening phone use. Overall, there are potential benefits of restricted mobile phone use during the pre-sleep period, yet, future research is needed to identify non-technological interventions to increase adherence to phone restriction (e.g., motivational interviewing) or otherwise decrease pre-sleep arousal (e.g., cognitive strategies).
The average amount of sleep people of all ages get has declined sharply in the past fifty years. The detrimental health effects of sleep deprivation are well documented and substantial. Even though electronic media use often takes place in the hours before sleep, the extent to which media use may interact with sleep is understudied and not well understood. Communication scholars are well-positioned to contribute in this area, as a systematic, theoretical understanding of the relationship between media and sleep is still lacking. This primer charts the state of knowledge on electronic media and sleep and explores possible next steps. First, we introduce the problem of sleep deprivation and describe the basic science of sleep with relevant terminology. Then, we review the research on electronic media and sleep and offer an agenda for research.
This study argues that going to bed may not be synonymous with going to sleep and that this fragmentation of bedtime results in a two-step sleep displacement. We separated bedtime (i.e. going to bed) from shuteye time (i.e. attempting to go to sleep once in bed) and assessed the prevalence of electronic media use in both time slots. A convenience sample of 338 adults (aged 18–25 years, 67.6% women) participated in an online survey. Results indicated a gap of 39 min between bedtime and shuteye time, referred to as ‘shuteye latency’. Respondents with a shuteye latency of, respectively, ≤30 min, ≤1 or >1 h, were 3.3, 6.1 and 9.3 times more likely to be rated as poor sleepers compared to those who went to sleep immediately after going to bed. Before bedtime, volume of electronic media use (17 h 55 min per week) was higher than non-media activities (14 h per week), whereas the opposite was true after bedtime (media = 3 h 41 min, non-media = 7 h 46 min). Shuteye
latency was related exclusively to prebedtime media use. Findings confirmed the proposed fragmentation of bedtime. Sleep displacement should therefore be redefined as a two-step process, as respondents not only engage in the delay of bedtime, but also in the delay of shuteye time once in bed. Theoretical, methodological and practical implications are discussed.
There is ample evidence that media use displaces sleep, but little theory about the mechanism that explains this. We studied sleep displacement as a self-control issue: People postpone going to bed because they have trouble ending their media exposure. We therefore modeled television viewing (habitual viewing, deficient TV self-regulation, and viewing volume) as a mediator of the effect of trait self-control on bedtime procrastination. A random sample of 821 adults participated in face-to-face interviews using standardized questionnaires. Lower self-control was associated with more bedtime procrastination. This relationship was mediated by habitual viewing, which led to less bedtime procrastination, and deficient TV self-regulation, which led to more bedtime procrastination. Evening viewing volume was not a significant mediator. Our results support the idea that (1) self-regulatory failure over television viewing can partly explain the common struggle with bedtime, and (2) strong viewing habits seem to inhibit bedtime procrastination.
Importance:
Sleep is vital to children's biopsychosocial development. Inadequate sleep quantity and quality is a public health concern with an array of detrimental health outcomes. Portable mobile and media devices have become a ubiquitous part of children's lives and may affect their sleep duration and quality.
Objective:
To conduct a systematic review and meta-analysis to examine whether there is an association between portable screen-based media device (eg, cell phones and tablet devices) access or use in the sleep environment and sleep outcomes.
Data sources:
A search strategy consisting of gray literature and 24 Medical Subject Headings was developed in Ovid MEDLINE and adapted for other databases between January 1, 2011, and June 15, 2015. Searches of the published literature were conducted across 12 databases. No language restriction was applied.
Study selection:
The analysis included randomized clinical trials, cohort studies, and cross-sectional study designs. Inclusion criteria were studies of school-age children between 6 and 19 years. Exclusion criteria were studies of stationary exposures, such as televisions or desktop or personal computers, or studies investigating electromagnetic radiation.
Data extraction and synthesis:
Of 467 studies identified, 20 cross-sectional studies were assessed for methodological quality. Two reviewers independently extracted data.
Main outcomes and measures:
The primary outcomes were inadequate sleep quantity, poor sleep quality, and excessive daytime sleepiness, studied according to an a priori protocol.
