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The impact of bedtime technology use on sleep quality and excessive daytime
sleepiness in adults

Article in Sleep Science · December 2023


DOI: 10.5935/1984-0063.20200128

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1 Technology use and EDS
ORIGINAL ARTICLE

The impact of bedtime technology use on sleep quality and excessive


daytime sleepiness in adults

Saad Mohammed AlShareef MD, MHPE1 ABSTRACT


Objectives: There have only been a few studies on electronic device use and sleep in adult populations,
1
Imam Mohammad Ibn Saud Islamic so we sought to investigate the impact of bedtime technology use on sleep quality and excessive
University (IMSIU), Department of daytime sleepiness (EDS) through a population-wide survey of Saudi Arabian adults. Material and
Medicine, College of Medicine, Riyadh Methods: This cross-sectional survey of 10,106 Saudi Arabian adults gathered data on the number
13317–4233, Saudi Arabia. and frequency of electronic device use (smartphones, tablets, computers, televisions, radios, and music
players) at bedtime, sleep quality, and EDS as measured by the Epworth sleepiness scale. Associations
between electronic device number and frequency of use and sleep-related outcomes were evaluated
using binary logistic regression. Results: Twenty-eight percent and 9.7% of respondents reported
“fairly” or “very bad” sleep quality in the preceding month, respectively. 95.1% of respondents had
smartphones in their bedrooms, which were used regularly (a few nights a week, every or almost every
night) by 80.7% of respondents. The number of devices in the bedroom had little effect on sleep
quality parameters and EDS, but regular use of almost all devices was associated with “bad” or “very
bad” sleep quality (odds ratios (ORs) 1.32-2.12); smartphone or tablet use was associated with sleep
latency >30 minutes (smartphones OR 1.98, 95% CI: 1.51-2.60; p<0.0001; tablets OR 1.44, 95% CI:
1.05-1.99; p<0.05). Electronic device use was associated with a 1.3-1.9-fold risk of moderate to severe
EDS. Discussion: This large study strengthens the limited evidence in adults that electronic device
use during bedtime usually reserved for sleep impacts sleep quality. Sleep hygiene advice must be
updated to include limiting electronic device use in the bedroom.
Keywords: Epworth Sleepiness Scale; Electronic Device; Excessive Daytime Sleepiness; Sleep
Hygiene; Smartphone.

*Corresponding author:
Saad Mohammed AlShareef MD, MHPE
E-mail: drsaad321@hotmail.com

Received: November 27, 2020;


Accepted: March 19, 2021.

