Sleep Medicine 11 (2010) 735742

Contents lists available at ScienceDirect

Sleep Medicine
journal homepage: www.elsevier.com/locate/sleep

Review Article

Electronic media use and sleep in school-aged children and adolescents: A review
Neralie Cain, Michael Gradisar *
School of Psychology, Flinders University, Adelaide, SA, Australia

a r t i c l e

i n f o

Article history:
Received 3 December 2009
Received in revised form 15 February 2010
Accepted 19 February 2010
Available online 29 July 2010
Keywords:
Child
Adolescent
Sleep
Media
Technology
Television
Computer

a b s t r a c t
Electronic media have often been considered to have a negative impact on the sleep of children and adolescents, but there are no comprehensive reviews of research in this area. The present study identied 36
papers that have investigated the relationship between sleep and electronic media in school-aged children and adolescents, including television viewing, use of computers, electronic gaming, and/or the internet, mobile telephones, and music. Many variables have been investigated across these studies, although
delayed bedtime and shorter total sleep time have been found to be most consistently related to media
use. A model of the mechanisms by which media use may affect sleep is presented and discussed as a
vehicle for future research.
2010 Elsevier B.V. All rights reserved.

During recent decades, research investigating the sleep patterns

and habits of children and adolescents has become increasingly
more prevalent. In these age groups, sleep is considered particularly important for learning and memory, as well as having implications for emotional regulation and behaviour [1,2]. More
specically, insufcient sleep and poor sleep quality have been
associated with impairments in declarative, procedural and working memory performance, as well as poor concentration, which
logically translates into poor academic performance [13].
It is now well known that there is an inverse relationship between sleep duration and age. For example, Iglowstein and colleagues reported that children move from getting a mean of 11 h
sleep at age 6, to 9.6 h at age 11, to 8.1 h at age 16 [4], and these
values are consistent with those reported by other authors [57].
Interestingly, the total sleep duration of children and adolescents
also seems to be decreasing over time, with young people today
receiving less sleep than their counterparts from previous generations [4,5]. But why is it that children and adolescents are getting
less sleep?
In the late 1970s it was postulated that the age-related decrease
in sleep duration was due to a biological decrease in sleep need
[8]. But when adolescents were given the opportunity to sleep for
10 h each day in the Stanford sleep camp studies, there was no difference in duration of sleep obtained by adolescents at different

* Corresponding author. Address: c/o School of Psychology, Flinders University,

GPO Box 2100, Adelaide, SA 5001, Australia. Tel.: +61 8 8201 2324; fax: +61 8 8201
3877.
E-mail address: michael.gradisar@inders.edu.au (M. Gradisar).
1389-9457/$ - see front matter 2010 Elsevier B.V. All rights reserved.
doi:10.1016/j.sleep.2010.02.006

ages or pubertal stages [8]. This suggests that environmental factors (such as decreased parental monitoring) and psychosocial factors (such as increased use of electronic media) have a
considerable inuence on the amount of sleep obtained by adolescents [8]. Nevertheless, despite popular press [811] and the common practice for clinicians to emphasise the negative impact of
electronic media on sleep, there have been no comprehensive reviews of empirical research in this area.1 The current papers aims
are to (1) describe the evolution of technology and how this may
be impacting child and adolescent sleep, (2) review relevant research
to date, and (3) provide future directions for both research and clinical practice.

1. Literature search and inclusion criteria

To identify papers for this review, a literature search was performed using the PsycInfo and PubMed databases with a variety
of search terms (e.g., media AND sleep; computer AND sleep).
Articles were also identied from the reference lists of these papers. Included articles described original research studies that
measured both an aspect of media use or ownership and an aspect
of sleep. Articles were only included if they contained participants
aged approximately 517 years and were available in English. Published abstracts, unpublished theses and dissertations, and articles
1
We are aware of one previous review [12]; however, only 9 academic articles
were discussed (compared to 36 in the current review) and this included studies
involving infants and toddlers, as well as school-aged children and adolescents.

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N. Cain, M. Gradisar / Sleep Medicine 11 (2010) 735742

lescents who reported getting 68 h sleep and those who reported

getting 35 h sleep [20].
Individual media items in a child or adolescents bedroom have
also been associated with sleep disturbance. The presence of a television in a child or adolescents bedroom has been related to delayed bedtimes [17,19], less time in bed [19], shorter total sleep
time [14,15,18], increased bedtime resistance [18], and higher
overall level of sleep disturbance [16,18]. But one study found no
signicant relationship between total sleep time and having a television in the bedroom [20]. The presence of a computer or electronic
gaming console in a child or adolescents bedroom has been associated with delayed bedtime [17,19], less time in bed [19], shorter
total sleep time [14,17], and increased prevalence of disorders of
bedtime resistance, delayed sleep onset, sleep anxiety, parasomnias, and sleep-disordered breathing [14]. Mobile telephones in bedrooms pose an additional problem as they alert the individual to
incoming calls or text messages. In a recent study in Belgium, adolescents who reported being woken up at least occasionally by text
messages were signicantly more tired than adolescents never woken by text messages [21]. Importantly, simply having a mobile or
xed-line telephone in the bedroom has been related to delayed
bedtime on weekend days and a discrepancy of more than 1 h between weekday and weekend bedtimes [17]. Despite this research
being correlational (the implications of which will be discussed in
further detail later), these results suggest that technology should
be kept out of bedrooms in order to promote good sleep among
children and adolescents. The following sections will explore research relating to children and adolescents use of these media
items (in or outside the bedroom), beginning with the most researched: television.

that primarily focused on age groups outside the range specied

above were excluded from this review.
Using these criteria, 36 research articles were identied. Of
these, 20 related to television viewing, 15 related to the use of
computers, electronic gaming, and/or the internet, 7 related to mobile telephones, and 2 related to music (although some papers
examined the inuence of more than one media type).

