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According to the National Sleep Foundation, teens needs 8-10 hours of sleep; school aged children need 9-11 hours; preschool need 10-13 hours; toddlers need 11-14 hours; infants need 12-15 hours; and newborns need 14-17. Media has been shown to affect sleep in children and adolescents, leading them to not getting enough quality sleep.

What the Evidence Says
Physical, emotional, social, and cognitive problems. A lack of sleep can lead to a variety of problems such as difficulties with learning, listening, concentrating, and solving problems (Seegers et al., 2016); anxiety and depression (Lemola, Perkinson-Gloor, Brand, Dewald-Kaufmann, & Grob, 2015); irritability (Konen, Dirk, Leonhardt, & Schmiedek, 2016); and unhealthy eating and weight gain (Sayin & Buyukinan, 2016).

Sleep onset latency and sleep disruption. The “blue light” from screens can disrupt the circadian rhythm (Figueiro & Overington, 2015). Notifications from mobile phone and tablets, whether audio or vibration notifications, can disrupt sleep (Adachi-Mejia, Edwards, Gilbert-Diamond, Greenough, & Olson, 2014). Watching violent or scary media before bed can also lead to sleep disruptions (Cantor, Byrne, Moyer-Gusa, & Riddle, 2010; Garrison, Liekweg, & Christakis, 2011). Using screens before bed can cause individuals to go to bed later, and not sleep as long (Hale & Guan, 2015; Pieters et al., 2014).

During the Visit
If your patient screens “positive” on the Media History Survey for sleep-related issues, discuss the problems with the patient and his/her family, and touch on how media may play a role in addressing or exacerbating these issues.
Recommendations
  • Encourage adolescents to adopt a healthy sleep routine that does not include falling asleep listening to music, watching a video, or in the middle of an instant messaging conversation. Tell patients to avoid all screens (phones, tablets, video games, television) at least one hour before bed. Highlight the importance of creating a calm sleep atmosphere with a regular bedtime, even on weekends.
  • Instruct patients to charge phones, tablets, and laptops outside of the bedroom overnight, and to keep TVs out of the bedroom (Falbe et al., 2015).
  • If the patient is suffering from drowsiness, ensure that parents understand the dangers of sleep deprivation. For adolescent patients, this includes not driving when drowsy. When sleep deprived, an individual is as impaired as driving with a blood alcohol content of .08%, which is illegal for drivers in many states.
  • If patients insist on using screen media before bed, advise them to turn on Night Shift Mode on an iOS device (iPhone or iPad), which changes the screen to a warmer color that is easier on the eyes. Similar apps on Android exist (Night Shift, Twilight).
  • Ensure that the patient is getting enough exercise in order to get quality sleep (Lang et al., 2016).
Future Directions
Sleep is crucial for healthy development in youth. As technologies become more prevalent in our lives, it is important to understand the effects on sleep.

References

  • Adachi-Mejia, A. M., Edwards, P. M., Gilbert-Diamond, D., Greenough, G. P., & Olson, A. L. (2014). Txt me i’m only sleeping: Adolescents with mobile phones in their bedroom. Fam Community Health, 37(4), 252-257. doi: 10.1097/FCH.0000000000000044
  • Adams, S. K., & Kisler, T. S. (2013). Sleep quality as a mediator between technology-related sleep quality, depression, and anxiety. Cyberpsychol Behav Soc Netw, 16(1), 25-30. doi: 10.1089/cyber.2012.0157
  • Alexandru, G., Michikazu, S., Shimako, H., Xiaoli, C., Hitomi, K., Takashi, Y., . . . Sadanobu, K. (2006). Epidemiological aspects of self-reported sleep onset latency in japanese junior high school children. J Sleep Res, 15(3), 266-275. doi: 10.1111/j.1365-2869.2006.00530.x
  • An, J., Sun, Y., Wan, Y., Chen, J., Wang, X., & Tao, F. (2014). Associations between problematic internet use and adolescents’ physical and psychological symptoms: Possible role of sleep quality. Journal of Addiction Medicine, 8(4), 282-287 210.1097/ADM.0000000000000026.
  • Aoki, H., Yamada, N., Ozeki, Y., Yamane, H., & Kato, N. (1998). Minimum light intensity required to suppress nocturnal melatonin concentration in human saliva. Neurosci Lett, 252(2), 91-94.
  • Bahammam, A., Bin Saeed, A., Al-Faris, E., & Shaikh, S. (2006). Sleep duration and its correlates in a sample of saudi elementary school children. Singapore Med J, 47(10), 875-881.