Results:
Twenty studies were included, and their quality was assessed. The studies involved 125 198 children (mean [SD] age, 14.5 [2.2] years; 50.1% male). There was a strong and consistent association between bedtime media device use and inadequate sleep quantity (odds ratio [OR], 2.17; 95% CI, 1.42-3.32) (P < .001, I2 = 90%), poor sleep quality (OR, 1.46; 95% CI, 1.14-1.88) (P = .003, I2 = 76%), and excessive daytime sleepiness (OR, 2.72; 95% CI, 1.32-5.61) (P = .007, I2 = 50%). In addition, children who had access to (but did not use) media devices at night were more likely to have inadequate sleep quantity (OR, 1.79; 95% CI, 1.39-2.31) (P < .001, I2 = 64%), poor sleep quality (OR, 1.53; 95% CI, 1.11-2.10) (P = .009, I2 = 74%), and excessive daytime sleepiness (OR, 2.27; 95% CI, 1.54-3.35) (P < .001, I2 = 24%).
Conclusions and relevance:
To date, this study is the first systematic review and meta-analysis of the association of access to and the use of media devices with sleep outcomes. Bedtime access to and use of a media device were significantly associated with the following: inadequate sleep quantity, poor sleep quality, and excessive daytime sleepiness. An integrated approach among teachers, health care professionals, and parents is required to minimize device access at bedtime, and future research is needed to evaluate the influence of the devices on sleep hygiene and outcomes.
This study examined how social media use related to sleep quality, self-esteem, anxiety and depression in 467 Scottish adolescents. We measured overall social media use, nighttime-specific social media use, emotional investment in social media, sleep quality, self-esteem and levels of anxiety and depression. Adolescents who used social media more – both overall and at night – and those who were more emotionally invested in social media experienced poorer sleep quality, lower self-esteem and higher levels of anxiety and depression. Nighttime-specific social media use predicted poorer sleep quality after controlling for anxiety, depression and self-esteem. These findings contribute to the growing body of evidence that social media use is related to various aspects of wellbeing in adolescents. In addition, our results indicate that nighttime-specific social media use and emotional investment in social media are two important factors that merit further investigation in relation to adolescent sleep and wellbeing.
Background:
The few studies that have investigated the relationship between mobile phone use and sleep have mainly been conducted among children and adolescents. In adults, very little is known about mobile phone usage in bed our after lights out. This cross-sectional study set out to examine the association between bedtime mobile phone use and sleep among adults.
Methods:
A sample of 844 Flemish adults (18-94 years old) participated in a survey about electronic media use and sleep habits. Self-reported sleep quality, daytime fatigue and insomnia were measured using the Pittsburgh Sleep Quality Index (PSQI), the Fatigue Assessment Scale (FAS) and the Bergen Insomnia Scale (BIS), respectively. Data were analyzed using hierarchical and multinomial regression analyses.
Results:
Half of the respondents owned a smartphone, and six out of ten took their mobile phone with them to the bedroom. Sending/receiving text messages and/or phone calls after lights out significantly predicted respondents' scores on the PSQI, particularly longer sleep latency, worse sleep efficiency, more sleep disturbance and more daytime dysfunction. Bedtime mobile phone use predicted respondents' later self-reported rise time, higher insomnia score and increased fatigue. Age significantly moderated the relationship between bedtime mobile phone use and fatigue, rise time, and sleep duration. An increase in bedtime mobile phone use was associated with more fatigue and later rise times among younger respondents (≤ 41.5 years old and ≤ 40.8 years old respectively); but it was related to an earlier rise time and shorter sleep duration among older respondents (≥ 60.15 years old and ≥ 66.4 years old respectively).
Conclusion:
Findings suggest that bedtime mobile phone use is negatively related to sleep outcomes in adults, too. It warrants continued scholarly attention as the functionalities of mobile phones evolve rapidly and exponentially.
A sample of 844 adults, aged 18-94 years old, was queried about media habits and sleep behavior in face-to-face interviews with standardized questionnaires. A substantial proportion of this sample reported using books (39.8%), television (31.2%), music (26.0%), Internet (23.2%), and videogames (10.3%) as a sleep aid. The use of media as sleep aids was associated with increased fatigue and higher scores on the Pittsburgh Sleep Quality Index (PSQI), indicating poorer sleep quality. There was no relationship with sleep duration. Finally, results suggest that media use coincides with later bedtimes, but also later rise times, a process called time shifting.
