Key highlights in this article:
- Screen Use Before Bed: Screen time before bed was generally not associated with impaired sleep in children aged 11 to 15 years, suggesting current presleep screen time guidelines may need reevaluation.
- Screen Use in Bed: Screen use in bed, especially interactive activities like gaming, was linked to delayed sleep onset and reduced total sleep time.
- Study Methodology: The study utilized a night-by-night approach with video recordings and wrist-worn accelerometers to objectively measure the impact of screen time on sleep.
Background
Not all screen time before bed among children aged 11 to less than 15 years was associated with impaired sleep, according to findings from a newly published study in JAMA Pediatrics, leading authors to suggest that presleep recommendations could require modification.1
"Many studies compared average screen time with average sleep and thus could not determine whether variation in screen time was associated with subsequent sleep that night," stated the study investigators. "A stronger study design would be a repeated-measures approach that examines how changing screen use from night to night is associated with subsequent sleep at the within-person level.1
According to The American Academy of Pediatrics (AAP), screen time can impact the child's sleep by making them more alert while raising their heart rate, making it harder to fall asleep.2
Study details and results
Authors noted that since self-reported data is unlikely to collect the complexity of modern screen use among youth, an objective, night-by-night approach was taken to advance this study field. The study investigators sought to determine if screen time is associated with sleep duration and quality that same night in youth by conducting a repeated-measure cohort study. The study was carried out in Dunedin, New Zealand from March to December 2021, with analysis performed from October to November 2023. Participants included healthy individuals aged 11 to 14.9 years.1
Screen time was captured using wearable or stationary video cameras from 2 hours before bedtime until the first youth attempted sleep, or shut-eye time, across 4 consecutive nights. Data from video recordings were coded using a "reliable protocol (κ = 0.92) to quantify device (8 options [eg, smartphone]) and activity (10 options [eg, social media]) type," according to the study authors.1
Wrist-worn accelerometers objectively measured sleep duration and quality. "The association of screen use with sleep measures was analyzed on a night-by-night basis using mixed-effects regression models including participant as a random effect and adjusted for weekends," said the investigators.1
All but 1 of the 79 participants (mean [SD] age, 12.9 years; 59.5% male) had screen time before bed. In the 2 hours before bed, screen use had no association with most measures of sleep healthy for that night, as mean difference was 0 minutes (95% CI, –3 to 2- minutes) for every 10 minutes more total screen time.1
In contrast, using screens once in bed and prior to attempting to sleep was associated with poor sleep health in various ways, as all types of screen behaviors were associated with sleep onset, particularly interactive screen use. This type of use in bed was associated with delayed onset of 10 minutes (95% CI, 4-16 minutes) for every 10 minutes more screen time or 35 minutes (95% CI, 16-54 minutes) on nights with interactive screen time compared with nights without.1
Every additional 10 minutes of screen time in bed was linked to shorter total sleep time (mean difference: –3 minutes [95% CI, –6 to –1 minute]). The mean difference in total sleep time was –9 minutes for every 10 minutes (95% CI, −16 to −2 minutes), and –4 minutes for passive screen use (95% CI, −7 to 0 minutes). Gaming (mean difference, –17 minutes; 95% CI, –28 to –7 minutes for every 10 minutes of gaming) and multitasking (mean difference, −35 minutes; 95% CI, –67 to –4 minutes on nights with vs without multitasking) were associated with less total sleep time, stated the investigative team.1
These data are in line with the AAP, which stated sleep can be impacted from screen time, "especially if [the] child is playing an action-packed video game or watching something intense. This can make it harder for them to fall asleep."2
Conclusion
Results from the study revealed, using an objective, repeated-measure method, that screen time once a child was in bed was linked to sleep impairment, particularly when screen time was interactive or involved gaming. However, "the findings showed that not all screen time before bed was associated with impaired sleep, suggesting that presleep recommendations require modification," concluded the study authors.1
References:
1. Brosnan B, Haszard JJ, Meredith-Jones KA, Wickham S, Galland BC, Taylor RW. Screen Use at Bedtime and Sleep Duration and Quality Among Youths. JAMA Pediatr. Published online September 03, 2024. doi:10.1001/jamapediatrics.2024.2914
2. Screen time affecting sleep. The American Academy of Pediatrics. Updated October 18, 2023. Accessed September 3, 2024. https://www.aap.org/en/patient-care/media-and-children/center-of-excellence-on-social-media-and-youth-mental-health/qa-portal/qa-portal-library/qa-portal-library-questions/screen-time-affecting-sleep#:~:text=Using%20a%20screen%20can%20affect,for%20them%20to%20fall%20asleep.