DOI: 10.5935/1984-0063.20200128

Sleep Sci. 2021; Ahead of Print


Technology use and EDS 2
INTRODUCTION We therefore sought to investigate the impact of bedtime
Sleep is essential to human health, wellbeing, and daily technology use on sleep quality and EDS by conducting a
functioning, impacting not only the individual’s mental and population-wide survey of adults in Saudi Arabia. Specifically, we
physical health1 but also society. For instance, excessive daytime investigated: (i) the number and frequency of use of electronic
sleepiness (EDS) is associated with high body mass index (BMI), devices (smartphones, tablets, computers, televisions, radios,
diabetes mellitus, depression, and reduced quality of life2,3, up to and music players) in the population; (ii) the prevalence of sleep
a third of fatal motor vehicle accidents are thought to involve quality and EDS disturbances; and (iii) the relationships between
sleepy drivers4, and sleepiness at work is known to represent electronic device use and sleep quality and EDS disturbances.
a significant economic burden to the individual, healthcare
MATERIAL AND METHODS
systems, and employers5. Sleep and sleepiness therefore have
widespread impacts on all aspects of public health and the
Participants and methods
economy, mandating measures to mitigate the consequences
of sleep-related dysfunction. To achieve this, understanding the
Population and study survey
factors impacting sleep quality at the population level is essential.
Technological advances, increased standards of living, This cross-sectional study was conducted online between
demand for 24/7 professional and personal availability and November 6, 2019 and December 6, 2019, as previously
most recently changing social interactions to web-based reported18,19. Briefly, participants aged 18 years and older were
communication due to the COVID-19 pandemic have randomly selected from the Saudi Telecom Company (STC)
transformed the home environment. This is particularly true in database, which covers all 13 Saudi provinces, and invited to
the bedroom, which has in many homes become media-rich, participate by e-mail and telephone. Participants were informed
containing multiple electronic devices including smartphones, of the research purpose and the investigator details. Each
televisions, tablet devices, and computers. In particular, the participant provided electronic consent. The internal review
advent of the smartphone – through its ubiquity, portability, board (IRB) of Imam Mohammad Ibn Saud Islamic University
and connectivity – has made it convenient to use at least one (IMSIU) approved the study protocol.
form of electronic device in bed. The constantly evolving and
changing nature of technology means that there is an ongoing Study questionnaire
need to study the impact of electronic devices on sleep behavior The study survey was a wide-ranging questionnaire
to inform policy on sleep hygiene fit for the technological era. designed to establish how sleep quality and EDS impact
There is now abundant evidence that the use of electronic social functioning and a range of outcomes not limited to
devices at night can adversely impact sleep behavior, resulting the impact of technology use but also other outcomes such
in sleep loss, irregular sleep-wake patterns, poorer sleep quality, as occupational outcomes and motor vehicle accidents, as
and EDS, particularly in children and adolescents6-12. Several described elsewhere18,19. In addition to including questions
mechanisms have been proposed as to how electronic devices on specific social outcomes devised according to literature
affect sleep quality: (i) exposure to the bright light emitted by review, the questionnaire assessed sleep parameters using
electronic devices, particularly short wavelength (blue) light, can validated instruments such as the Epworth sleepiness scale.
suppress melatonin secretion to delay sleep onset and disrupt Briefly, the questionnaire (see Supplementary Information for
sleep13; (ii) indirectly, by displacing sleep (i.e., taking up time those parts of the questionnaire relevant to the current study)
that would otherwise be spent sleeping)14; and (iii) increased was administered in Arabic and assessed: (i) demographics
arousal (mental, physical, and/or physiological) through the (gender, age, height, weight, and marital status); (ii) sleep
nature of the content, which can often be graphic, violent, quality (subjective assessment of sleep quality measured as very
emotional, or sexual15. However, the majority of current studies good, fairly good, fairly bad, very bad; sleep latency measured
on technology use and its impact on sleep have been conducted as 0-5min, 5-15min, 15-30min, or >30min; sleep duration (in
in children and adolescents, and it is unclear whether the impact hours), and sleep efficiency (proportion of time spent asleep
of technology use on sleep is the same between this population whilst in bed, expressed as a percentage); (iii) the Epworth
and the adult population. Indeed, rather than being a predictor sleepiness scale (ESS; validated Arabic version)20, subcategorized
or sleep disturbance, technology use might be a consequence as per Johns (1991)21 into 0-10 normal daytime sleepiness, 11-
of poor sleep in adults16. Very few studies on technology use 12 mild excessive daytime sleepiness, 13-15 moderate excessive
and sleep disturbance have been conducted at the population daytime sleepiness, 16-24 severe excessive daytime sleepiness;
level in adults, with those that have being of limited sample size. (iv) the presence or absence of electronic devices (smartphones,
Similarly, most studies on this topic have examined individual tablet computers, music players, computers/laptops, televisions,
devices such as smartphones but not the full range of electronic and radios) in the bedroom; and (v) the frequency of use of
devices that might be found in bedrooms such as televisions, these devices (never, rarely, a few nights a month, a few nights
computers, and tablet computers, while others have only a week, every or almost every night) when they should have
examined specific technology-related behaviors such as social otherwise been sleeping.
media use17.

Sleep Sci. 2021; Ahead of Print


3 Technology use and EDS

Outcome measures Table 1. Demographics of the survey respondents (total n=10,106).


Variable Number Mean (SD) Proportion, %
Five outcomes were investigated and assessed: (i) hours
Age (years) 8,617 30.7 (11.3)
of sleep; (ii) sleep efficiency (sleep efficiency=total sleep time/
Gender Male 4,089 47.3
time in bed, expressed as a %); (iii) sleep quality (very good,
Female 4,560 52.7
fairly good, fairly bad, or very bad); (iv) sleep latency (0-5min,
5-15min, 15-30min, or >30min); and (v) EDS (normal, mild, BMI (kg/m ) 2
8,602 26.7 (7.7)
moderate, and severe). Marital status Married 3,699 42.9
Divorced 254 2.9
Statistical analysis Single 4,616 53.6
Participant demographics were analyzed using descriptive Widowed 48 0.6
statistics with means (±standard deviation (SD)) for continuous Sleeping
Never 7,550 74.7
medications
variables and counts (with percentages) for categorical
variables. For logistic regression, the number of devices in Several 941 9.3
days
the bedroom was binarized into ≤1 or ≥2, and frequency of
More 208 2.1
electronic device use was binarized into “infrequent” (never, than half
rarely, or a few nights a month) and “frequent” (a few nights of days
a week, every or almost every night). Binary logistic regression Nearly 160 1.6
models were built for each outcome variable controlling for every day
age, gender, BMI, marital status, and sleeping medication use.
There were no strong intercorrelations between variables, as Table 2. Prevalence of sleep-related parameters in the survey respondents
assessed by pairwise correlations all being ≤0.722. Odds ratios (total n=10,106)
Mean Proportion,
were calculated with 95% confidence intervals (CIs). A p-value Variable Number
(SD) %
of <0.05 was considered statistically significant. All analyses
Subjective sleep
were performed using IMS SPSS Statistics v. 24 (IBM Statistics, quality1
Very good 1,592 15.8
Chicago, IL, U.S.). Fairly
4,674 46.2
good
RESULTS Fairly bad 2,861 28.3
Very bad 979 9.7
Overall sample
0-5
Sleep latency1 716 7.1
A total of 10,106 individuals completed all or part of minutes
the survey. The demographics of the survey respondents are 5-15
2,751 27.2
presented in Table 1. The average age of respondents was 30.7 minutes