The pervasiveness of media use in our society has raised concerns about its potential impact on important lifestyle behaviours, including sleep. Although a number of studies have modelled poor sleep as a negative outcome of media use, a critical assessment of the literature indicates two important gaps: (i) studies have almost exclusively relied on concurrent data, and thus have not been able to assess the direction of effects; and (ii) studies have largely been conducted with children and adolescents. The purpose of the present 3-year longitudinal study, therefore, was to examine whether both sleep duration and sleep problems would be predictors or outcomes of two forms of media use (i.e. television and online social networking) among a sample of emerging adults. Participants were 942 (71.5% female) university students (M = 19.01 years, SD = 0.90) at Time 1. Survey measures, which were assessed for three consecutive years starting in the first year of university, included demographics, sleep duration, sleep problems, television and online social networking use. Results of a cross-lagged model indicated that the association between sleep problems and media use was statistically significant: sleep problems predicted longer time spent watching television and on social networking websites, but not vice versa. Contrary to our hypotheses, sleep duration was not associated with media use. Our findings indicate no negative effects of media use on sleep among emerging adults, but instead suggest that emerging adults appear to seek out media as a means of coping with their sleep problems.
Previous research suggests that single use of television, computer or game console may be associated with sleep problems. In practice, youngsters have a multiple rather than a single use of electronic media (EM) every day. This study examined the association between electronic stimulation throughout the day, the final evening activity every day of the week, EM availability in the bedroom and sleep problems in 332 middle-school children (girls = 53%; mean age = 12.9). Cell phones (odds ratio [OR] = 2.5 [1.20–5.38]) and MP3 players (OR = 2.5 [1.13–5.70]) were found to predict sleep problem. An evening screen time of one hour or more is associated with a higher risk of sleep problems (OR = 3.10 [1.24–7.78]), particularly going to bed late (OR = 3.4 [1.59–7.271]) and difficulty waking up (OR = 2.15 [1.01–4.6]). Possession and pattern of EM use by adolescents are associated with impaired sleep quality and late bedtimes, indicating the need to control adolescents' screen time.
Exposure to light from self-luminous displays may be linked to increased risk for sleep disorders because these devices emit optical radiation at short wavelengths, close to the peak sensitivity of melatonin suppression. Thirteen participants experienced three experimental conditions in a within-subjects design to investigate the impact of self-luminous tablet displays on nocturnal melatonin suppression: 1) tablets-only set to the highest brightness, 2) tablets viewed through clear-lens goggles equipped with blue light-emitting diodes that provided 40 lux of 470-nm light at the cornea, and 3) tablets viewed through orange-tinted glasses (dark control; optical radiation <525 nm ≈ 0). Melatonin suppressions after 1-h and 2-h exposures to tablets viewed with the blue light were significantly greater than zero. Suppression levels after 1-h exposure to the tablets-only were not statistically different than zero; however, this difference reached significance after 2 h. Based on these results, display manufacturers can determine how their products will affect melatonin levels and use model predictions to tune the spectral power distribution of self-luminous devices to increase or to decrease stimulation to the circadian system.
Many people spend an increasing amount of time in front of computer screens equipped with light-emitting diodes (LED) with a short wavelength (blue range). Thus we investigated the repercussions on melatonin (a marker of the circadian clock), alertness, and cognitive performance levels in 13 young male volunteers under controlled laboratory conditions in a balanced crossover design. A 5-h evening exposure to a white LED-backlit screen with more than twice as much 464 nm light emission {irradiance of 0,241 Watt/(steradian × m(2)) [W/(sr × m(2))], 2.1 × 10(13) photons/(cm(2) × s), in the wavelength range of 454 and 474 nm} than a white non-LED-backlit screen [irradiance of 0,099 W/(sr × m(2)), 0.7 × 10(13) photons/(cm(2) × s), in the wavelength range of 454 and 474 nm] elicited a significant suppression of the evening rise in endogenous melatonin and subjective as well as objective sleepiness, as indexed by a reduced incidence of slow eye movements and EEG low-frequency activity (1-7 Hz) in frontal brain regions. Concomitantly, sustained attention, as determined by the GO/NOGO task; working memory/attention, as assessed by "explicit timing"; and declarative memory performance in a word-learning paradigm were significantly enhanced in the LED-backlit screen compared with the non-LED condition. Screen quality and visual comfort were rated the same in both screen conditions, whereas the non-LED screen tended to be considered brighter. Our data indicate that the spectral profile of light emitted by computer screens impacts on circadian physiology, alertness, and cognitive performance levels. The challenge will be to design a computer screen with a spectral profile that can be individually programmed to add timed, essential light information to the circadian system in humans.