2. Bedroom media presence and sleep

According to the National Sleep Foundations 2006 Sleep in
America Poll, almost all American adolescents (97%) had at least
one electronic media device in their bedroom [13]. These items included such things as music players (90%), televisions (57%), video
game consoles (43%), mobile (42%) or xed-line telephones (34%),
computers (28%), and internet access (21%). Older adolescents
had more media devices in their bedrooms than younger adolescents, with a median of two devices for 6th8th graders and four
devices for 9th12th graders [13]. In line with this, studies with
primary school children have revealed lower prevalence rates of
1843% for televisions in bedrooms [1418], 1820% for computers
or video games [14,17], and 14% for mobile phones [17]. Other
studies have found gender differences, with adolescent boys being
more likely than adolescent girls to have a television or computer
game console in their bedroom [19].
The National Sleep Foundation found that adolescents who had
four or more media devices in their bedrooms got signicantly less
sleep on both school nights and non-school nights than adolescents who had three media devices or less [13]. These adolescents
were also more likely to have fallen asleep at school or while doing
homework at least a few times per week, felt too tired or sleepy
during the day, and more likely to think that they have a sleep
problem. Adolescents with more media devices in their bedroom
also drank more caffeinated beverages during the day and were
more likely to be evening types (i.e., having a preference for
going to bed late and getting up late) than adolescents with fewer
media devices in their bedroom. Considering that the percentage of
children who watch television or play video games before bed is
signicantly higher among children who have a television or video
game console in their bedroom [17], it is likely that bedroom media presence has an indirect effect on sleep (see Fig. 1). Consistent
with this hypothesis, adolescents (aged 1218 years) who reported
getting more than 8 h sleep per night have been found to engage in
less technology-related activities after 9 pm compared with ado-

3. Television viewing and sleep

Television broadcasting began in the late 1930s in Britain and
the early 1940s in America, followed later by countries such as Japan in 1953 and Australia in 1956 [22]. Following the Second
World War, television experienced a popularity boom in the
1950s and 1960s as televisions became more affordable, but even
then, key stations only broadcasted for several hours per day
[22,23]. Television viewing became more exible from the 1980s,
with the introduction of video cassette recorders, and 1990s, with
cable television and the large clear images associated with digital
broadcasting [23]. Even today, large wide-screen television sets

Socio-Economic Status?

Increased
Daytime
Media Use
Electronic
Media Device
in Bedroom

Age?

Possible Mechanism???

Increased PreBedtime
Media Use

Media use directly displaces

sleep
Media use causes increased
mental/emotional/
physiological arousal
Bright light exposure delays
the Circadian Rhythm

Parental Control?
Fig. 1. A graphical representation of the potential impact of electronic media on sleep.

Sleep
Problems

Impaired
Daytime
Functioning

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N. Cain, M. Gradisar / Sleep Medicine 11 (2010) 735742

vision had a negative effect on their childs sleep [18]. These gures
are important, considering that much of the research reviewed in
this paper relies on parent-report data (see Section 7 for further
discussion of this issue).
In terms of television viewing in the evening or at bedtime, it
has been reported that as many as 82% of American adolescents
watch television after 9 pm and 34% watch DVDs or videos [20].
Watching television in the evenings has been associated with signicantly shorter total sleep time on both weekends and weekdays
[33,34] and with a generally higher frequency of sleep problems
compared with children not watching television after 9 pm [30].
Similarly, children and adolescents who often or occasionally
watch television in the evening have signicantly later bedtimes
and wake-up times on weekdays and/or weekend days [17,34].
Television viewing at bedtime has also been found to be signicantly correlated with sleepwake transition disorders, disorders
of excessive somnolence, and overall sleep problem severity in
children aged 56 years [31]. A discrepancy of more than 1 h between weekday and weekend bedtimes has also been associated
with watching television before bedtime [17]. Subjective reports
from adolescents are also consistent with these ndings [35].
The results presented in Table 1 reveal that many different variables have been investigated in relation to television viewing and
sleep among school-aged children. As yet, however, there is little
consensus regarding which aspects of sleep may be related to television viewing. The most consistent results to date seem to be decreased total sleep time, prolonged sleep onset latency, and
delayed bedtime. More research is clearly needed to determine
whether or not other aspects of sleep are also related to television
viewing.
It is important to note that all of the abovementioned studies
are correlational and that empirical evidence in this area is rare.
In a small experimental study, 11 boys (aged 1214 years) were
exposed to 1 h of a subjectively exciting movie, approximately 2
3 h prior to bedtime [36]. Their sleep was then monitored using
both subjective and objective measures (i.e., sleep diary and polysomnography, respectively). Compared to a control evening when
they did not watch television or play video games at all, participants had signicantly lower sleep efciency (i.e., percentage
of time in bed that the individual was actually asleep) on the

are becoming increasingly more affordable and more prevalent,

with many homes now having multiple sets [18].
Although early research found no signicant correlation between television viewing and evening sleep duration for schoolaged children [24], a number of subsequent studies have found a
relationship between television viewing and a variety of sleep variables (see Table 1). For example, one study found that the number
of hours of television watched per day predicted increased bedtime
resistance in children aged 410 years, after controlling for demographic variables of age, gender, and socio-economic status [18].
Comparing children who watched less than 2 h of television each
weekday, children who watched more than 2 h of television each
weekday had increased sleep onset latency, increased sleep anxiety, increased night waking, and increased total sleep disturbance
[18]. In a longitudinal study, the number of hours of television
viewing at age 14 was associated with increased sleep problems
at follow-up (age 1622) [25]. In addition, adolescents who chose
to reduce their television viewing to less than 1 h per day were less
likely to experience sleep problems at follow-up. Other studies
have found television use to be associated with less time in bed
on weekdays [19], delayed bedtime on both weekdays and weekend days [14,19,2628], later wake-up time or out-of-bed time
[14,19,26], increased sleep onset latency [14,29,30], shorter sleep
duration [14,26,27,31], and sleep disorders involving bedtime
resistance, sleep anxiety, and/or parasomnias [14,18,30,31]. This
appears to be a worldwide phenomenon, with research now available from Australia, Europe, Asia, and North America.
In addition to active television viewing, one study also examined the relationship between passive television viewing and sleep
among 5- to 6-year-old children [31]. The authors found that the
amount of time the television was switched on during the childs
waking hours was signicantly correlated with decreased total
sleep duration. Furthermore, passive television exposure was associated with disorders of initiating and maintaining sleep and overall sleep problem severity.
In an Indian survey of parental opinions about the effect of television on childrens sleep it was reported that 18% of parents believed their child (aged 310 years) had a decreased or disturbed
sleep pattern as a result of television viewing [32]. In contrast, an
American study found that only 6.5% of parents believed that tele-

