Sleep duration, restfulness, and screens in the sleep environment
Open accessAbstract
BACKGROUND AND OBJECTIVE: Associations of inadequate sleep with numerous health outcomes among youth necessitate identifying its modifiable determinants. Television (TV) has been associated with sleep curtailment, but little is known about small screens (eg, smartphones), which can be used in bed and emit notifications. Therefore, we examined associations of different screens in sleep environments with sleep duration and perceived insufficient rest or sleep. METHODS: Participants included 2048 fourth- and seventh-graders participating in the Massachusetts Childhood Obesity Research Demonstration Study in 2012 to 2013. Using linear and log binomial regression, we examined cross-sectional associations of small screens and TVs in sleep environments and screen time with weekday sleep duration and perceived insufficient rest or sleep in the past week. RESULTS: Children who slept near a small screen (compared with never) reported 20.6 fewer minutes of sleep (95% confidence interval [CI], -29.7 to -11.4) and had a higher prevalence of perceived insufficient rest or sleep (prevalence ratio, 1.39; 95% CI, 1.21 to 1.60). Children who slept in a room with a TV (compared with no TV) reported 18.0 fewer minutes of sleep (95% CI, -27.9 to -8.1). TV or DVD viewing and video or computer game playing were associated with both sleep outcomes (P < .01). Some associations were stronger among Hispanic, non-Hispanic black, and older children (P < .05 for heterogeneity). CONCLUSIONS: Sleeping near a small screen, sleeping with a TV in the room, and more screen time were associated with shorter sleep durations. Presence of a small screen, but not a TV, in the sleep environment and screen time were associated with perceived insufficient rest or sleep. These findings caution against unrestricted screen access in children's bedrooms.
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58% of the participants experienced poor sleep quality.
“The results of this study indicated that 58% of the participants experienced poor sleep quality, which is higher than the 40% reported in a previous study (51).”
From Relationship of screen time with anxiety, depression, and sleep quality among adolescents: a cross-sectional study (2024) · cites this paper as [51]
The citation is attached to the previous study’s purported 40% figure; the 58% figure is the citing authors’ own result. Falbe’s Table 1 reports perceived insufficient rest or sleep in 32.8% of fourth-graders and 22.6% of seventh-graders, but does not report that 40% experienced poor sleep quality. Searches for the 40% figure and poor sleep quality found no supporting passage in our copy. (LLM, conf=0.76)
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“These findings were consistent with existing evidence from previous studies where the exposure to and use of screen media was negatively associated with nighttime sleep duration among school-aged children [37, 42, 68] and adolescents [69, 70].”
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“Based on caregivers’ self-reports, potential sociodemographic confounders for the association between screen time and sleep outcomes were selected based on previous literature and theory.(6,11,29,30) Sex (female, male) and race/ethnicity (categorical variable with the following categories: non-Latino/Hispanic white [1…”
MethodDisruption of Circadian Rhythms by Light During Day and Night
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Media Use and Sleep in Teenagers: What Do We Know?
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“The blue light emitted by screens can interfere with melatonin production and circadian rhythms [18, 19].”
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Electronic device use in bed reduces sleep duration and quality in adults
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Racial Disparities in Obesity Treatment Among Children and Adolescents
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“children can be related to several factors including sleeping with a television in the bedroom [36], sleeping near a small screen and having more screen time [51]”
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Alerting or Somnogenic Light: Pick Your Color
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“circadian disorders, insomnia, daytime sleepiness, mood alteration, and poorer cognitive performance [1,2].”
BackgroundChanges in Sleep Duration and Timing During the Middle-to-High School Transition
Mitchell, J. A., Morales, K. H., Williamson, A. A., Huffnagle, N., Ludwick, A., Grant, S. F. A., Dinges, D. F., & Zemel, B. S. (2020) · Journal of Adolescent Health · doi:10.1016/j.jadohealth.2020.04.024 · Cited by 42 · see citing works
“, screen time in bed) (24, 25) or school level factors (e.”