Sleep-related problems, which affect 50-70 million Americans, involve all areas of life, including cognitive performance, emotional well-being, work and leisure-time activities, and general physical and mental well-being. We examined the association of insufficient sleep with health-related quality of life (HRQOL) and health behaviors.
Data were obtained from the Behavioral Risk Factor Surveillance System, an ongoing, state-based, random-digit telephone survey of the non-institutionalized US population aged >or =18 years. In 2002, HRQOL measures were administered in 18 states and the District of Columbia, yielding complete responses to questions regarding sleep and demographic characteristics from 98% of study participants (n=79,625).
An estimated 26% of adults reported frequent (> or =14 days in the past 30 days) sleep insufficiency. They were significantly more likely than those without frequent sleep insufficiency to report fair/poor general health, frequent physical distress, frequent mental distress, activity limitations, depressive symptoms, anxiety, and pain. In addition, they were significantly more likely to smoke, to be physically inactive, to be obese, and, among men, to drink heavily.
Insufficient sleep is associated with a variety of adverse health behaviors and impairment in all HRQOL domains investigated. Accordingly, assessment of sleep appears to be an important component of general medical care. Moreover, expanded assessment of sleep in the general population may provide a better understanding of prevalence of impaired sleep and its many implications.
This book is both an exam guide to children´s sleep medicine and a practical manual for diagnosis and management of sleep disorders in children. An overview of the most frequent sleep disorders encountered in newborns, infants, children and adolescents is provided. This book discusses the main sleep disorders in detail, including insomnia, respiratory disturbances, movement disorders during sleep, circadian rhythm disorders, parasomnias, and disorders associated with increased sleepiness. It also covers sleep disorders associated with neurological, psychiatric, and medical diseases.
This book is divided into two parts. The first part is an introduction to childhood sleep physiology and pathology, epidemiology of sleep disorders, and diagnostic procedures. The second part describes the most frequent sleep disorders in greater depth.
Sleep Disorders in Children is aimed at sleep researchers, pediatricians, child neurologists and child psychiatrists, as well as patient organizations and families with affected children.
A relationship between evening technology use and sleep has been established, and models suggest various mechanisms to explain this relationship. Recent updates to these models also suggest the influence of individual difference factors, such that the relationship between technology and sleep varies between young people. Flow is an experience of immersion and time distortion that could vary between adolescents when using technology. The aim of the present study was to investigate the effects of flow on the self-selected bedtimes of adolescents when videogaming. Seventeen older adolescent, experienced videogamers (age = 15.9 ± 0.83 years), played a new videogame on two school-night evenings in a sleep laboratory. Game difficulty was set to “hard” one evening (flow condition) and “easy” on the other evening (disrupted flow). Trait and state flow were measured, along with heart rate during videogaming, and bedtime measured objectively with real-time cameras. An interaction effect for heart rate indicated an elevated heart rate in the easy condition after 150 min of gaming (p < 0.02). No significant differences were found in bedtimes between the easy and hard conditions (p = 0.77). Adolescents high on trait flow played for longer and selected significantly later bedtimes than their low trait flow peers but only for the hard (flow) condition (12:22 AM vs. 10:53 PM, p = 0.004). Similarly, adolescents with high state flow went to bed significantly later than those low on state flow (12:24 PM vs. 10:52 PM, p = 0.001), again only in the hard condition. These findings suggest that individual and situational characteristics may amplify the effects of technology use on the “sleep” of adolescents and provides support for the displacement of bedtime hypothesis.
Purpose:
Technology-related behaviors (e.g., computer use) before bedtime (BT) have been associated with poorer and shorter sleep in adolescents; however, less is known about other behaviors in relation to sleep. This study characterized a range of behaviors in the hour before bed (i.e., pre-BT behaviors [PBBs]) and examined their relationship with sleep parameters during school and vacation periods (i.e., restricted and extended sleep opportunities, respectively). Mechanistic roles of chronotype and cognitive presleep arousal (PSAcog) were also examined.
Methods:
During the last week of a school term and throughout a 2-week vacation, 146 adolescents (47.26% male, age M ± standard deviation = 16.2 ± 1.0 years) from the general community completed daily sleep measure using actigraphy, self-report measures on PBBs and PSAcog (Presleep Arousal Scale) for both school and vacation periods, and chronotype (Morningness-Eveningness Questionnaire).