Table 1
Relationship between television viewing and sleep variables.
Authors

Age (years)

Weissbluth et al. [24]

Tynjala et al. [28]
Gupta et al. [32]
Owens et al. [18]
Van den Bulck [35]
Saarenpaa-Heikkila et al. [27]
Toyran et al. [30]
Thorleifsdottir et al. [34]

516
1116
510
410
1718
917
69
610
1115
1619
1317
1217
1215
613
1415
1213
56
511
511
1219
612

Johnson et al. [25]

Van den Bulck [19]
Gaina et al. [42]
BaHammam et al. [33]
Fuligni and Hardway [43]
Gaina et al. [29]
Paavonen et al. [31]
Li et al. [14]
Adam et al. [26]
Oka et al. [17]

TIB

TST

SOL

WASO

GTB

WUT

DS/T

BR

SA

Parasomnias

SWT

DES

Overall sleep disturbance

X
U
X
U
U

U
U

U
U
X
U
U

U
U

U
U

U
U
U

U
U
U

U
U
U
U

U
U
U
U

X
U
X
U
U
U
U
U

U
U

Note: U = examined in study (signicant relationship between variables); X = examined in study (non-signicant); TIB = shorter time in bed; TST = shorter total sleep time;
SOL = longer sleep onset latency; WASO = more night waking; GTB = delayed bedtime; WUT = delayed wake-up time; DS/T = daytime sleepiness or tiredness; BR = bedtime
resistance; SA = sleep anxiety; SDB = sleep-disordered breathing; SWT = sleepwake transition disorders; DES = disorders of excessive somnolence.

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N. Cain, M. Gradisar / Sleep Medicine 11 (2010) 735742

any sleep disorders (e.g., bedtime resistance, sleep anxiety, parasomnias) [14] and, in contrast to another study [19], found no signicant relationship with wake-up times on weekdays or weekend
days nor with weekday bedtimes or daytime sleepiness.
When considering the use of computers or electronic games in
the evening or at night it has been reported that 55% of American
adolescents access the internet and 24% play computer games after
9 pm [20]. Playing video games or using a computer before bed has
been associated with later bedtimes [17,37], shorter total sleep
duration [17,33,37], later wake-up time on weekend days [17], increased daytime tiredness [37], and poorer overall sleep quality
[45]. A discrepancy of more than 1 h between weekday and weekend bedtimes and a discrepancy of more than 2 h between weekday and weekend wake-up times have also been associated with
playing video games before bed [17].
In terms of internet use, three studies have obtained consistent
results despite measuring internet use in different ways. Van den
Bulck measured the amount of time that adolescents spent using
the internet at any time of day [19], Oka and colleagues categorized
children according to whether or not they used the internet before
bed two or more times per week [17], while Yen and colleagues
used a self-report questionnaire to assess symptoms of internet
addiction [46]. Taken together, this research revealed that internet
use is related to delayed bedtimes [17,19], delayed weekend wakeup times or out-of-bed times [17,19], shorter total sleep times
[17,46], shorter time in bed on weekdays [19], higher levels of
tiredness [19], and higher levels of subjective insomnia [46] (see
Table 3). A discrepancy of more than 2 h between weekday and
weekend wake-up times was also associated with using the internet before bed [17].
In a small experimental study (described earlier), participants
were exposed to 1 h of video-game play approximately 23 h prior
to bedtime [36]. Compared to a control evening, participants had
signicantly longer sleep onset latencies on the experimental night
and experienced signicant changes in their sleep architecture,
with less time spent in slow-wave sleep. But there was no difference in overall sleep efciency or time spent awake after sleep onset. A second experimental study involved 22 male participants
aged 1215 years who participated in three experimental conditions: playing a violent video game, playing a non-violent video
game, neither playing video games nor watching exciting television programs [47]. Games were played for 2 h, ending half an hour
before bedtime, and a comprehensive questionnaire and sleep
diary was also completed on each occasion. There were no signicant differences between the two game-playing conditions for any
sleep item. Compared to the control night, however, participants
went to bed signicantly later on both gaming nights and, after
playing the non-violent game, participants reported that it was signicantly easier to fall asleep, and their out-of-bed time the following morning was signicantly earlier. Weaver and colleagues
conducted a similar experimental study involving 13 male adolescents (aged 1418 years) and found that, compared to a passive
DVD viewing control condition, pre-sleep video game playing resulted in a small increase in sleep onset latency and a small decrease in subjective sleepiness [48]. But in contrast to previous
studies, there were no changes in sleep architecture.