(SD±11.3) years, with an average BMI of 26.7 (SD±7.7) kg/ 15-30


2,979 29.5
minutes
m2. Most respondents were single (53.6%) or married (42.9%).
>30
Thirteen percent of respondents had taken some form of minutes
3,660 36.2
medication to aid sleep in the preceding month, the majority of
Sleep duration (h) 10,106 6.64 (2.1)
whom (9.3%) had taken medication only infrequently.
Sleep efficiency (%) 9,9612 86.6 (31.7)
Prevalence of sleep quality parameters and daytime sleepiness Epworth sleepiness
Normal 3,724 36.8
scale3
Overall, the prevalence of poor sleep quality was high Mild 4,871 48.2
in the study population, with 38% of respondents reporting Moderate 959 9.5
“fairly bad” or “very bad” sleep quality in the preceding month. Severe 552 5.5
The average sleep duration was 6.64 hours (SD±2.1) and
Notes: Reported by respondents; n=9,961 could be calculated; 3 0-10
1 2
average sleep efficiency was 86.6% (SD±31.7%). The majority normal, 11-12 mild, 13-15 moderate, 16-24 severe excessive daytime
(58.8%) of respondents reported at least mild EDS, with 15.0% sleepiness.
reporting moderate or severe EDS (Table 2).
respondents reported regularly using their smartphones when they
Prevalence of bedtime technology use should have been sleeping (80.7%), while fewer respondents used
Only 416 (4.1%) of respondents did not have any form of tablet computers (10.3%) or other devices (all <10%).
technology in their bedroom (Table 3). 95.1% of respondents had a
Associations between demographic and sleep
smartphone in their bedroom, while 21.4%, 32.9%, 17.9%, 2.6%, and
parameters and bedtime technology use
7.5% had a tablet, computer, television, radio, or music player in their
bedrooms, respectively. The proportion of individuals with ≤1 or ≥2 Multivariable logistic regression models were constructed
devices in their bedrooms was similar at ~50%. The vast majority of to examine associations between the number of electronic

Sleep Sci. 2021; Ahead of Print


Technology use and EDS 4
Table 3. Bedtime technology use by the survey respondents (total
n=10,106). Frequency of electronic device use was binarized into
“infrequent” (never, rarely, or a few nights a month) and “frequent” (a few
nights a week, every or almost every night).
Variable Number Percentage
Technology in bedroom
Smartphone 9,606 95.1
(n=10,106)
Tablet 2,162 21.4
Computer 3,329 32.9
TV 1,811 17.9
Radio 258 2.6
Music player 758 7.5
Number of devices
≤1 4,994 49.4
(n=10,106) Figure 1. Binary logistic regression examining the association between the number
≥2 5,112 50.6 of devices in the bedroom (≤1 or ≥2) and sleep parameters: number of hours slept,
sleep efficiency, sleep quality (SQ; V=very, F=fairly), sleep latency (SL), and excessive
Frequency of daytime sleepiness (ESS). Points represent odds ratios (OR), error bars represent 95%
smartphone use Infrequent 1,905 19.3 confidence intervals (CI).
(n=9890)
Frequent 7,985 80.7 or computer use (OR 2.12, 95% CI: 1.51-2.99; p<0.0001) in
Frequency of tablet use
Infrequent 8,789 89.7
the bedroom when the respondent would normally have been
(n=9795) sleeping. Only smartphone or tablet use were associated with
Frequent 1,006 10.3 increased sleep latency, with regular smartphone use conferring
Frequency of computer
Infrequent 8,899 90.7 a two-fold risk of taking >30 minutes to fall asleep (OR 1.98,
use (n=9816)
95% CI: 1.51-2.60) and regular tablet use conferring an ~1.5-
Frequent 917 9.3 fold risk of taking >30 minutes to fall asleep (OR 1.44, 95% CI:
Frequency of TV use 1.05-1.99). The effects of regular electronic device use on EDS
Infrequent 9,025 92.0
(n=9805)
were modest, with smartphone, tablet, computer, and television
Frequent 780 8.0
use all associated with a 1.3-1.7-fold risk of moderate to severe
Frequency of radio use
Infrequent 9,655 98.6 EDS and regular use of a music player conferring a slightly
(n=9790)
higher risk (OR 1.89, 95% CI: 1.34-2.66; p<0.0001).
Frequent 135 1.4
Frequency of music DISCUSSION
Infrequent 9,288 94.9
player use (n=9789)
Frequent 501 5.1
Here we present new data on the prevalence of
electronic device use at bedtime, sleep quality, and EDS in a large
devices in the bedroom and the frequency of their use and representative sample of the adult Saudi Arabian population
sleep-related parameters. Associations between the number of and their inter-relationships. Similar to other populations and
electronic devices in the bedroom and the frequency of their ethnicities, the results indicate a high burden of sleep dysfunction
use and demographic parameters are shown in Supplementary in Saudi Arabia: 38.0% of respondents self-reported fairly or
Table 1. Of interest, regular device users (those using devices very bad sleep quality and 15.0% moderate or severe EDS,
a few nights a week, every or almost every night) or users with which has previously been reported to affect between 3 and
multiple devices in the bedroom were, in general, more likely to 38% of the population depending on the definition of EDS
be male and divorced or single rather than female and married. and the methodology used23. The average sleep duration of the
When controlling for these demographic variables (age, sample was 6.6 hours, less than reported in the Australian 2016
gender, BMI, marital status, and sleeping medication use), the Sleep Health Foundation National Survey (seven hours24) and
number of devices in the bedroom had little effect on sleep under the 7-9 hours recommended for adults by the National
quality parameters and EDS, with a small but significant effect Sleep Foundation25.
on the number of hours slept (OR 1.04, 95% CI: 1.00-1.08; The landscape of technology use has evolved rapidly
p=0.045; Figure 1) and perceived sleep quality (OR 1.32, 95% over the last few years, and contemporary data on the prevalence
CI: 1.13-1.54; p=0.001 for “fairly bad” sleep quality; Figure 1). of technology in the adult bedroom are scare. This study found
However, regular bedtime use (a few nights a week, that electronic devices in the bedroom were almost ubiquitous,
every or almost every night) of individual electronic devices had with ~95% of the sample reporting at least one electronic
greater effects on sleep-related parameters (Figure 2). Regular device in their bedroom, usually a smartphone, which was used
use of almost all devices was associated with reduced, and regularly by four fifths of respondents during the time that they
generally “bad” or “very bad,” sleep quality (ORs 1.32-2.12); the should have been sleeping. Of course, smartphone ownership
risk of very bad sleep quality was particularly pronounced with is now extremely common; in advanced economies such as
regular smartphone (OR 1.98, 95% CI: 1.52-2.60; p<0.0001) Saudi Arabia, >90% of people own smartphones26, and in a