Results:
Adolescents engaged in a variety of behaviors before bed. Notably, playing video games was associated with significantly later school and vacation BT and shorter school sleep duration (controlling for chronotype). During vacation, online social media was associated with significantly longer sleep onset latency, and this relationship was mediated by higher PSAcog. In contrast, on school nights, spending time with family was associated with significantly earlier BT and longer sleep duration.
Conclusions:
Technology-related PBBs video games and online social media were risk factors for shorter and poorer sleep, whereas time with family was protective of sleep duration. In addressing sleep problems in adolescents, therapeutic procedures that target the potentially addictive nature of technology use and reduce PSAcog were implicated.
Getting a good night's sleep is challenging for adolescents because of early school start times and adolescents' substantial social and physical changes. We tested whether key indices of sleep health are associated with usual styles of coping with stress and interpersonal conflict in healthy black and white adolescents. Two hundred forty-two (57% female, 56% black) high school students completed daily sleep diaries, questionnaires, and actigraphy across a school week. Linear regression models tested associations, independent of race, gender, and other covariates. Students who reported using disengagement coping exhibited poor sleep health. They had shorter sleep duration, more fragmented sleep, delayed sleep, and increased daytime sleepiness. Unexpectedly, positive engagement coping was related to daytime sleepiness and delayed sleep, although not in models that included disengagement coping. Coping strategies may be an important influence on adolescent sleep. Future research should evaluate the antecedent-consequent relationships among coping, sleep, and stress.
Significance
The use of light-emitting electronic devices for reading, communication, and entertainment has greatly increased recently. We found that the use of these devices before bedtime prolongs the time it takes to fall asleep, delays the circadian clock, suppresses levels of the sleep-promoting hormone melatonin, reduces the amount and delays the timing of REM sleep, and reduces alertness the following morning. Use of light-emitting devices immediately before bedtime also increases alertness at that time, which may lead users to delay bedtime at home. Overall, we found that the use of portable light-emitting devices immediately before bedtime has biological effects that may perpetuate sleep deficiency and disrupt circadian rhythms, both of which can have adverse impacts on performance, health, and safety.
Teenagers need sufficient sleep to function well on a daily basis, yet there is a lack of consolidated evidence advising which factors protect, or harm, adolescents’ sleep. A meta-analysis of 41 studies, published between 2003 and February, 2014, calculating mean weighted r values, was conducted to better understand the strength of protective and risk factors for 85,561 adolescents’ (age range = 12–18y) bedtime, sleep onset latency (SOL) and total sleep time (TST). Results showed good sleep hygiene and physical activity were associated with earlier bedtimes. Video gaming, phone use, computer use, evening light and internet use were related to delayed bedtimes. Good sleep hygiene was negatively correlated with sleep latency. Alternatively, sleep latency lengthened as levels of a negative family environment increased. Tobacco use, computer use, evening light, a negative family environment and caffeine were associated with decreased total sleep time, whereas good sleep hygiene and parent-set bedtimes were related to longer sleep length. Good sleep hygiene appears to be a protective factor, whereas a negative home environment and evening light appear to be risk factors. Cautious use of technology (other than television), caffeine, tobacco and alcohol should be considered, as these factors, as well as pre-sleep worry, are likely to have some negative impact on sleep. Parent-set bedtimes and physical activity may be beneficial. Future research directions are discussed.
We systematically examined and updated the scientific literature on the association between screen time (e.g., television, computers, video games, and mobile devices) and sleep outcomes among school-aged children and adolescents. We reviewed 67 studies published from 1999 to early 2014. We found that screen time is adversely associated with sleep outcomes (primarily shortened duration and delayed timing) in 90% of studies. Some of the results varied by type of screen exposure, age of participant, gender, and day of the week. While the evidence regarding the association between screen time and sleep is consistent, we discuss limitations of the current studies: 1.) causal association not confirmed; 2.) measurement error (of both screen time exposure and sleep measures); 3.) limited data on simultaneous use of multiple screens, characteristics and content of screens used. Youth should be advised to limit or reduce screen time exposure, especially before or during bedtime hours to minimize any harmful effects of screen time on sleep and well-being. Future research should better account for the methodological limitations of the extant studies, and seek to better understand the magnitude and mechanisms of the association. These steps will help the development and implementation of policies or interventions related to screen time among youth.