experimental night. But there was no effect on any other sleep

variables, including sleep onset latency and time spent awake after
sleep onset.
Many children and adolescents watch television in the evenings
for the purpose of aiding sleep onset [18,37]. For example, one
study found that 76.5% of their sample (495 children aged 4
10 years) had television viewing as part of their usual bedtime routines [18]. As seen in Table 2, use of television has been associated
with reduced total sleep time, longer sleep onset latency, delayed
bedtime, increased bedtime resistance, increased sleep anxiety,
and an increased level of overall sleep disturbance. It has not been
signicantly associated with parasomnias or time spent awake
after sleep onset.
When considering daytime consequences, one study found no
signicant correlations between any of their television viewing
variables and daytime sleepiness in children aged 410 years
[18]. But others found television use to be associated with increased daytime sleepiness or tiredness in adolescents aged 12
17 years [19,27]. The use of television as a sleep aid was also associated with increased tiredness in this age group [37]. As the American Academy of Sleep Medicine stressed the importance of
daytime dysfunction in the context of sleep disturbance [38], further research is clearly needed on the impact of television viewing
on the daytime consequences of poor sleep.
Overall, it appears that television viewing among children and
adolescents should be limited, especially in the evenings. Two
hours per day has been suggested as a recommended maximum
for school-aged children [39]. Furthermore, consistent with common sleep hygiene recommendations, it appears that televisions
should be kept out of bedrooms in order to create an environment
conducive to sleep.
4. Use of computer or electronic games and sleep
Computer and electronic games were introduced to the public in
the early 1970s; however, their popularity surged in the late 1980s
and 1990s with the rapid progression of gaming technology and
several major video gaming companies competing for prominence
[23]. In the 2000s, while the use of computer game software declined considerably (as more games were produced solely for gaming consoles), internet gaming surged in popularity as more
individuals gained access to this technology [23]. For example, the
Australian Bureau of Statistics reported that the number of households with access to a home computer doubled from 1998 to
2008, and the number of households with internet access increased
vefold over the same time period [40]. Canadian data also showed
an increase in household internet access from 2001 to 2005 [41].
Frequent use of computer or electronic games has been associated with later bedtimes on weekend days [14,19,26], longer sleep
onset latency [29,42], later out-of-bed times on weekend days [19],
earlier out-of-bed times on weekdays [19], shorter total sleep time
or less time in bed [14,19,26,43,44], and higher levels of daytime
tiredness [19] (see Table 3). These results persist even after controlling for demographic and activity variables and presence of a
gaming computer in the bedroom [14,19]. One study, however,
also found that computer use was not signicantly correlated with

Table 2
Relationship between sleep variables and use of television as a sleep aid.
Authors

Age (years)

TST

SOL

WASO

Owens et al. [18]

Eggermont and Van den Bulck [37]

410
1217

U
U

GTB

BR

SA

Parasomnias

Daytime sleepiness/tiredness

Overall sleep disturbance

X
U

Note: U = examined in study (signicant relationship between variables); X = examined in study (non-signicant); TST = shorter total sleep time; SOL = longer sleep onset
latency; WASO = more night awakenings; GTB = delayed bedtime; BR = bedtime resistance; SA = sleep anxiety.

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N. Cain, M. Gradisar / Sleep Medicine 11 (2010) 735742

Table 3
Relationship between sleep variables and use of computer, internet, or electronic games.
Authors

Age (years)

TIB

Van den Bulck [19]

Gaina et al. [42]
BaHammam et al. [33]
Eggermont and Van den Bulck [37]
Fuligni and Hardway [43]
Gaina et al. [29]
Li et al. [14]
Mesquita and Reimao [45]
Punamaki et al. [44]
Adam et al. [26]
Oka et al. [17]
Yen et al. [46]

1217
1215
613
1217
1415
1213
511
1518
1218
511
612
1218

TST

SOL

GTB

WUT

BR

SA

Parasomnias

Daytime sleepiness/tiredness

Overall sleep quality

U
U
U
U

U
U

X
U

U
U
U
U

U
U

U
U
U

Note: U = examined in study (signicant relationship between variables); X = examined in study (non-signicant); TIB = less time in bed; TST = shorter total sleep time;
SOL = longer sleep onset latency; GTB = delayed bedtime; WUT = later weekend wake-up time; BR = bedtime resistance; SA = sleep anxiety.

Overall, it appears that time playing computer or electronic

games should be limited both during the day and in the evening
for school-aged children and adolescents. Consistent with recommendations regarding television viewing, a cut-off of 2 h of
game-playing per day has been suggested as being appropriate
[29], but results from a recent experimental study suggest that it
may be important to distinguish between violent and non-violent
games, as it appears that playing non-violent games in the evening
may produce positive effects on sleep [47]. Research regarding
internet use has suggested that excessive use at any time of day
may be related to negative consequences for sleep, although no
recommendations have yet been made regarding frequency or
duration of use.
5. Mobile telephone use and sleep
Since rst being tested in the late 1970s, mobile telephone technology has developed rapidly [23]. Telephones are now not only
used for making and receiving calls, but also for text-messaging
(introduced in the early 1990s) [23], accessing the internet (introduced in the early 2000s) [23], playing games, listening to music,
and storing other personal information (e.g., calendar). Due to
the rapid development of technology in this area, it should be
noted that studies performed on mobile phone use may not have
included all of the above.
Mobile phone use among Finnish adolescents has been associated with shorter sleep duration [44]. Similarly, Japanese adolescents aged 1315 who use their mobile telephone every day
were found to be more evening-typed and have later wake-up
times and shorter total sleep duration [49]. They also reported
being less satised with their current sleep duration than students
who did not use a mobile telephone every day [49]. Furthermore,
adolescents who reported using their telephone for more than
20 min at a time reported staying in bed longer after waking up