BackgroundElectronic Screen Use and Sleep Duration and Timing in Adults
Zhong, C., Masters, M., Donzella, S. M., Diver, W. R., & Patel, A. V. (2025) · JAMA Network Open · doi:10.1001/jamanetworkopen.2025.2493 · Cited by 50 · see citing works
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Use of digital screens by adolescents and association on sleep quality: a systematic review
da Silva, S. S., da Silveira, M. A. C., de Almeida, H. C. R., do Nascimento, M. C. P., dos Santos, M. A. M., & Heimer, M. V. (2022) · Cadernos de Saúde Pública · doi:10.1590/0102-311xen300721 · Cited by 38 · see citing works
Screen use, sleep duration, daytime somnolence, and academic failure in school-aged adolescents
Pérez-Chada, D., Arias, S., Schönfeld, D., Gozal, D., Perez‐Lloret, S., & On behalf of the Sleep in Adolescents Collaborative study group (2023) · PLoS ONE · doi:10.1371/journal.pone.0281379 · Cited by 38 · see citing works
Growing Up Digital: Media Research Symposium
Shifrin, D. L., Hill, D., Jana, L. A., & Flinn, S. K. (2015) · Cited by 37 · see citing works
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Bedtime Screen Use Behaviors and Sleep Outcomes in Early Adolescents: A Prospective Cohort Study
Nagata, J. M., Cheng, C. M., Shim, J. E., Kiss, O., Ganson, K. T., Testa, A. M., He, J., & Baker, F. C. (2024) · Journal of Adolescent Health · doi:10.1016/j.jadohealth.2024.06.006 · Cited by 35 · see citing works
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A Preliminary Evaluation of a School-Based Media Education and Reduction Intervention
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Mohd Saat, N. Z., Hanawi, S. A., Hanafiah, H., Ahmad, M., Farah, N. M. F., & Abdul Rahman, N. A. A. (2024) · Frontiers in Public Health · doi:10.3389/fpubh.2024.1459952 · Cited by 34 · see citing works
“The results of this study indicated that 58% of the participants experienced poor sleep quality, which is higher than the 40% reported in a previous study (51).”
Tsang, S. M. H., Cheing, G. L. Y., Lam, A. K. C., Siu, A. M. H., Pang, P. C. K., Yip, K.-C., Chan, J. W. K., & Jensen, M. P. (2023) · Frontiers in Public Health · doi:10.3389/fpubh.2023.1178769 · Cited by 33 · see citing works
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Why won’t she sleep? Screen exposure and sleep patterns in young infants
Ribner, A., & McHarg, G. (2019) · Infant Behavior and Development · doi:10.1016/j.infbeh.2019.101334 · Cited by 32 · see citing works
“(Falbe et al., 2015), which have consistently demonstrated a negative relation between use of electronic screen-based media and sleep.”
BackgroundA systematic review of media parenting in the context of childhood obesity research
Aftosmes‐Tobio, A., Ganter, C., Kronsteiner-Gicevic, S., Newlan, S., Simon, C. L., Davison, K. K., & Manganello, J. A. (2016) · BMC Public Health · doi:10.1186/s12889-016-2981-5 · Cited by 31 · see citing works
Smartphone Usage Patterns and Dietary Risk Factors in Adolescents
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Anderson, Y. C., Wynter, L. E., Treves, K. F., Grant, C. C., STEWART, J. M., Cave, T. L., Wild, C. E. K., Derraik, J. G. B., Cutfield, W. S., & Hofman, P. L. (2016) · Journal of Paediatrics and Child Health · doi:10.1111/jpc.13315 · Cited by 31 · see citing works
Associations between sleep quality and psychological distress in early adolescence
Jamieson, D., Beaudequin, D. A., McLoughlin, L. T., Parker, M. J., Lagopoulos, J., & Hermens, D. F. (2020) · Journal of Child and Adolescent Mental Health · doi:10.2989/17280583.2020.1811288 · Cited by 32 · see citing works
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Screen exposure exacerbates ADHD symptoms indirectly through increased sleep disturbance
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“A study of 4th to 7th graders showed that shorter sleep duration and perceived insufficient rest were associated with increased screen use during bedtime and sleeping with a television in the room.(24)”
BackgroundMental health in Japanese children during school closures due to the COVID‐19
Saito, M., Kikuchi, Y., Lefor, A. K., & Hoshina, M. (2021) · Pediatrics International · doi:10.1111/ped.14718 · Cited by 27 · see citing works
Circle(s) of Life: The Circadian Clock from Birth to Death
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Sleep behaviors in children with different frequencies of parental-reported sleep bruxism
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Childhood sleep: assessments, risk factors, and potential mechanisms
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“Current literature reports that sleeping with a screen device (especially a mobile phone) in the bedroom is negatively associated with sleep duration [119, 149].”