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5 Technology use and EDS

Figure 2. Binary logistic regression examining the association between frequent and infrequent device use in the bedroom and sleep parameters: number of hours slept, sleep efficiency, sleep
quality (SQ; V=very, F=fairly), sleep latency (SL), and excessive daytime sleepiness (ESS). Points represent odds ratios (OR), error bars represent 95% confidence intervals (CI).

2016 study of 844 Flemish adults, half of respondents owned a using electronic devices in bed after lights out. In a recent study,
smartphone9. Specifically with respect to smartphone use in the 90% of highly selected adults working in a healthcare institution
bedroom, even in 2011, the National Sleep Foundation’s 2011 in Saudi Arabia reported using their smartphones at bedtime6,
Sleep in America poll reported that 95% of respondents used consistent with the current results. These data provide new
electronic devices at least a few nights a week within the hour insights into the very high prevalence of electronic device use
before bed, although televisions were the most popular device in the bedroom in adults in a developed country, a result likely
at that time10. Bhat et al. (2018)7 reported that 70% of a sample to be mirrored in similarly developed countries where nearly the
of 855 hospital employees used social media while in bed, entire adult population owns a smartphone.
while very recently Lastella et al. (2020)11 conducted telephone There have only been a few studies of bedtime
interviews in 1,225 adults and established that 42% reported technology use and sleep quality in adult populations6,7,9,11,12,