on weekend mornings and having more frequent daytime naps

compared to students who used their telephone for shorter durations [49]. Another Japanese study, however, later found no significant difference between adolescents with short sleep onset
latency (i.e., less than 10 min) and long sleep onset latency (i.e.,
more than 10 min) for mobile telephone ownership or mobile telephone use [42]. A more recent study of Taiwanese adolescents also
found no relationship between problematic mobile phone usage
(based on symptoms of addiction or dependence) and total sleep
time or subjective insomnia [46]. Swedish researchers found a
borderline signicant relationship between daytime tiredness
and mobile phone use, but found no signicant relationship between self-reported sleep disturbance and mobile phone use [50].
When considering use of mobile telephones at bedtime or during the night, a recent study found that 34% of American adolescents reported text messaging and 44% reported talking on the
telephone after 9 pm [20]. Furthermore, up to one-third of adolescents reported being woken up by incoming text messages at least
once per month [21]. This appears to be more of a problem with
increasing age, as older adolescents (mean age 16 years) were woken up by text messages signicantly more often than younger
adolescents (mean age 13 years) [21]. Mobile phone use after
lights out (which includes both incoming and outgoing calls
and text messages) was also found to be related to increased tiredness measured concurrently [21] and 1 year later [51]. In particular, adolescents who used mobile telephones between midnight
and 3 am were most likely to be very tired (3.9 times more than
adolescents who never used mobile telephones after lights out)
[51].
While it is clear that children and adolescents use mobile telephones in the evening and at night, the impact of this use on their
sleep and daytime functioning is less clear. As seen in Table 4, results in this area appear to be less consistent than in other areas of
electronic media discussed in this paper. Given the wide-ranging

Table 4
Relationship between sleep variables and mobile telephone use.
Authors

Age (years)

TST

Harada et al. [49]

Van den Bulck [21]
Gaina et al. [42]
Punamaki et al. [44]
Van den Bulck [51]
Soderqvist et al. [50]
Yen et al. [46]

1315
1217
1215
1218
1217
1519
1218

SOL

WUT

Evening
type

Dissatised with
sleep

Nap
frequently

Daytime sleepiness/
tiredness

Subjective
insomnia

U
X
U
U
U
X

X
X

Note: U = examined in study (signicant relationship between variables); X = examined in study (non-signicant); TST = shorter total sleep time; SOL = longer sleep onset
latency; WUT = later weekend wake-up time.

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N. Cain, M. Gradisar / Sleep Medicine 11 (2010) 735742

activities a mobile phone provides and its portability this could become the most frequently used media device (day and night) and
thus should be an essential item assessed in future studies.

6. Music and sleep

Surprisingly, the effect of music on the sleep of children and
adolescents has rarely been studied, despite the fact that electronic
transmission of music has followed a similar developmental timeline to that of television. FM radio transmission began in the 1960s,
with audio cassettes and compact discs developed in the 1980s,
followed later by portable MP3 players in the late 1990s [23].
A recent study found that 42% of American adolescents reported
listening to music on an MP3 player after 9 pm [20], and the National Sleep Foundation reported that 90% of adolescents have a
music player in their bedroom [13]. But only two studies have explored the effectiveness of music as a sleep aid among school-aged
children and adolescents. In a cross-sectional correlational study
use of music as a sleep aid was related to later bedtime on weekdays, less sleep on weekdays, and increased tiredness among adolescents aged 1217 years [37]. But it was not signicantly related
to bedtime or total sleep time on weekend days [37]. In an experimental study with participants in the 5th grade, participants were
randomly allocated to either receive sedative classical music at
naptime and bedtime for three weeks or not to receive music during this time [52]. The researcher found that children in the experimental group had better subjective global sleep quality over time
than those in the control group [52]. They also experienced
improvements in subjective sleep efciency and subjective sleep
duration, and there was a signicant decrease over time in the percentage of children who were considered poor sleepers [52]. The
intervention received by the experimental group, however, also involved a component of relaxation training, as the children in this
group were instructed to monitor their breathing and relax their
muscles as they listened to the music. Therefore, it cannot be concluded that the effects on sleep were purely a result of listening to
music. Considering the widespread use of music players in the
evening, more research is needed to ascertain the effects of different types of music on sleep.

7. Study limitations
The research studies reviewed here are plagued by a number of
limitations. The rst limitation is that only three experimental
studies were found [36,47,52]. Instead, most report on cross-sectional correlational studies, which means that causal direction is
difcult to ascertain. It is possible that children and adolescents
who use technology in the evening do so because they do not need
as much sleep as their peers or because they already have a delayed sleep pattern and cannot fall asleep at their designated bedtime. For example, in a household where a parent encourages his/
her teenager to go to bed at 10 pm, the delayed adolescent may go
to his/her bedroom (but not feel sleepy) and occupy time by using
his/her mobile telephone, computer or television until feeling sleepy enough to go to bed several hours later. Another factor, such as
parenting style or the presence of childhood behavioural problems,
may also impact both media use and sleep problems among younger children. For example, a child who exhibits difcult behaviours
may be encouraged to watch television to give the parents a break
and keep the child occupied. Consistent with this hypothesis, research has revealed that sleep problems are common among children with behaviour problems [53] and some studies have found
that children with behavioural and emotional problems spend
more time watching television [54].

