Megan Brooks

June 11, 2015

SEATTLE — Adolescents aren't getting enough sleep, and use of smartphones and other devices before bed may be contributing to sleep debt and decreased daytime functioning, potentially posing safety and health risks, new research indicates.

"Technology use in the hour before sleep is nearly universal among the adolescents studied, and it was shown to have consequences for next-day function, including greater frequency of waking early or unrefreshed and greater frequency of excessive daytime sleepiness," Ann Johansson, BSN, RN, from the University of Pittsburgh School of Nursing, Pennsylvania, who led the study, told Medscape Medical News.

Co-investigator Eileen Chasens, PhD, RN, presented the findings in a poster here at SLEEP 2015, the Annual Meeting of the Associated Professional Sleep Societies.

The study is a secondary analysis of a subsample of 259 adolescents (mean age, 17 years; range, 13 to 21 years; 52% male) who responded to the 2010 National Sleep Foundation's Sleep in America Poll. The survey includes questions on demographic characteristics, sleep duration, frequency of waking unrefreshed, daytime sleepiness (questions from the Epworth Sleepiness Scale), and frequency of technology use during the hour before bedtime.

"Despite multiple expert panels who say adolescents need 8.5 to 10 hours of sleep per night, we found the average sleep duration among our sample of adolescents was 7.7 hours per night," Johansson said. Yet, 60% of the adolescents said they needed at least 8 hours a night to "function at best."

There was no statistical difference in sleep duration by sex. Those younger than 16 had an average of 30 minutes more nighttime sleep than older adolescents.

"Major reasons for shorter sleep duration are late bedtimes (60% of our sample went to bed between 11 pm and 2 am, and 9% after 2 am), and early rise times (22% wake before 6 am)," Johansson said.

The American Academy of Pediatrics has issued a policy statement recommending that schools consider moving their start times after 8:30 am to allow children and adolescents to get more sleep.

Technology use right before bed was almost universal. More than 50% of the sample reported using social media, Internet, and/or texting nightly or almost every night before bed. Girls were more apt to report text messaging, and boys were more likely to report playing video games.

Frequent use of technology before bed was significantly associated with increased daytime sleepiness (P < .05).

Teens Need Tech Education

Less than 10% of adolescents reported turning off their cellphone at night and nearly 30% reported that phone calls/text messages and/or emails wake them up few nights a week to every night. The frequency of being awoken by a cell phone was associated with increased daytime sleepiness and waking unrefreshed (P < .05), the researchers found.

"Our kids are already sleep deprived and then we add technology on top, which decreases their sleep quality and quantity, we are just compounding the problem," Johansson told Medscape Medical News. "Part of sleep hygiene is putting technology away in the hour before bed. These kids need education on this. If you want to have a good night's sleep, you need to put the technology away."

Saul Rothenberg, PhD, behavioral sleep psychologist at North Shore-LIJ Sleep Disorders Center in Great Neck, New York, is not surprised by the data. "A recent study showed that the decrease in sleep and the increase in shift in clock was proportional to the number of electronic devices kids have in their bedroom. The more devices they had the more likely they were to sleep insufficiently and have late sleep schedules and it gets worse as they progress through adolescence," he told Medscape Medical News.

He also noted that other research spanning roughly a 20-year period (1991 to 2012) has shown that kids are getting less sleep now than in the early 1990s. "The whole curve has shifted and 20 years ago there were very few electronic devices in bedrooms."

But Dr Rothenberg cautioned that just telling adolescents not to use their smartphones and other devices before bed is fruitless. "I have seen enough teenagers that I know if you want to keep them as patients you just can't tell them not to do that, it's not realistic," he said.

"The way I approach it with my teenage patients is to try to recruit their common sense. The vast majority come in for circadian rhythm dysregulation, but the chief complaint is, 'I can't fall asleep.' I tell them, if you are doing any activity before bed and it's making you become more awake, that's not a good idea; if you are doing something that is making you sleepy, that's okay," Dr Rothenberg said.

The study had no commercial funding. The authors and Dr Rothenberg have disclosed no relevant financial relationships.

SLEEP 2015: Annual Meeting of the Associated Professional Sleep Societies. Abstract 1045. Presented June 11, 2015.

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