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Technology use and EDS 6
with the largest study representing 1,225 participants11; the with the current results, bedtime electronic device use may well
current study is therefore the largest to examine this topic. contribute to daytime sleepiness, but whether this is a result of
The current data showed that the number of devices in the sleep displacement rather than the effects of blue light exposure
bedroom had little association with sleep quality parameters. or stimulating content still requires further clarification.
However, regular use of almost all devices was associated with Given that the data on nighttime technology use and sleep
reduced subjective sleep quality. The data showing that there in adults are relatively scarce, it is worth examining the current
was a particularly pronounced risk of very bad sleep quality with data with more extensive literature in children and adolescents.
regular smartphone or computer use are consistent with a very Our data are consistent with studies examining screen-based
recent study, showing that duration of electronic device used electronic device use in children and adolescents, with a meta-
was associated with poorer sleep quality in a general population analysis of the literature (n=20 studies) showing that bedtime
of adults as determined using the same scale (very good, fairly media device use is associated with inadequate sleep quantity
good, fairly bad, or very bad)11. Furthermore, in their study (OR 2.17, 95% CI: 1.42-3.32; p<0.001), poor sleep quality
of adult healthcare workers in Saudi Arabia, Alshobaili et al. (OR 1.46, 95% CI: 1.14-1.88; p=0.003), and excessive daytime
(2019)6 established a dose-dependent relationship between the sleepiness (OR, 2.72, 95% CI: 1.32-5.61; p=0.007)8. Although it
time spent using a smartphone at bedtime and risk of poor sleep has been suggested that the relationships between technology
quality as measured using the Pittsburgh sleep quality index and sleep disturbances in adults and children differ9, our data
(PSQI), with odds ratios ranging from 2.2 for 15-30 minutes of suggest that bedtime electronic device use probably similarly
use to 7.5 for >60 minutes of use. impacts adults, at least in terms of sleep quality and EDS.
In the current study, smartphone and tablet use but no This study has a number of limitations. This was a
other device use conferred a 1-5-2-fold risk of longer sleep self-reporting survey, with its inherent limitation of recall
latency (>30 minutes), an association not detected in other recent bias, and many people tend to overestimate sleep latency and
studies of electronic device use and sleep6,7,9,11,12. However, the underestimate total time asleep29. Like all cross-sectional surveys,
National Sleep Foundation’s 2011 Sleep in America poll similarly no conclusions about causality can be drawn. The available
found that use of “active” electronic devices such as computers survey sample was from those enrolled in the STC database,
and mobile phones in the hour before bed impacted sleep latency, and this may have introduced selection bias, particularly since
while “passive” devices such as televisions and music players did these individuals already use communication technologies.
not10. Smartphones and tablets are important sources of short There may also have been responder bias, since prospective
wavelength blue light that has been shown to suppress melatonin participants were told about the purpose of the research.
after only two hours of exposure and lead to sleep dysfunction, Nevertheless, the young median age of the sample (28 years
and recognizing this many have recently been equipped with vs. 29.9 years) and high obesity prevalence (31.2% vs. 35.4%)
“nighttime modes” to reduce blue light emission13,27. Indeed, are highly consistent with key sociodemographic statistics
in an interventional study, wearers of a blue light shield worn for Saudi Arabia30, increasing confidence that the survey is
two hours before sleep had significantly reduced sleep latency representative of the wider population. Other confounders
compared to controls28. Smartphone and tablet users, who are that might affect sleepiness such as caffeine intake, shift-work,
likely to hold these portable devices close to their eyes and and comorbidities were not included in the analysis and might
receive high levels of blue light, may be particularly adversely reduce or abrogate these effects in progressively adjusted
affected by this phenomenon. Furthermore, the content viewed outcome models31,32. Approximately 10% of the demographic
on smartphones and tablets is likely to be more stimulating data were missing or incomplete; however, there was very little
than that received aurally (such as music and radio). Overall, missing sleep parameter or technology use data, providing
these types of active device are likely to expose individuals to all confidence in the results. Although the study is strengthened by
three modes of sleep disruption, namely light exposure, sleep having looked at individual device usage, we did not establish
displacement, and increased arousal. Rather than solely using the temporal relationship between device use and bedtime
nighttime modes to reduce the chances of sleep disruption, routines or the duration of their use, which would have been
optimal sleep hygiene might be to not to use these devices at all useful for examining dose effects. Although the study was
before sleeping. conducted in a single country and therefore the results will
This study detected only modest effects of bedtime be subject to cultural and geographical biases, Saudi Arabia is
technology use on EDS. Bhat et al. (2018)7 similarly used nevertheless an economically developed country with similar
the Epworth sleepiness scale to assess EDS but found no adoption of technology to other high-income countries, so
association between high electronic social media use after lights the results are likely to be generalizable, at least in terms of the
out and daytime sleepiness7, although this might be explained broad conclusion that technology use at bedtime impacts sleep
by the study specifically examining social media use rather than quality and sleepiness.
electronic device use in general. Although they used a different This is the largest study to examine the relationships
instrument to assess daytime sleepiness, Saling et al. (2016)12 between bedtime technology use, EDS, and sleep quality in
similarly found that using a phone after lights out made a small adults at the population-wide scale. Despite the limitations of
but significant contribution to daytime sleepiness. Taken together self-reporting surveys and the potential for selection bias, this