Of the 36 studies reviewed, 21 used self-report data, 10 used

parent-report data, 5 used both parent and self-report data, and
2 studies used objective data obtained from polysomnography
(in addition to self-report measures). Of the self- and parent-report
data, 17 collected data using general questions (such as rating how
often a certain sleep problem occurs or estimating total sleep time
without reference to other sleep parameters), 13 asked participants to estimate sleep parameters (e.g., estimated bedtimes,
wake-up times, sleep onset latencies), and only 6 asked about actual sleep parameters for a given night (e.g., sleep diary). It is evident from these observations there has been very little consistency
between studies in the method and/or content of sleep information
obtained. Furthermore, parent-reports of sleep parameters may
not be an accurate way of measuring the sleep habits of older children and adolescents [55,56]. In future studies, sleep should be
measured using self-report estimates of sleep parameters (including go-to-bed time, sleep onset latency, time spent awake after
sleep onset, wake-up time, and out-of-bed time, each estimated
separately for weekdays and weekend days) or using records of
these parameters taken from sleep diaries. Subjective reports such
as these have been validated against objective sleep measures (e.g.,
actigraphy) in adolescent populations [57]. Considering the importance of daytime consequences of sleep problems, ratings of daytime functioning (e.g., sleepiness) at different times of day should
also be included.
Consideration must be given to whether or not differences reported in these studies are meaningful, even if they are statistically
signicant. In some cases, the difference between groups in bedtime or wake-up time was only 1015 min [17,34]. While this difference was statistically signicant, we must consider whether a
bedtime delay of 10 min produces a clinically signicant impairment in total sleep quality or daytime consequences. Alternatively,
it may be clinically important to consider the impact of media on
the discrepancy between weekday and weekend sleep patterns
for adolescents, as a discrepancy of more than 2 h between weekday and weekend wake-up times has been considered clinically
signicant by other researchers and clinicians [38]. It should be
noted that this has been considered by one group of researchers,
who reported that a wake-up time discrepancy of this size was
associated with playing video games or using the internet before
bed more than two nights per week [17].
Different age ranges have been used in the studies reviewed
here. As many developmental changes occur with sleep patterns
and sleep habits during the school years, especially with the onset
of puberty, it may be more informative to use smaller age ranges.
For example, one group of researchers acknowledged that it is
likely that the effects of both active TV viewing and passive TV
exposure are largely age-dependent (p. 158) [31]. There are also
differences in the type and extent of electronic media use among
children of different ages [44] and it is likely that parental control
of media use also changes with age. Finally, it has been found that
time spent using a computer on weekend days mediates the relationship between age and weekend total sleep time, suggesting
that the interrelationship between age, media use, and sleep is
likely to be complex [26].
Studies summarised in this paper come from a variety of countries and cultures. It is possible that there are cultural differences
in the magnitude of the effect of media on sleep, as there are cultural differences in technology available (e.g., households in the
United States are more likely to have cable television, students
in Japan are more likely to have mobile telephones that can also
be used for internet access and television viewing) [17] and also
differences in sleep habits between cultures [58]. Cultural differences have been found in the use of media devices by boys and
girls, with girls using computers more than boys in Brazil, but boys
using computers more than girls in the United States [45].

N. Cain, M. Gradisar / Sleep Medicine 11 (2010) 735742

8. Possible mechanisms
A number of mechanisms have been proposed by which media
use might impact sleep quality or quantity. First, media use may
directly displace sleep or other activities related to good sleep hygiene (such as physical activity). Second, media use in the evenings
may cause children to become physiologically aroused, making it
more difcult for them to relax prior to bedtime. A number of studies have found increases in physiological arousal associated with
playing computer games [47,5962], and with the advent of more
physical computer gaming technology (such as the Nintendo Wii)
this issue becomes increasingly more relevant. Third, evening
exposure to bright light from television or computer screens may
suppress melatonin and consequently delay the circadian rhythm
[63]. Finally, electromagnetic radiation from mobile telephones
has been found to change sleep architecture [64,65] and delay melatonin production [66].
It is beyond the scope of this paper to comprehensively review
the support for and against the model presented in Fig. 1. Furthermore, it is acknowledged that much of the research in this area has
been correlational in nature and, consequently, the causal directions presented in the proposed model are largely speculative. In
addition to the results relating to the potential mechanisms described above, however, studies providing preliminary support
for other aspects of the model have already been mentioned in this
review. For example, the percentage of children who watch television or play video games before bed has been found to be higher
among children who have a television or video game console in
their bedroom [17] and the relationship between age and weekend
total sleep time has been found to be mediated by time spent using
a computer [26]. It would be useful for future studies to comprehensively test this model, using research designs that move beyond
the correlational analyses which are prevalent in this area.

9. Conclusions
Despite the aforementioned limitations, it appears that the use
of electronic media by children and adolescents does have a negative impact on their sleep, although the precise effects and mechanisms remain unclear. Across different media types, the most
consistent results have been obtained regarding delayed bedtime
and shorter total sleep time associated with excessive media use.
In future research, it would be good to develop and test a model
of the mechanisms by which media use affects sleep (such as that
presented in Fig. 1). This would provide further evidence to inform
clinicians, parents, young people, and the popular press and will
likely become even more relevant as technology continues to develop in the future.
Looking towards the future, the research community faces the
challenge of keeping up with advances in technology. For example,
studies on mobile telephones have so far only considered making
and receiving calls and sending and receiving text messages. Mobile telephone technology, on the other hand, has evolved at such
a rate that many people now use their mobile telephone to access
the internet, send and receive emails, engage in social networking,
listen to music, and play games. Furthermore, as television and
computer screens become increasingly larger and bright light
exposure from screens is considered to inuence melatonin production, future studies may need to incorporate variables which
would not have been considered in previous research.
Eventually, guidelines about the duration and timing of electronic media use should be developed for children and adolescents
of different ages and these should be made known to the public.
Considering the evidence to date it appears that watching television and using other media devices at bedtime should generally