  • Bartel, K. A., Gradisar, M., & Williamson, P. (2015). Protective and risk factors for adolescent sleep: A meta-analytic review. Sleep Med Rev, 21, 72-85. doi: 10.1016/j.smrv.2014.08.002
  • Bonnet, M. H., & Arand, D. L. (1998). Sleepiness as measured by modified multiple sleep latency testing varies as a function of preceding activity. Sleep, 21(5), 477-483.
  • Brunborg, G. S., Mentzoni, R. A., Molde, H., Myrseth, H., Skouveroe, K. J., Bjorvatn, B., & Pallesen, S. (2011). The relationship between media use in the bedroom, sleep habits and symptoms of insomnia. J Sleep Res, 20(4), 569-575. doi: 10.1111/j.1365-2869.2011.00913.x
  • Calamaro, C. J., Mason, T. B., & Ratcliffe, S. J. (2009). Adolescents living the 24/7 lifestyle: Effects of caffeine and technology on sleep duration and daytime functioning. Pediatrics, 123(6), e1005-1010. doi: 10.1542/peds.2008-3641
  • Cantor, J., Byrne, S., Moyer-Gusã©, E., & Riddle, K. (2010). Descriptions of media-induced fright reactions in a sample of us elementary school children. Journal of Children and Media, 4(1), 1 – 17.
  • Chaput, J. P., Gray, C. E., Poitras, V. J., Carson, V., Gruber, R., Olds, T., . . . Tremblay, M. S. (2016). Systematic review of the relationships between sleep duration and health indicators in school-aged children and youth. Appl Physiol Nutr Metab, 41(6 Suppl 3), S266-282. doi: 10.1139/apnm-2015-0627
  • Dworak, M., Schierl, T., Bruns, T., & Struder, H. K. (2007). Impact of singular excessive computer game and television exposure on sleep patterns and memory performance of school-aged children. Pediatrics, 120(5), 978-985. doi: 10.1542/peds.2007-0476
  • Eggermont, S., & Van Den Bulck, J. (2006). Nodding off or switching off? The use of popular media as a sleep aid in secondary-school children. Journal of Paediatrics & Child Health, 42(7), 428-433.
  • Falbe, J., Davison, K. K., Franckle, R. L., Ganter, C., Gortmaker, S. L., Smith, L., . . . Taveras, E. M. (2015). Sleep duration, restfulness, and screens in the sleep environment. Pediatrics, 135(2), e367-375. doi: 10.1542/peds.2014-2306
  • Figueiro, M., & Overington, D. (2015). Self-luminous devices and melatonin suppression in adolescents. Lighting Research and Technology. doi: 10.1177/1477153515584979
  • Figueiro, M. G., Wood, B., Plitnick, B., & Rea, M. S. (2011). The impact of light from computer monitors on melatonin levels in college students. Neuro Endocrinol Lett, 32(2), 158-163.
  • Foley, L. S., Maddison, R., Jiang, Y., Marsh, S., Olds, T., & Ridley, K. (2013). Presleep activities and time of sleep onset in children. Pediatrics, 131(2), 276-282. doi: 10.1542/peds.2012-1651
  • Fossum, I. N., Nordnes, L. T., Storemark, S. S., Bjorvatn, B., & Pallesen, S. (2014). The association between use of electronic media in bed before going to sleep and insomnia symptoms, daytime sleepiness, morningness, and chronotype. Behav Sleep Med, 12(5), 343-357. doi: 10.1080/15402002.2013.819468
  • Gamble, A. L., D’rozario, A. L., Bartlett, D. J., Williams, S., Bin, Y. S., Grunstein, R. R., & Marshall, N. S. (2014). Adolescent sleep patterns and night-time technology use: Results of the australian broadcasting corporation’s big sleep survey. PLoS One, 9(11), e111700. doi: 10.1371/journal.pone.0111700
  • Garmy, P., Nyberg, P., & Jakobsson, U. (2012). Sleep and television and computer habits of swedish school-age children. J Sch Nurs, 28(6), 469-476. doi: 10.1177/1059840512444133
  • Garrison, M. M., & Christakis, D. A. (2012). The impact of a healthy media use intervention on sleep in preschool children. Pediatrics, 130(3), 492-499. doi: 10.1542/peds.2011-3153
  • Garrison, M. M., Liekweg, K., & Christakis, D. A. (2011). Media use and child sleep: The impact of content, timing, and environment. Pediatrics, 128(1), 29-35. doi: 10.1542/peds.2010-3304
