More than half of children and teenagers who text, or surf the internet at bedtime are likely not only to have problems falling asleep, but experience mood, behavior and cognitive problems during the day, said US researchers at a conference in Canada this week, who also found that on average, a teenager sends a total of over 3,400 electronic messages at bedtime every month.

The pilot study, by lead author Dr Peter G. Polos and and colleagues, from the JFK Medical Center, in Edison, New Jersey, was presented at the CHEST 2010, the 76th annual meeting of the American College of Chest Physicians (ACCP), which is taking place this week in Vancouver, from 30 October to 4 November.

Polos told the media that one of the most surprising things they discovered was the number of texts and emails each child sent per night, on average they found this to be 33.5.

"It is significant that these children are engaging in stimulating activity when they should be in an environment to promote sleep," he added.

Polos and colleagues analyzed questionnaire responses from 40 children and young people aged between 8 and 22 and found that those who used electronic technology to do things like text, send emails, surf the internet and play online games at bedtime not only experienced sleep-related problems such as excessive movements, leg pain and insomnia, but also had a "high rate of daytime problems, which can include attention deficit hyperactivity disorder [ADHD], anxiety, depression, and learning difficulties", said Polos in a statement.

For the STRICT (sleep time related information and communication technology) study, the researchers analyzed participants' responses to a modified version of the Children's Sleep Habits Questionnaire (CSHQ), completed between September 2009 and May 2010. The participants, whose mean age was 15, were patients attending the JFK Sleep Clinic.

The CSHQ covers 19 items and includes questions about sleep/wake patterns, measures of daytime sleepiness, mood and cognition. There were also questions about type, duration and frequency of information and communication technology (ICT) use, and questions about limits set by parents.

The analysis showed that: 77.5 per cent of the participants had persistent problems falling asleep.
On average, participants were woken once per night by an ICT device.
On average, a participant sent 33.5 emails or texts per night when they were supposed to be asleep; and the average number of people texted each night was 3.7.
The average number of messages sent via ICT per person per month at sleep time was 3,404 and occurred over periods ranging from 10 minutes to 4 hours after bedtime.
Among the adolescent participants, the older they were, the later they went to bed, and the more time they spent with their ICT devices at bedtime.
Boys were more likely to use ICT to surf the net and play online games, while girls were more likely to text and make cell phone calls.
High rates of cognitive and mood problems during the day were linked with sleep time related use of ICT, including ADHD, anxiety, depression, and learning difficulties.
There were also higher rates of nighttime problems such as excessive movements, leg pain and insomnia. Polos and colleagues concluded that use of ICT at bedtime may have "an adverse impact on sleep hygiene and daytime function which may be significant", and that questions about this should be included in routine evaluations of patients reporting problems sleeping.

"These data suggest that further studies are needed to evaluate the short and long term consequences of STRICT on sleep," they wrote.

Polos explained that "sleep is largely habitual in nature", and if "children begin this type of behavior, they may set themselves up for the need for external stimulation before sleep later in life".

This could lead to problems like difficulty falling asleep, not having enough sleep, and feeling sleepy during the day, he said adding that:

"More research is needed to determine all of the short- and long-term consequences."

Many parents know that healthy sleep habits are especially important to ensure progress at school and healthy development, and are concerned about how best to handle the growing problem of ICT devices in the bedroom.

Polos said that using cell phones or computers, to talk, text, surf the net, or play games, is "more addictive, seductive, and interactive than passively watching television," because of the graphics, rapid responses and interactivity.

"The sooner parents establish appropriate times for children to use this technology, the better," he urged, adding that perhaps they should also "move key items, such as computers, from a child's bedroom into a common area".

Dr David Gutterman, President of the American College of Chest Physicians said concern about insomnia and other sleep disorders in children is growing and that "research shows that the problem is increasing, so it is more important than ever for physicians to ask questions about technology use when evaluating children for sleep issues".

"The Effect of Sleep Time Related Information and Communication Technology (STRICT) on Sleep Patterns and Daytime Functioning in Children and Young Adults: A Pilot Study."
Peter G. Polos, Sushanth Bhat, Irving Smith, Besher Kabak, Eli Neiman, Joan Sillari, Sudhansu Chokroverty, and Michael Seyffert.
Presented at CHEST 2010, the 76th annual meeting of the American College of Chest Physicians (ACCP), in Vancouver, Canada, 1 November 2010.

Additional source: American College of CHEST Physicians.

: Catharine Paddock, PhD