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Preschoolers' engagement with screen content and associations with sleep and cognitive development
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Relationship between Sedentary Time, Physical Activity and Multiple Lifestyle Factors in Children
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Hubbard, J. T., Frisk, M. K., Ruppert, É., Tsai, J. W., Fuchs, F., Robin-Choteau, L., Husse, J., Calvel, L. Y., Gregor Eichele, C., Franken, P., et al. (2021) · Proceedings of the National Academy of Sciences · doi:10.1073/pnas.2017364118 · Cited by 25 · see citing works
“Indeed, the present findings provide an explanation for the physiological and behavioral disturbances induced by the exposure to inappropriate lighting commonly observed in today’s society, currently ascribed solely to a misalignment of the behavior relative to circadian time (1, 2).”
BackgroundScreen time and obesity prevalence in adolescents: an isotemporal substitution analysis
Byun, D., Kim, Y., Jang, H., & Oh, H. (2024) · BMC Public Health · doi:10.1186/s12889-024-20639-x · Cited by 24 · see citing works
Media devices, family relationships and sleep patterns among adolescents in an urban area
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Drifting Off in Paradise: Why People Sleep in Virtual Reality
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“Such improvements may help with addressing related concerns in regards to sleeping near small screens [20].”
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“Une étude (91) a établi l’association entre le fait d’essayer”
Hashem, S. A., Refay, A. S. E., Mostafa, H. H., Kamel, I. H., & Sherif, L. S. (2020) · Open Access Macedonian Journal of Medical Sciences · doi:10.3889/oamjms.2020.5249 · Cited by 21 · see citing works
“Besides, the benefits related to rapid access to information and rapid mass communication, screen exposure cause many health and psychological problems among children and adolescents [28].”
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“11,15,21 Due to their portability, children use tablets and smartphones until sleeping time, often without supervision by parents or people responsible, and this behavior can cause addiction and affect the quantity and quality of sleep.”
Kontostoli, E., Jones, A., Pearson, N., Foley, L. S., Biddle, S., & Atkin, A. J. (2022) · International Journal of Behavioral Medicine · doi:10.1007/s12529-022-10077-7 · Cited by 20 · see citing works
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“15 In addition, video games may lead to mental arousal and thus affect sleep, 43 and the violent content of video games has a particularly pronounced effect on sleep conditions.”
BackgroundSleep Habits of Elementary and Middle School Children in South Texas
Surani, S., Hesselbacher, S. E., Surani, S., Sadasiva, S., Surani, Z., Surani, S. S., Khimani, A., & Subramanian, S. (2015) · Sleep Disorders · doi:10.1155/2015/179103 · Cited by 20 · see citing works
“, smartphones) and televisions in the bedroom have recently been associated with shorter sleep duration in a survey of 4th through 7th graders [22].”
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“48”
Rea, C. J., Smith, R. L., & Taveras, E. M. (2016) · Journal of Clinical Sleep Medicine · doi:10.5664/jcsm.6274 · Cited by 19 · see citing works
“35 However, although both parent screen time and limiting TV time were associated with child sleep duration in univariate analysis, these associations were no longer significant after controlling for demographic characteristics.”