  • Gradisar, M., Wolfson, A. R., Harvey, A. G., Hale, L., Rosenberg, R., & Czeisler, C. A. (2013). The sleep and technology use of americans: Findings from the national sleep foundation’s 2011 sleep in america poll. J Clin Sleep Med, 9(12), 1291-1299. doi: 10.5664/jcsm.3272
  • Hale, L., & Guan, S. (2015). Screen time and sleep among school-aged children and adolescents: A systematic literature review. Sleep Med Rev, 21, 50-58. doi: 10.1016/j.smrv.2014.07.007
  • Harmat, L., Takacs, J., & Bodizs, R. (2008). Music improves sleep quality in students. J Adv Nurs, 62(3), 327-335. doi: 10.1111/j.1365-2648.2008.04602.x
  • Ji, X., & Liu, J. (2016). Subjective sleep measures for adolescents: A systematic review. Child Care Health Dev. doi: 10.1111/cch.12376
  • King, D. L., Delfabbro, P. H., Zwaans, T., & Kaptsis, D. (2013). Sleep interference effects of pathological electronic media use during adolescence. International Journal of Mental Health and Addiction, 12(1), 21-35. doi: 10.1007/s11469-013-9461-2
  • King, D. L., Gradisar, M., Drummond, A., Lovato, N., Wessel, J., Micic, G., . . . Delfabbro, P. (2013). The impact of prolonged violent video-gaming on adolescent sleep: An experimental study. J Sleep Res, 22(2), 137-143. doi: 10.1111/j.1365-2869.2012.01060.x
  • Konen, T., Dirk, J., Leonhardt, A., & Schmiedek, F. (2016). The interplay between sleep behavior and affect in elementary school children’s daily life. J Exp Child Psychol, 150, 1-15. doi: 10.1016/j.jecp.2016.04.003
  • Lang, C., Kalak, N., Brand, S., Holsboer-Trachsler, E., Puhse, U., & Gerber, M. (2016). The relationship between physical activity and sleep from mid adolescence to early adulthood. A systematic review of methodological approaches and meta-analysis. Sleep Med Rev, 28, 32-45. doi: 10.1016/j.smrv.2015.07.004
  • Lemola, S., Perkinson-Gloor, N., Brand, S., Dewald-Kaufmann, J. F., & Grob, A. (2015). Adolescents’ electronic media use at night, sleep disturbance, and depressive symptoms in the smartphone age. J Youth Adolesc, 44(2), 405-418. doi: 10.1007/s10964-014-0176-x
  • Li, S., Jin, X., Wu, S., Jiang, F., Yan, C., & Shen, X. (2007). The impact of media use on sleep patterns and sleep disorders among school-aged children in china. Sleep, 30(3), 361-367.
  • Lowden, A., Akerstedt, T., Ingre, M., Wiholm, C., Hillert, L., Kuster, N., . . . Arnetz, B. (2011). Sleep after mobile phone exposure in subjects with mobile phone-related symptoms. Bioelectromagnetics, 32(1), 4-14. doi: 10.1002/bem.20609
  • Lucas, B. D. (1999). Childhood sleep disturbances linked to tv. Patient Care, 33(17), 13.
  • Munezawa, T., Kaneita, Y., Osaki, Y., Kanda, H., Minowa, M., Suzuki, K., . . . Ohida, T. (2011). The association between use of mobile phones after lights out and sleep disturbances among japanese adolescents: A nationwide cross-sectional survey. Sleep, 34(8), 1013-1020. doi: 10.5665/SLEEP.1152
  • Nathan, N., & Zeitzer, J. (2013). A survey study of the association between mobile phone use and daytime sleepiness in california high school students. BMC Public Health, 13(1), 840. doi: 10.1186/1471-2458-13-840
  • Nuutinen, T., Ray, C., & Roos, E. (2013). Do computer use, tv viewing, and the presence of the media in the bedroom predict school-aged children’s sleep habits in a longitudinal study? BMC Public Health, 13, 684. doi: 10.1186/1471-2458-13-684
  • Oshima, N., Nishida, A., Shimodera, S., Tochigi, M., Ando, S., Yamasaki, S., . . . Sasaki, T. (2012). The suicidal feelings, self-injury, and mobile phone use after lights out in adolescents. J Pediatr Psychol, 37(9), 1023-1030. doi: 10.1093/jpepsy/jss072
  • Owens, J., Maxim, R., Mcguinn, M., Nobile, C., Msall, M., & Alario, A. (1999). Television-viewing habits and sleep disturbance in school children. Pediatrics, 104(3), e27.
