Screen Time and the Sandman

Nemours/Alfred I. duPont Hospital for Children

Dr Jones is a pediatrician at Nemours/Alfred I. duPont Hospital for Children in Wilmington, Delaware. 

Charles A. Pohl, MD––Series Editor:Dr Pohl is professor of pediatrics and senior associate dean of student affairs and career counseling at Jefferson Medical College in Philadelphia, Pennsylvania.

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Does increased screen time before bed delay sleep onset?

The sleep duration of young people has declined over the last 100 years, and numerous problems have been linked to this decline, including poor academic performance, a lack of coordination, and increased aggression, hyperactivity, and obesity.1 This decrease in total sleep has been attributed to later bedtimes rather than earlier wake times. Electronic media use immediately before sleep has been hypothesized to affect sleep patterns through time displacement, depression of melatonin, and cognitive arousal.1 This study aimed to describe the most popular activities in the 90-minute period before sleep onset in preadolescents and adolescents. It also examined the relationship between presleep activity and sleep onset, particularly as it relates to electronic media use.

Foley and colleagues extracted data from a national cross-sectional survey of New Zealand children and young adults aged 5 to 24 years, focusing on 2,017 participants aged 5 to 18 years. Data were collected during a face-to-face home visit using a computer-assisted personal interview, followed by a telephone interview 7 to 14 days later. Each interview collected 2 days of self-reported use-of-time data using the Multimedia Activity Recall for Children and Adolescents (MARCA). The top 20 presleep behaviors were categorized as screen sedentary time (eg, television, computer, video games), nonscreen sedentary time (eg, reading, eating, talking), and self-care (eg, showering, brushing teeth, preparing for bed). The time of sleep onset was classified into 1 of 4 categories: very early, early, late, and very late.

screen time

Screen sedentary time was higher in the group with late sleep onset. The top 20 most popular activities accounted for approximately 80% of time in the 90-minute presleep period. Television watching (screen sedentary time), dressing and undressing (self-care), and brushing teeth (self-care) were the 3 most popular activities. Older participants and male participants engaged in more screen time in the presleep period than did younger participants and female participants. Those with later sleep onset reported up to 13 more minutes of presleep screen-based sedentary activities than did those with an earlier sleep onset.

Among the study’s limitations, as noted by the authors, were the following:

•The study had a 45% nonparticipation rate despite having used a large, nationally represented sample.

•The study’s cross-sectional design prevented direct causality from being demonstrated.

•Although self-report tools such as the MARCA have been shown to be psychometrically sound, they can be associated with error due to memory bias or social desirability bias.

•The study focused on time of sleep onset but not on sleep duration.

•The setting of participants’ presleep activity was unknown; the assumption was that the child was at home.

Addressing screen time before sleep onset may promote earlier sleep onset. The study supports the idea that engaging in screen time immediately before sleep may affect sleep onset in children and adolescents. Presleep screen time as it relates to sleep onset provides a talking point between pediatricians and parents. Recognizing that screen time no is longer limited to television watching will help pediatricians adequately address healthy media use and sleep hygiene, which should be routine discussions during well child visits.


1. Foley LS, Maddison R, Jiang Y, Marsh S, Olds T, Ridley K. Presleep activities and time of sleep onset in children. Pediatrics. 2013;131(2):276-282.