741

be discouraged [31]. Parents should also be informed that simply

having electronic media devices in the bedroom can negatively affect their childrens sleep.
10. Research priorities
It is recommended that future research should concentrate on
the following areas:
1. Using experimental methods to better establish causal links
between electronic media use and sleep.
2. Including the latest technologies (e.g., portable electronic
devices) in future studies.
3. Assessing the statistical and clinical signicance of research
ndings that relate to measures of sleep quality, sleep quantity,
and sleep timing.
4. Attempting to test the mechanisms involved in the relationships between electronic media use and sleep.
Financial support
N/A.
Conicts of interest
Nil.
References
[1] Curcio G, Ferrara M, de Gennaro L. Sleep loss, learning capacity and academic
performance. Sleep Med Rev 2006;10:32337.
[2] Dewald JF, Meijer AM, Oort FJ, Kerkhof GA, Bgels SM. The inuence of sleep
quality, sleep duration and sleepiness on school performance in children and
adolescents: a meta-analytic review. Sleep Med Rev 2010;14:17989.
[3] Gradisar M, Terrill G, Johnston A, Douglas P. Adolescent sleep and working
memory performance. Sleep Biol Rhythms 2008;6:14654.
[4] Iglowstein I, Jenni OG, Molinari L, Largo RH. Sleep duration from infancy to
adolescence: reference values and generational trends. Pediatrics
2003;111:3027.
[5] Dollman J, Ridley K, Olds T, Lowe E. Trends in the duration of school-day sleep
among 10- to 15-year-old South Australians between 1985 and 2004. Acta
Paediatr 2007;96:10114.
[6] Klackenberg G. Sleep behaviour studied longitudinally. Acta Paediatr Scand
1982;71:5016.
[7] Szymczak JT, Jasinska M, Pawlak E, Zwierzykowska M. Annual and weekly
changes in the sleepwake rhythm of school children. Sleep 1993;16:4335.
[8] Carskadon MA, Harvey K, Duke P, Anders TF, Litt IF, Dement WC. Pubertal
changes in daytime sleepiness. Sleep 1980;2:45360.
[9] ABC Australia. Eyes wide open. Four Corners; 2007 August 13.
[10] Critchley C. Hello, world: under 8 and on the mobile. The Advertiser; 2009 June
8. p. 5.
[11] SBS Australia. Sleep. Insight; 2009 April 28.
[12] Zimmermann FJ. Childrens media use and sleep problems: issues and
unanswered questions. Menlo Park, CA: Kaiser Family Foundation; 2008.
[13] National Sleep Foundation. 2006 Sleep in America Poll. Washington,
DC: National Sleep Foundation; 2006.
[14] Li S, Jin X, Wu S, Jiang F, Yan C, Shen X. The impact of media use on sleep
patterns and sleep disorders among school-aged children in china. Sleep
2007;30:3617.
[15] Mindell JA, Meltzer LJ, Carskadon MA, Chervin RD. Developmental aspects of
sleep hygiene: ndings from the 2004 National Sleep Foundation Sleep in
America Poll. Sleep Med 2009;10:7719.
[16] Mistry KB, Minkovitz CS, Strobino DM, Borzekowski DLG. Childrens television
exposure and behavioural and social outcomes at 5.5 years: does timing of
exposure matter? Pediatrics 2007;120:7629.
[17] Oka Y, Suzuki S, Inoue Y. Bedtime activities, sleep environment, and sleep/
wake patterns of Japanese elementary school children. Behav Sleep Med
2008;6:22033.
[18] Owens J, Maxim R, McGuinn M, Nobile C, Msall M. Television-viewing habits
and sleep disturbance in school children. Pediatrics [serial online] 1999 [cited
2008 May 13];104:e27. Available from: www.pediatrics.org/cgi/content/full/
104/3/e27.
[19] Van den Bulck J. Television viewing, computer game playing, and internet use
and self-reported time to bed and time out of bed in secondary-school
children. Sleep 2004;27:1014.
[20] Calamaro CJ, Mason TBA, Ratcliffe SJ. Adolescents living the 24/7 lifestyle:
effects of caffeine and technology on sleep duration and daytime functioning.

742

[21]
[22]
[23]
[24]
[25]

[26]

[27]

[28]
[29]

[30]
[31]

[32]
[33]

[34]

[35]
[36]

[37]

[38]

[39]
[40]
[41]
[42]

[43]
[44]

N. Cain, M. Gradisar / Sleep Medicine 11 (2010) 735742

Pediatrics [serial online] 2009 [cited 2009 June 22];123:e1005e1010.
Available from: http://www.pediatrics.org/cgi/content/full/123/6/e1005.
Van den Bulck J. Text messaging as a cause of sleep interruption in adolescents,
evidence from a cross-sectional study. J Sleep Res 2003;12:263.
Smith A. Television: an international history. New York: Oxford University
Press; 1995.
Microsoft Corporation. Microsoft Encarta Online Encyclopedia 2009 [cited
2009 July 28]. Available from: http://au.encarta.msn.com.
Weissbluth M, Poncher J, Given G, Schwab J, Mervis R, Rosenberg M. Sleep
duration and television viewing. J Pediatr 1981;99:4868.
Johnson JG, Cohen P, Kasen S, First MB, Brook JS. Association between
television viewing and sleep problems during adolescence and early
adulthood. Arch Pediatr Adolesc Med 2004;158:5628.
Adam EK, Snell EK, Pendry P. Sleep timing and quantity in ecological and
family context: a nationally representative time-diary study. J Fam Psychol
2007;21:419.
Saarenpaa-Heikkila OA, Rintahaka PJ, Laippala PJ, Koivikko MJ. Subjective
daytime sleepiness and related predictors in Finnish schoolchildren. Sleep
Hypnosis 2000;2:13946.
Tynjala J, Kannas L, Valimaa R. How young Europeans sleep. Health Educ Res
1993;8:6980.
Gaina A, Sekine M, Hamanishi S, Chen X, Kanayama H, Yamagami T, et al.
Epidemiological aspects of self-reported sleep onset latency in Japanese junior
high school children. J Sleep Res 2006;15:26675.
Toyran M, Ozmert E, Yurdakok K. Television viewing and its effect on physical
health of schoolage children. Turk J Pediatr 2002;44:194203.
Paavonen EJ, Pennonen M, Roine M, Valkonen S, Lahikainen AR. TV exposure
associated with sleep disturbances in 5- to 6-year-old children. J Sleep Res
2006;15:15461.
Gupta RK, Saini DP, Acharya U, Miglani N. Impact of television on children.
Indian J Pediatr 1994;61:1539.
BaHammam A, Bin Saeed A, Al-Faris E, Shaikh S. Sleep duration and its
correlates in a sample of Saudi elementary school children. Singapore Med J
2006;47:87581.
Thorleifsdottir B, Bjornsson JK, Benediktsdottir B, Gislason T, Kristbjarnarson
H. Sleep and sleep habits from childhood to young adulthood over a 10-year
period. J Psychosom Res 2002;53:52937.
Van den Bulck J. Is television bad for your health? Behavior and body image of
the adolescent couch potato. J Youth Adolescence 2000;29:27388.
Dworak M, Schierl T, Bruns T, Struder HK. Impact of singular excessive
computer game and television exposure on sleep patterns and memory
performance of school-aged children. Pediatrics 2007;120:97885.
Eggermont S, Van den Bulck J. Nodding off or switching off? The use of popular
media as a sleep aid in secondary-school children. J Paediatr Child Health
2006;42:42833.
American Academy of Sleep Medicine. The International Classication of Sleep
Disorders Diagnostic and Coding Manual. 2nd ed. Westchester, IL: American
Academy of Sleep Medicine; 2005.
American Academy of Pediatrics Committee on Communications. Media
violence. Pediatrics 1995;95:94951.
Australian Bureau of Statistics. Household use of information technology,
Australia, 200708. Canberra: Australian Bureau of Statistics; 2008.
Media Awareness Network. Young Canadians in a wired world: phase II
student survey. Ottawa: Media Awareness Network; 2005.
Gaina A, Sekine M, Kanayama H, Sengoku K, Yamagami T, Kagamimori S. Shortlong sleep latency and associated factors in Japanese junior high school
children. Sleep Biol Rhythms 2005;3:1625.
Fuligni AJ, Hardway C. Daily variation in adolescents sleep, activities, and
psychological well-being. J Res Adolesc 2006;16:35378.
Punamaki R-L, Wallenius M, Nygard C-H, Saarni L, Rimpela A. Use of
information and communication technology (ICT) and perceived health in
adolescence: the role of sleeping habits and waking-time tiredness. J Adolesc
2007;30:56985.