Sleep duration mediates the relationship between health behavior patterns and obesity
Kaar, J. L., Schmiege, S. J., Vadiveloo, M. K., Simon, S. L., & Tovar, A. (2018) · Sleep Health · doi:10.1016/j.sleh.2018.07.004 · Cited by 19 · see citing works
“Further, there may be other factors outside of diet and activity behaviors that impact sleep duration; including family routines and/or chaos.(34,35)”
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“For example, previous papers (Falbe et al., 2015; Gentile et al., 2011) documented that video games use can lead to the development of anxiety, depression, social phobia, and sleep problems.”
BackgroundSleeping patterns and childhood obesity: an epidemiological study in 1,728 children in Greece
Kanellopoulou, A., Notara, V., Magriplis, E., Αntonogeorgos, G., Gil, A. P. R., Κornilaki, E. N., Lagiou, A., Yannakoulia, M., & Panagiotakos, D. B. (2021) · Journal of Clinical Sleep Medicine · doi:10.5664/jcsm.9160 · Cited by 19 · see citing works
“36,37 Although in the present study sleep duration was positively associated with better dietary habits and inversely associated with the presence of a TV and or a PC/tablet in the children ’ s room, no signi fi cant interaction between sleep duration and dietary habits, playing video games, or…”
Waller, N. A., Zhang, N., Cocci, A. H., D'Agostino, C., Wesolek-Greenson, S., Wheelock, K. M., Nichols, L. P., & Resnicow, K. (2021) · Child Care Health and Development · doi:10.1111/cch.12869 · Cited by 18 · see citing works
Correa, V. S., Centofanti, S. A., Dorrian, J., Wicking, A., Wicking, P., & Lushington, K. (2022) · Sleep Health · doi:10.1016/j.sleh.2022.02.004 · Cited by 18 · see citing works
- Authors
- Falbe, J., Davison, K. K., Franckle, R. L., Ganter, C., Gortmaker, S. L., Smith, L., Land, T., & Taveras, E. M.
- Affiliations
- University of California, Berkeley (US)
- Departments of Nutrition and
- Technische Universität Berlin (DE)
- Harvard University (US)
- National Institute for Children’s Health Quality (US)
- Massachusetts Department of Public Health (US)
- Massachusetts General Hospital (US)
- Corresponding author
- Falbe, Jennifer
- ORCID
- Venue
- PEDIATRICS
- Publisher
- American Academy of Pediatrics (AAP)
- Published
- 2015-02-01
- Volume
- 135
- Issue
- 2
- Pages
- e367-e375
- ISSN
- 0031-4005 (ISSN-L)
- 1098-4275
- PMC
- PMC4306800
- OpenAlex
- W2167535168
- Cited by
- 237
- References
- 49
- Citations by year
- 2026: 9 · 2025: 8 · 2024: 18 · 2023: 25 · 2022: 24 · 2021: 33 · 2020: 25 · 2019: 22 · 2018: 26 · 2017: 16 · 2016: 18 · 2015: 12 · 2014: 1
- FWCI
- 35.81
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- PEDIATRICS (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- eScholarship (California Digital Library) (submittedVersion)
- Funders
- American Heart Association (#14POST20140055)
- National Institutes of Health
- Centers for Disease Control and Prevention (U18DP003370)
- National Institute of Diabetes and Digestive and Kidney Diseases (DK007703., T32DK007703)
- National Center for Chronic Disease Prevention and Health Promotion (U18DP003370)
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
- Social Sciences › Education › Child Development and Digital Technology
- Social Sciences › Sociology and Political Science › Impact of Technology on Adolescents
- Keywords
- sleep duration, sleep environment, small displays, smartphones, television viewing, screen time, children, adolescents, Hispanic children, non-Hispanic Black children
- MeSH terms
- Child, Cross-Sectional Studies, Female, Health Surveys, Humans, Male, Massachusetts, Motor Activity, Rest, Risk Factors, Sleep, Sleep Deprivation, Social Environment, Television, Videodisc Recording, Video Games, Cell Phone, Pediatric Obesity
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