Sleep Sci. 2021; Ahead of Print


7 Technology use and EDS

study provides insights into not only the prevalence of sleep 12. Saling LL, Haire M. Are you awake? Mobile phone use after lights out.
Comput Hum Behav. 2016 Nov;64:932-7.
problems but also bedtime technology use and their relationships. 13. Heo JY, Kim K, Fava M, Mischoulon D, Papakostas GI, Kim MJ, et al.
Like in other countries, there is a high burden of sleep-related Effects of smartphone use with and without blue light at night in healthy
dysfunction in Saudi Arabia, which given its impact on health, adults: a randomized, double-blind, cross-over, placebo-controlled
comparison. J Psychiatr Res. 2017 Apr;87:61-70. DOI: https://doi.
waking function, and short- and long-term wellbeing, constitutes org/10.1016/j.jpsychires.2016.12.010
a public health priority. Our data strengthen the currently 14. Gregory AM, Sadeh A. Annual research review: sleep problems in
childhood psychiatric disorders--a review of the latest science. J
limited evidence that electronic device use impacts sleep quality. Child Psychol Psychiatry. 2016 Mar;57(3):296-317. DOI: https://doi.
Given that sleep hygiene advice issued by healthcare providers org/10.1111/jcpp.12469
does not consistently include information on electronic device 15. Cain N, Gradisar M. Electronic media use and sleep in school-aged
children and adolescents: a review. Sleep Med. 2010 Sep;11(8):735-42.
use, there is a need to update all sleep hygiene advice to include DOI: https://doi.org/10.1016/j.sleep.2010.02.006
limiting electronic device use in the bedroom and, if their use 16. Tavernier R, Willoughby T. Sleep problems: predictor or outcome
of media use among emerging adults at university?. J Sleep Res. 2014
is absolutely necessary, to apply nighttime modes to reduce blue Feb;23(4):389-96. DOI: https://doi.org/10.1111/jsr.12132
light emission. 17. Alshareef S. The impact of social media volume and addiction on medical
student sleep quality and academic performance: a cross‑sectional
observational study. Imam J Appl Sci. 2017 Jul/Dec;1(2):81-94.
ETHICAL APPROVAL 18. AlShareef SM. Occupational outcomes associated with sleep quality and
This project was reviewed by the internal review board excessive daytime sleepiness: results from a national survey. Nat Sci Sleep.
2020 Oct;2020:875-82. DOI: https://doi.org/10.2147/NSS.S271154
(IRB) of Imam Mohammad Ibn Saud Islamic University 19. AlShareef SM. Excessive daytime sleepiness and associations with
(IMSIU). sleep-related motor vehicle accidents: results from a nationwide survey.
Sleep Breath. 2020 Nov 26; [Epub ahead of print]. DOI: https://doi.
org/10.1007/s11325-020-02260-5
CONFLICTS OF INTEREST 20. Ahmed AE, Fatani A, Al-Harbi A, Al-Shimemeri A, Ali YZ, Baharoon S,
None. et al. Validation of the Arabic version of the Epworth sleepiness scale.
J Epidemiol Glob Health. 2014 Dec;4(4):297-302. DOI: https://doi.
org/10.1016/j.jegh.2014.04.004
SOURCES OF FUNDING 21. Johns MW. A new method for measuring daytime sleepiness: the
Epworth sleepiness scale. Sleep. 1991 Nov;14(6):540-5. DOI: https://
None. doi.org/10.1093/sleep/14.6.540
22. Dormann CF, Elith J, Bacher S, Buchmann C, Carl G, Carré G, et al.
REFERENCES Collinearity: a review of methods to deal with it and a simulation study
evaluating their performance. Ecography. 2013 Jan;36(1):27-46.
1. Chanchlani N. Health consequences of shift work and insufficient sleep.
23. Kolla BP, He JP, Mansukhani MP, Frye MA, Merikangas K. Excessive
BMJ. 2017 Feb;356:i6599. DOI: https://doi.org/10.1136/sbmj.i6599
sleepiness and associated symptoms in the U.S. adult population:
2. Fernandez-Mendoza J, Vgontzas AN, Kritikou I, Calhoun SL, Liao
prevalence, correlates, and comorbidity. Sleep Health. 2020 Feb;6(1):79-
D, Bixler EO. Natural history of excessive daytime sleepiness: role
87. DOI: https://doi.org/10.1016/j.sleh.2019.09.004
of obesity, weight loss, depression, and sleep propensity. Sleep. 2015
24. Adams RJ, Appleton SL, Taylor AW, Gill TK, Lang C, McEvoy RD, et
Mar;38(3):351-60. DOI: https://doi.org/10.5665/sleep.4488
al. Sleep health of Australian adults in 2016: results of the 2016 Sleep
3. Hasler G, Buysse DJ, Gamma A, Ajdacic V, Eich D, Rössler W, et al.
Health Foundation national survey. Sleep Health. 2017 Feb;3(1):35-42.
Excessive daytime sleepiness in young adults: a 20-year prospective
DOI: https://doi.org/10.1016/j.sleh.2016.11.005
community study. J Clin Psychiatry. 2005 Apr;66(4):521-9. DOI: https://
25. Khubchandani J, Price JH. Short sleep duration in working American
doi.org/10.4088/jcp.v66n0416
adults, 2010-2018. J Community Health. 2020;45(2):219-27. DOI:
4. Centers for Disease Control and Prevention (CDC). Drowsy driving - 19
https://doi.org/10.1007/s10900-019-00731-9
states and the District of Columbia, 2009-2010. MMWR Morb Mortal
26. Taylor K, Silver L. Smartphone ownership is growing rapidly around the
Wkly Rep. 2013 Jan;61(51-52):1033-7.
world, but not always equally. Washington, DC: Pew Research Center;
5. Metlaine A, Leger D, Choudat D. Socioeconomic impact of insomnia
2019.
in working populations. Ind Health. 2005;43(1):11-9. DOI: https://doi.
27. Wood B, Rea MS, Plitnick B, Figueiro MG. Light level and duration of
org/10.2486/indhealth.43.11
exposure determine the impact of self-luminous tablets on melatonin
6. Alshobaili FA, AlYousefi NA. The effect of smartphone usage at
suppression. Appl Ergon. 2013 Mar;44(2):237-40. DOI: https://doi.
bedtime on sleep quality among Saudi non-medical staff at King Saud
org/10.1016/j.apergo.2012.07.008
University Medical City. J Family Med Prim Care. 2019 Jun;8(6):1953-7.
28. Ayaki M, Hattori A, Maruyama Y, Nakano M, Yoshimura M, Kitazawa M,
DOI: https://doi.org/10.4103/jfmpc.jfmpc_269_19
et al. Protective effect of blue-light shield eyewear for adults against light
7. Bhat S, Pinto-Zipp G, Upadhyay H, Polos PG. “To sleep, perchance to
pollution from self-luminous devices used at night. Chronobiol Int. 2016
tweet”: in-bed electronic social media use and its associations with insomnia,
Jan;33(1):134-9. DOI: https://doi.org/10.3109/07420528.2015.1119158
daytime sleepiness, mood, and sleep duration in adults. Sleep Health. 2018
29. Harvey AG, Tang NKY. (Mis)perception of sleep in insomnia: a puzzle
Apr;4(2):166-73. DOI: https://doi.org/10.1016/j.sleh.2017.12.004
and a resolution. Psychol Bull. 2012;138(1):77-101. DOI: https://doi.
8. Carter B, Rees P, Hale L, Bhattacharjee D, Paradkar MS. Association
org/10.1037/a0025730
between portable screen-based media device access or use and
30. Mundi I. Saudi Arabia demographics profile 2018. Index Mundi
sleep outcomes: a systematic review and meta-analysis. JAMA
[Internet]. 2019; [access in ANO Mês dia]. Available from: http://www.
Pediatr. 2016 Dec;170(12):1202-8. DOI: https://doi.org/10.1001/
indexmundi.com/saudi_arabia
jamapediatrics.2016.2341
31. Kuppermann M, Lubeck DP, Mazonson PD, Patrick DL, Stewart AL,
9. Exelmans L, Van Den Bulck J. Bedtime mobile phone use and sleep
Buesching DP, et al. Sleep problems and their correlates in a working
in adults. Soc Sci Med. 2016 Jan;148:93-101. DOI: https://doi.
population. J Gen Intern Med. 1995 Jan;10(1):25-32. DOI: https://doi.
org/10.1016/j.socscimed.2015.11.037
org/10.1007/BF02599573
10. Gradisar M, Wolfson AR, Harvey AG, Hale L, Rosenberg R, Czeisler CA.
32. Philip P, Leger D, Taillard J, Quera-Salva MA, Niedhammer I, Mosqueda
The sleep and technology use of Americans: findings from the National
JG, et al. Insomniac complaints interfere with quality of life but not
Sleep Foundation’s 2011 Sleep in America poll. J Clin Sleep Med. 2013
with absenteeism: respective role of depressive and organic comorbidity.
Dec;9(12):1291-9. DOI: https://doi.org/10.5664/jcsm.3272
Sleep Med. 2006 Oct;7(7):585-91. DOI: https://doi.org/10.1016/j.
11. Lastella M, Rigney G, Browne M, Sargent C. Electronic device use in bed
sleep.2006.04.006
reduces sleep duration and quality in adults. Sleep Biol Rhythms. 2020
Jan;18:121-9.

