Smartphones and tablets 'disrupt children's sleep'

“Streaming instead of dreaming: Using phones and tablets before bed stops kids from sleeping and can lead to health issues” is the rather poetic headline from the Mail Online.

A review of previous data found significant links between media devices like smartphones and tablets, and disrupted sleep in children.

Researchers looked at data from more than 125,000 children and found a clear association between using media devices and sleep problems, such as not getting enough sleep at night, reduced sleep quality and daytime sleepiness.

Sleep problems were also more likely if the children had access to – but did not use – media devices at bedtime.

The media has suggested that the reason for this is because children are restless, anticipating social media messages. While this is a plausible suggestion, the cause of the association was not actually looked into by researchers.

Evidence shows that night-time sleep is just as important as healthy eating and exercise for children’s development. Those who don’t get enough sleep are more likely to be overweight or obese.

This is likely to be because they tend to crave and eat sugary or starchy food during the day to give them energy to stay awake.

Aside from banning the use of media devices in the bedroom, other ways you can help your child get a good night’s sleep include relaxation techniques, such as a warm bath or reading a book, and creating a dark, quiet, tidy bedroom environment ideal for sleeping.

Where did the story come from?

The study was carried out by researchers from King’s College London; Cardiff University School of Medicine; University Hospital of Wales; the University of Nottingham School of Medicine; University College London; Stony Brook University School of Medicine; and Johns Hopkins University Baltimore-Washington-India Clinical Trials Unit.

The study was partly funded by a grant from the Eunice Kennedy Shriver National Institute of Child Health and Human Development. The authors reported no conflict of interest.

It was published in the peer-reviewed journal JAMA Pediatrics and is open access, so it’s free to read online.

The Mail Online reported that, “Youngsters are restless because they anticipate receiving texts and social media messages from friends, which affects their night-time routine.” But the reason behind the association was not actually examined in this study.

The media also failed to point out the limitations of the results: this type of study cannot prove that media devices disrupt sleep, and the studies were so different that combining them could not produce reliable results.

What kind of research was this?

This systematic review and meta-analysis examined whether there is an association between access to or use of portable screen-based media devices, such as smartphones and tablets, in the sleep environment and sleep outcomes.

Systematic reviews and meta-analyses are useful ways of pooling evidence from a particular research area, but they are only ever as good as the individual studies included.

All 20 studies included were of cross-sectional design – these types of studies are good at providing observational data, but cannot demonstrate changes over time or a cause and effect relationship.

What did the research involve?

Twelve medical databases were searched for studies published between 2011 and 2015 that measured the association between exposure to a media device and the influence on sleep.

The search was designed to reflect the variety of interactive media devices now used.

Twenty studies involving a total of 125,198 children and adolescents aged between 6 and 19 years were found – 17 of these met the defined quality standards.

Most of the studies were conducted in Europe, with some from North America, Asia and Australasia.

The researchers pooled results of similar studies in a meta-analysis.

What were the basic results?

Children who used media devices before bedtime, compared with no media device, were:

• more than twice as likely to get an adequate amount of sleep (odds ratio [OR] 2.17; 95% confidence interval [CI] 1.42 to 3.32)
• nearly half as likely to have poor-quality sleep (OR 1.46; 95% CI 1.14 to 1.88)
• nearly three times as likely to have excessive daytime sleepiness (OR 2.72; 95% CI 1.32 to 5.61)

Children who had media device access at bedtime, compared with no access, but did not report using the device were more likely to have:

• an inadequate amount of sleep (OR 1.79; 95% CI 1.39 to 2.31)
• poor-quality sleep (OR 1.53; 95% CI 1.11 to 2.10)
• excessive daytime sleepiness (OR 2.27; 95% CI 1.54 to 3.35)

How did the researchers interpret the results?

The authors concluded that, “Media device access and use at bedtime are significantly associated with detrimental sleep outcomes and lead to poor health outcomes.”

They recommended that, “Interventions to minimise device access and use need to be developed and evaluated.

“Interventions should include a multidisciplinary approach from teachers and healthcare professionals to empower parents to minimise the deleterious influence on child health.” 

Conclusion

This study found an association between using media devices like smartphones and tablets and getting an inadequate amount of sleep, poor-quality sleep, and excessive daytime sleepiness.

Children who used media devices before bed were more than twice as likely to have an inadequate amount of sleep, and almost three times as likely to be excessively sleepy during the daytime.

For children who had access to media devices but did not use them, the odds of these poor sleep outcomes were still increased, but smaller than for those actually using media devices.

But this type of study cannot prove that the problems with sleep were caused by the use of or access to media devices, as many other factors may have contributed.

The study had other limitations:

• The number of participants was not reported in all studies, which could have biased the results.
• Statistically, the results may not be reliable. As the authors acknowledge, there were a lot of differences found between the studies (heterogeneity). For example, some were non-randomised, and therefore grouping them together and pooling their data might lead to biased results. The confidence intervals were also fairly wide, which means the results should be interpreted with caution.
• The studies relied on self-reported data, which may be inaccurate because of problems remembering events or not reporting accurately.

Getting a good night’s sleep is important at any age. Tips for a better night’s sleep include taking regular daily exercise, avoiding caffeine later in the day, and making the bedroom environment conducive to sleep.

Taking away your teenagers’ tablet and phone before they get into bed may spark a few arguments, but it could be worth it in the long run. Lack of sleep can make teenagers grumpy and bad tempered.

Read more about how TVs, phones and screens spoil kids’ sleep.

Links To The Headlines

Streaming instead of dreaming: Using phones and tablets before bed stops kids from sleeping and can lead to health issues. Mail Online, October 31 2016

Smartphones and tablets in bedrooms disrupt sleep even when switched off. The Daily Telegraph, October 31 2016

Child’s sleep suffers even if they don’t touch phone in the bedroom. The Times, November 1 2016 (subscription required)

Links To Science

Carter B, Rees P, Hale L. Association Between Portable Screen-Based Media Device Access or Use and Sleep Outcomes – A Systematic Review and Meta-analysis. JAMA Pediatrics. Published online October 31 2016