  • Pieters, D., De Valck, E., Vandekerckhove, M., Pirrera, S., Wuyts, J., Exadaktylos, V., . . . Cluydts, R. (2014). Effects of pre-sleep media use on sleep/wake patterns and daytime functioning among adolescents: The moderating role of parental control. Behav Sleep Med, 12(6), 427-443. doi: 10.1080/15402002.2012.694381
  • Saunders, T. J., Gray, C. E., Poitras, V. J., Chaput, J. P., Janssen, I., Katzmarzyk, P. T., . . . Carson, V. (2016). Combinations of physical activity, sedentary behaviour and sleep: Relationships with health indicators in school-aged children and youth. Appl Physiol Nutr Metab, 41(6 Suppl 3), S283-293. doi: 10.1139/apnm-2015-0626
  • Sayin, F. K., & Buyukinan, M. (2016). Sleep duration and media time have a major impact on insulin resistance and metabolic risk factors in obese children and adolescents. Child Obes, 12(4), 272-278. doi: 10.1089/chi.2015.0126
  • Seegers, V., Touchette, E., Dionne, G., Petit, D., Seguin, J. R., Montplaisir, J., . . . Tremblay, R. E. (2016). Short persistent sleep duration is associated with poor receptive vocabulary performance in middle childhood. J Sleep Res, 25(3), 325-332. doi: 10.1111/jsr.12375
  • Shochat, T., Flint-Bretler, O., & Tzischinsky, O. (2010). Sleep patterns, electronic media exposure and daytime sleep-related behaviours among israeli adolescents. Acta Paediatr, 99(9), 1396-1400. doi: 10.1111/j.1651-2227.2010.01821.x
  • Suganuma, N., Kikuchi, T., Yanagi, K., Yamamura, S., Morishima, H., Adachi, H., . . . Takeda, M. (2007). Using electronic media before sleep can curtail sleep time and result in self-perceived insufficient sleep. Sleep & Biological Rhythms, 5(3), 204-214.
  • Thompson, D. A., & Christakis, D. A. (2005). The association between television viewing and irregular sleep schedules among children less than 3 years of age. Pediatrics, 116(4), 851-856.
  • Thompson, G. (2010). The brainchild of project siesta. Sleep Review, 11(8), 24-27.
  • Tremblay, M. S., Carson, V., Chaput, J. P., Connor Gorber, S., Dinh, T., Duggan, M., . . . Zehr, L. (2016). Canadian 24-hour movement guidelines for children and youth: An integration of physical activity, sedentary behaviour, and sleep. Appl Physiol Nutr Metab, 41(6 Suppl 3), S311-327. doi: 10.1139/apnm-2016-0151
  • Van Den Bulck, J. (2007). Adolescent use of mobile phones for calling and for sending text messages after lights out: Results from a prospective cohort study with a one-year follow-up. Sleep, 30(9), 1220-1223.
  • Wallenius, M., Rimpelä, A., Punamäki, R.-L., & Lintonen, T. (2008). Digital game playing motives
  • among adolescents: Relations to parent-child communication, school performance, sleeping habits, and perceived health. Journal of Applied Developmental Psychology, 30(4), 463-474.
    Weaver, E., Gradisar, M., Dohnt, H., Lovato, N., & Douglas, P. (2010). The effect of presleep video-game playing on adolescent sleep. J Clin Sleep Med, 6(2), 184-189.
  • Werner, A. (2011). What’s keeping America awake? Sleep Review, 12(5), 40-43.
  • Wheaton, A. G., Chapman, D. P., & Croft, J. B. (2016). School start times, sleep, behavioral, health, and academic outcomes: A review of the literature. J Sch Health, 86(5), 363-381. doi: 10.1111/josh.12388
  • Wood, B., Rea, M. S., Plitnick, B., & Figueiro, M. G. (2013). Light level and duration of exposure determine the impact of self-luminous tablets on melatonin suppression. Appl Ergon, 44(2), 237-240. doi: 10.1016/j.apergo.2012.07.008
  • Woods, H. C., & Scott, H. (2016). #sleepyteens: Social media use in adolescence is associated with poor sleep quality, anxiety, depression and low self-esteem. J Adolesc, 51, 41-49. doi: 10.1016/j.adolescence.2016.05.008

This toolkit was created with funding from Harvard Pilgrim Health Care