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Technology use and EDS 8
Supplementary Information. The questionnaire used in this study.

SECTION 1: Thinking about your sleep over the last month…


1. How long does it take you to fall asleep?

0-5min, 5-15min, 15-30min, or more than 30min.

2. How many hours of sleep do you normally get (excluding naps)?

3. On a typical ‘working’ day, what time would do you go to bed?

4. On a typical ‘working’ day, what time would do you go to sleep?

5. During the past month, how would you rate your sleep quality overall?

Very good, fairly good, fairly bad, or very bad.

SECTION 2: About your sleepiness during the day…

6. How likely are you to doze off or fall asleep sitting and reading?

Would never doze/slight chance of dozing/moderate chance of dozing/high chance of dozing.

7. How likely are you to doze off or fall asleep watching TV?

Would never doze/slight chance of dozing/moderate chance of dozing/high chance of dozing.

8. How likely are you to doze off or fall asleep sitting, inactive in a public place (e.g., a theatre or a meeting)?

Would never doze/slight chance of dozing/moderate chance of dozing/high chance of dozing.

9. How likely are you to doze off or fall asleep as a passenger in a car for an hour without a break?

Would never doze/slight chance of dozing/moderate chance of dozing/high chance of dozing.

10. How likely are you to doze off or fall asleep lying down to rest in the afternoon when circumstances permit?

Would never doze/slight chance of dozing/moderate chance of dozing/high chance of dozing.

11. How likely are you to doze off or fall asleep sitting and talking to someone?

Would never doze/slight chance of dozing/moderate chance of dozing/high chance of dozing.

12. How likely are you to doze off or fall asleep sitting quietly after a lunch without alcohol?

Would never doze/slight chance of dozing/moderate chance of dozing/high chance of dozing.

13. How likely are you to doze off or fall asleep in a car, while stopped for a few minutes in the traffic?

Would never doze/slight chance of dozing/moderate chance of dozing/high chance of dozing.

