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Use of screen-based media devices at bedtime impacts children's sleep

Children who use screen-based media devices near bedtime were more like to have poor sleep quality, which was likely to affect their behavior the following day, according to research published in JAMA Pediatrics.

“The deleterious association between screen-based media use and sleep in children and adolescents is a major public health concern. Given the evolving technological landscape and the replacement of textbooks with media devices in schools, screen-based media device access and use are likely to rise,” Ben Carter, PhD, MSc, of the department of biostatistics and health informatics, King’s College, London, and colleagues wrote. “It is imperative that teachers, health care professionals, parents and children are educated about the damaging influence of device use on sleep.”

According to the researchers, 89% of all adolescents and 72% of all children have at least one screen-based media device, such as tablets and smartphones, where they sleep. The lights from these devices impact alertness, physiological sleep and circadian timing, and the content on the devices can be “psychologically stimulating,” they wrote. 

The studies Carter and colleagues identified in their meta-analysis comprised 125,198 children; the average participant age was 14.5 years and 50.1% of the children were male.

Bedtime media device use vs. not having access to one

Researchers analyzed two studies for excessive daytime sleepiness and found 21.3% of children used a media device before bedtime; 6.7% did not have access (Pooled OR = 2.72, 95% CI, 1.32-5.61). Five studies explored poor sleep quality. In these, 52.1% of children used a media device before bedtime, compared to 34.4% that did not have access,(Pooled OR = 1.46, 95% CI, 1.14-1.88). The seven studies where the primary outcome was insufficient amount of sleep showed 45.4% of children used a media device before bedtime and 31.5% did not have access. (Pooled OR = 2.17, (95% CI, 1.42-3.32).

Researchers found that having a media device in the sleep environment, even if it was not used at bedtime, also had an impact on sleep quality. Three studies focused on excessive daytime sleepiness reported that 13.2% of children had access to a device before bedtime, but did not use it at bedtime; 4.9% did not have access. (Pooled OR = 2.27, 95% CI, 1.54-3.35), Four studies explored poor sleep quality. In these, 44% of children had access to a device before bedtime, compared to 32.4% that did not. (Pooled OR = 1.53, 95% CI, 1.11-2.1). In the six studies researchers analyzed for insufficient amount of sleep, 41% of children used a media device before bedtime and 31.5% of children did not have access. (OR = 1.79, 95% CI, 1.39-2.31).

Long and short-term health problems from sleep disturbances could include substance abuse, mental health issues such as suicidal tendencies and depression, suppressed growth, lowered immunity, obesity, inactive behavior and poor diet, according to researchers. “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,” researchers wrote.

The fact so few studies were available showcases how technology is evolving faster than research can be done, Charles A. Czeisler, PhD, MD, FRCP, of the division of sleep and circadian disorders, Brigham and Women’s Hospital, Boston, and Theresa L. Shanahan, MD, department of pediatrics, Newton-Wellesley Hospital, Boston wrote in an accompanying editorial.

“These findings make it clear that the rapid development of technology and media use has outpaced the ability of medical researchers to assess the positive and negative effects of ubiquitous exposure to media during the critical years of brain development in children and teenagers,” they wrote. – by Janel Miller

Disclosure: Carter and Shanahan report no relevant financial disclosures. Please see the study for a full list of Czeisler's relevant financial disclosures.