To describe the technology use and sleep quality of Americans, and the unique association between technology use and sleep disturbances.
Interviews were conducted via random digit dialing (N = 750) or the Internet (N = 758). 1,508 Americans (13-64 years old, 50% males) matched to 2009 U.S. Census data provided complete interviews. The sample was further divided into adolescents (13-18 years, N = 171), young adults (19-29 years, N = 293), middle-aged adults (30-45 years, N = 469), and older adults (46-64 years, N = 565) to contrast different generations' technology use. Participants answered a 47-item semi-structured survey, including questions about their sleep habits, and the presence and use of technology in the hour before bed in the past 2 weeks.
Nine of 10 Americans reported using a technological device in the hour before bed (e.g., TVs the most popular; 60%). However, those under 30 years of age were more likely to use cell phones (72% of adolescents, 67% of young adults) than those over 30 years (36% of middle-aged, and 16% of older adults). Young adults' sleep patterns were significantly later than other age groups on both weekdays and weekend nights. Unlike passive technological devices (e.g., TV, mp3 music players), the more interactive technological devices (i.e., computers/laptops, cell phones, video game consoles) used in the hour before bed, the more likely difficulties falling asleep (β = 9.4, p < 0.0001) and unrefreshing sleep (β = 6.4, p < 0.04) were reported.
Technology use near bedtime is extremely prevalent in the United States. Among a range of technologies, interactive technological devices are most strongly associated with sleep complaints.
A commentary on this article appears in this issue on page 1301.
Gradisar M; Wolfson AR; Harvey AG; Hale L; Rosenberg R; Czeisler CA. The sleep and technology use of Americans: findings from the National Sleep Foundation's 2011 Sleep in America Poll. J Clin Sleep Med 2013;9(12):1291-1299.
The aim of the current study was to examine sleep patterns and rates of insomnia in a population-based study of adolescents aged 16-19 years. Gender differences in sleep patterns and insomnia, as well as a comparison of insomnia rates according to DSM-IV, DSM-V and quantitative criteria for insomnia (Behav. Res. Ther., 41, 2003, 427), were explored. We used a large population-based study in Hordaland county in Norway, conducted in 2012. The sample included 10 220 adolescents aged 16-18 years (54% girls). Self-reported sleep measurements included bedtime, rise time, time in bed, sleep duration, sleep efficiency, sleep onset latency, wake after sleep onset, rate and frequency and duration of difficulties initiating and maintaining sleep and rate and frequency of tiredness and sleepiness. The adolescents reported short sleep duration on weekdays (mean 6:25 hours), resulting in a sleep deficiency of about 2 h. A majority of the adolescents (65%) reported sleep onset latency exceeding 30 min. Girls reported longer sleep onset latency and a higher rate of insomnia than boys, while boys reported later bedtimes and a larger weekday-weekend discrepancy on several sleep parameters. Insomnia prevalence rates ranged from a total prevalence of 23.8 (DSM-IV criteria), 18.5 (DSM-V criteria) and 13.6% (quantitative criteria for insomnia). We conclude that short sleep duration, long sleep onset latency and insomnia were prevalent in adolescents. This warrants attention as a public health concern in this age group.
This article reviews the contextual and neuropsychological challenges of the adolescent period with particular attention to the role that universal prevention can play in moderating the harmful effects of stress. The centrality of emotion regulation skills to long-term health and wellness suggests their importance in prevention and intervention efforts for youth. Mindfulness has been shown to be an effective means of reducing stress and improving emotion balance in research with adults, although research on mindfulness with adolescents is limited. The authors present available data and describe one potentially effective program for adolescent mindfulness: Learning to BREATHE.
Although observational studies have consistently reported an association between media use and child sleep problems, it is unclear whether the relationship is causal or if an intervention targeting healthy media use can improve sleep in preschool-aged children.
We conducted a randomized controlled trial of a healthy media use intervention in families of children aged 3 to 5 years. The intervention encouraged families to replace violent or age-inappropriate media content with quality educational and prosocial content, through an initial home visit and follow-up telephone calls over 6 months. Sleep measures were derived from the Child Sleep Habits Questionnaire and were collected at 6, 12, and 18 months after baseline; repeated-measures regression analyses were used.