SECTION 3: About your electronic device use at bedtime…

Sleep Sci. 2021; Ahead of Print


9 Technology use and EDS

14. Do you have a smartphone in your bedroom?

Yes/No (skip next question if no).

15. How often do you use the smartphone in bed when you would normally be sleeping?

Never/rarely/a few nights a month/a few nights a week/every or almost every night.

16. Do you have a tablet in your bedroom?

Yes/No (skip next question if no).

17. How often do you use the tablet in bed when you would normally be sleeping?

Never/rarely/a few nights a month/a few nights a week/every or almost every night.

18. Do you have a music player in your bedroom?

Yes/No (skip next question if no).

19. How often do you use the music player in bed when you would normally be sleeping?

Never/rarely/a few nights a month/a few nights a week/every or almost every night.

20. Do you have a computer/laptop in your bedroom?

Yes/No (skip next question if no).

21. How often do you use the computer/laptop in bed when you would normally be sleeping?

Never/rarely/a few nights a month/a few nights a week/every or almost every night.

22. Do you have a TV in your bedroom?

Yes/No (skip next question if no).

23. How often do you use the TV in bed when you would normally be sleeping?

Never/rarely/a few nights a month/a few nights a week/every or almost every night.

24. Do you have a radio in your bedroom?

Yes/No (skip next question if no).

25. How often do you use the radio in bed when you would normally be sleeping?

Never/rarely/a few nights a month/a few nights a week/every or almost every night.

SECTION 4: About you…

17. What is your gender?


Male/Female.

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Technology use and EDS 10

18. How old are you?

19. How tall are you (in cm)

20. How much do you weigh (in kg)?

21. What is your marital status?

Married/common law, single, separated, divorced, or widowed.


22. Over the past one month, how many times did you take medication (with or without a prescription) to help you sleep?

Supplementary Table 1. Binary logistic regression examining the association between number of devices or frequent and infrequent device use in the
bedroom and demographic parameters expressed OR (95% CI; p=value). Dash (-) denotes reference group.
Number of
Parameter Smartphone Tablet Computer Television Radio Music player
devices (≤1 or ≥2
0.95 0.97 0.95
1.01 (1.00-1.01; 0.99 (0.98-1.00; 1.03 (1.02-1.04; 1.07 (1.06-1.09;
Age (0.95-0.96; (0.96-0.99; (0.93-0.97;
0.04) 0.20) p<0.0001) p<0.0001)
p<0.0001) p<0.0001) p<0.0001)
Gender Female - - - - - - -
0.52
1.29 (1.34-1.65; 1.31 (1.15-1.50; 1.44 (1.21-1.71; 1.48 (1.23-1.78; 0.84 (0.55-1.30; 1.46 (1.13-1.88;
Male (0.43-0.63;
p<0.0001) p<0.0001) p<0.0001) p<0.0001) 0.44) 0.004)
p<0.0001)
Marital status Married - - - - - - -
3.50
3.04 (2.32-3.97; 1.54 (1.08-2.21; 2.71 (1.89-3.89; 1.99 (1.26-3.12; 1.07 (0.38-3.02; 2.08 (1.03-4.18;
Divorced (2.27-5.39;
p<0.0001) 0.02) p<0.0001) 0.003) 0.90) 0.04)
p<0.0001)
4.87 (4.26-5.56; 1.16 (0.99-1.37; 1.81 (1.45-2.26; 3.16 (2.42-4.12; 2.43 (1.90-3.11; 1.39 (0.80-2.40; 2.28 (1.56-3.32;
Single
p<0.0001) 0.07) p<0.0001) p<0.0001) p<0.0001) 0.24) p<0.0001)
1.61 (0.90-2.88; 0.96 (0.51-1.82; 2.03 (0.83-4.94; 1.70 (0.40-7.25; 1.31 (0.45-3.79; 2.32 (0.80-6.69; Sample too
Widowed
p=0.11) 0.90) 0.12) 0.47) 0.62) 0.12) small
Sleeping
medication Never - - - - - - -
use
Several 1.1 (0.95-1.29; 0.93 (0.75-1.13; 1.32 (1.07-1.65; 0.89 (0.69-1.14; 1.27 (0.99-1.63; 0.85 (0.43-1.67; 1.27 (0.94-1.71;
days 0.21) 0.46) 0.009) 0.35) 0.06) 0.64) 0.13)
Over half 1.34 (0.98-1.84; 0.93 (0.60-1.43; 0.94 (0.60-1.50; 1.13 (0.73-1.73; 1.71 (1.11-2.65; 1.32 (0.40-4.31; 1.69 (1.02-2.78;
of days 0.07) 0.73) 0.81) 0.59) 0.02) 0.65) 0.04)
Nearly 1.06 (0.75-1.50; 1.06 (0.67-1.68; 1.68 (1.07-2.63; 1.53 (0.94-2.51; 1.79 (1.10-2.92; 1.81 (0.70-4.68; 1.35 (0.68-2.66;
every day 0.75) 0.81) 0.02) 0.09) 0.02) 0.22) 0.39)

Sleep Sci. 2021; Ahead of Print

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