[45] Mesquita G, Reimao R. Nightly use of computer by adolescents: its effect on

quality of sleep. Arq Neuropsiquiatr 2007;65:42832.
[46] Yen CF, Ko CH, Yen JY, Cheng CP. The multidimensional correlates associated
with short nocturnal sleep duration and subjective insomnia among
Taiwanese adolescents. Sleep 2008;31:151525.
[47] Ivarsson M, Anderson M, Akerstedt T, Lindblad F. Playing a violent television
game affects heart rate variability. Acta Paediatr 2009;98:16672.
[48] Weaver E, Gradisar M, Dohnt H, Lovato N, Douglas P. The effect of pre-sleep
video game playing on adolescent sleep. J Clin Sleep Med 2010;6:1849.
[49] Harada T, Morikuni M, Yoshii S, Yamashita Y, Takeuchi H. Usage of mobile
phone in the evening or at night makes Japanese students evening-typed and
night sleep uncomfortable. Sleep Hypnosis 2002;4:14953.
[50] Soderqvist F, Carlberg M, Hardell L. Use of wireless telephones and selfreported health symptoms: a population-based study among Swedish
adolescents aged 1519 years. Environ Health [serial online] 2008 [cited
2009 June 22];7. Available from: http://www.ehjournal.net/content/7/1/18.
[51] Van den Bulck J. 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 2007;30:12203.
[52] Tan LP. The effects of background music on quality of sleep in elementary
school children. J Music Ther 2004;41:12850.
[53] Sneddon PL. Sleep problems in young children with and without behavior
problems. Dissertation Abstracts International: Section B: The Sciences and
Engineering 2008;69:1975.
[54] Mitrofan O, Paul M, Spencer N. Is aggression in children with behavioural and
emotional difculties associated with television viewing and video game
playing? A systematic review. Child Care Health Dev 2009;35:515.
[55] Owens JA, Spirito A, McGuinn M, Nobile C. Sleep habits and sleep disturbance
in elementary school-aged children. J Dev Behav Pediatr 2000;21:2736.
[56] Holley S, Hill CM, Stevenson J. A comparison of actigraphy and parental report
of sleep habits in typically developing children aged 6 to 11 years. Behav Sleep
Med 2010;8:1627.
[57] Wolfson AR, Carskadon MA, Acebo C, Seifer R, Fallone G, Labyak SE, et al.
Evidence for the validity of a sleep habits survey for adolescents. Sleep
2003;26:2136.
[58] Owens JA. Sleep in children: cross-cultural perspectives. Sleep Biol Rhythms
2004;2:16573.
[59] Anderson CA, Bushman BJ. Effects of violent video games on aggressive
behaviour, aggressive cognition, aggressive affect, physiological arousal, and
prosocial behaviour: a meta-analytic review of the scientic literature. Psychol
Sci 2001;12:3539.
[60] Fleming MJ, Rickwood DJ. Effects of violent versus non-violent video games on
childrens arousal, aggressive mood, and positive mood. J Appl Soc Psychol
2001;31:204771.
[61] Hebert S, Beland R, Dionne-Fournelle O, Crete M, Lupien SJ. Physiological stress
response to video-game playing: the contribution of built-in music. Life Sci
2005;76:237180.
[62] Wang X, Perry AC. Metabolic and physiologic responses to video game play in
7- to 10-year old boys. Arch Pediatr Adolesc Med 2006;160:4115.
[63] Higuchi S, Motohashi Y, Liu Y, Maeda A. Effects of playing a computer game
using a bright display on presleep physiological variables, sleep latency, slow
wave sleep and REM sleep. J Sleep Res 2005;14:26773.
[64] Hamblin DL, Wood AW. Effects of mobile phone emissions on human brain
activity and sleep variables. Int J Radiat Biol 2002;78:65969.
[65] Loughran SP, Wood AW, Barton JM, Croft RJ, Thompson B, Stough C. The effect
of electromagnetic elds emitted by mobile phones on human sleep.
Neuroreport 2005;16:19736.
[66] Wood AW, Loughran SP, Stough C. Does evening exposure to mobile phone
radiation affect subsequent melatonin production? Int J Radiat Biol
2006;82:6976.