Among the 565 children analyzed, the most common sleep problem was delayed sleep-onset latency (38%). Children in the intervention group had significantly lower odds of "any sleep problem" at follow-up in the repeated-measures analysis (odds ratio = 0.36; 95% confidence interval: 0.16 to 0.83), with a trend toward a decrease in intervention effect over time (P = .07). Although there was no significant effect modification detected by baseline sleep or behavior problems, gender, or low-income status, there was a trend (P = .096) toward an increased effect among those with high levels of violence exposure at baseline.
The significant effects of a healthy media use intervention on child sleep problems in the context of a randomized controlled trial suggest that the previously reported relationship between media use and child sleep problems is indeed causal in nature.
University students have poor sleep hygiene, leading to poorer health. Facets of self-regulation such as planning, behavioural inhibition, cognitive flexibility and working memory were explored in relation to three sleep hygiene behaviours: Avoiding stress or anxiety before bed, avoiding going to bed hungry or thirsty, and making the bedroom restful. One hundred and thirty-seven participants took part in an Internet-based survey over two time points separated by a period of two weeks. Only cognitive flexibility and behavioural inhibition correlated with sleep hygiene. Cognitive flexibility significantly predicted an aspect of sleep hygiene after controlling for past behaviour. However, when past behaviour was controlled for, behavioural inhibition no longer predicted sleep hygiene. Thus, cognitive flexibility may play a role in explaining sleep hygiene; however, behavioural inhibition does not appear as important as previously assumed. Further research could build on this study to determine whether cognitive flexibility can be experimentally improved.
Electronic media have often been considered to have a negative impact on the sleep of children and adolescents, but there are no comprehensive reviews of research in this area. The present study identified 36 papers that have investigated the relationship between sleep and electronic media in school-aged children and adolescents, including television viewing, use of computers, electronic gaming, and/or the internet, mobile telephones, and music. Many variables have been investigated across these studies, although delayed bedtime and shorter total sleep time have been found to be most consistently related to media use. A model of the mechanisms by which media use may affect sleep is presented and discussed as a vehicle for future research.
To investigate how playing a violent/nonviolent television game during the evening affects sympathetic and parasympathetic reactions during and after playing as well as sleep quality during the night after playing.
In total, 19 boys, 12-15 years of age, played television games on two occasions in their homes and participated once without gaming. Heart rate, heart rate variability (HRV) and physical activity were measured during gaming/participating and the night to follow using a portable combined heart rate and movement sensor. A sleep diary and questionnaires about gaming experiences and session-specific experiences were filled in. Criteria for Selection of Games: Violent game involves/rewards direct physical violence (no handguns) against another person, and nonviolent game involves/rewards no violence; same game design ('third-person game'); conducted in the same manner; no differences concerning motor activity; similar sound and light effects; no sexual content, violence against women or racial overtones.
During violent (vs. nonviolent) gaming, there was significantly higher activity of the very low frequency component of the HRV and total power. During the night after playing, very low frequency, low frequency and high frequency components were significantly higher during the violent (vs. nonviolent) condition, just as total power. There were no significant differences between the three conditions (violent/nonviolent/no gaming) with respect to an index reflecting subjectively perceived sleep difficulties. Nor was there any difference between violent and nonviolent condition for any single sleep item.
Violent gaming induces different autonomic responses in boys compared to nonviolent gaming--during playing and during the following night--suggesting different emotional responses. Subjectively perceived sleep quality is not influenced after a single gaming experience. Future studies should address the development of the autonomic balance after gaming over longer time than a night, physiological adaptation to frequent gaming and potential gender differences.
To describe the use of media as a sleep aid in adolescents and relate this to their sleep routines and feelings of tiredness.
A questionnaire about using media as a sleep aid, media presence in bedrooms, time to bed and time out of bed on average weekdays and average weekend days, and questions regarding level of tiredness in the morning, at school, after a day at school and after the weekend was completed by 2546 seventh and 10th grade children in a random sample of 15 schools.
Of the adolescents, 36.7% reported watching television to help them fall asleep. In total, 28.2% of the boys and 14.7% of the girls used computer games as a sleep aid. Music was used to fall asleep by 60.2% of the adolescents in this sample. About half of the adolescents read books to fall asleep. Except for reading books, using media as a sleep aid is negatively related to respondents' time to bed on weekdays, their number of hours of sleep per week and their self-reported level of tiredness.
Using media as a sleep aid appears to be common practice among adolescents. Those who reported using music, television, and computer games more often as a sleeping aid slept fewer hours and were significantly more tired.