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The impact of bedtime technology use on sleep quality and excessive daytime
sleepiness in adults
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1 author:
Saad Alshareef
Imam Muhammad bin Saud Islamic University
29 PUBLICATIONS 209 CITATIONS
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All content following this page was uploaded by Saad Alshareef on 23 June 2021.
*Corresponding author:
Saad Mohammed AlShareef MD, MHPE
E-mail: drsaad321@hotmail.com
DOI: 10.5935/1984-0063.20200128
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,
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.
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5. During the past month, how would you rate your sleep quality overall?
6. How likely are you to doze off or fall asleep sitting and reading?
7. How likely are you to doze off or fall asleep watching TV?
8. How likely are you to doze off or fall asleep sitting, inactive in a public place (e.g., a theatre or a meeting)?
9. How likely are you to doze off or fall asleep as a passenger in a car for an hour without a break?
10. How likely are you to doze off or fall asleep lying down to rest in the afternoon when circumstances permit?
11. How likely are you to doze off or fall asleep sitting and talking to someone?
12. How likely are you to doze off or fall asleep sitting quietly after a lunch without alcohol?
13. How likely are you to doze off or fall asleep in a car, while stopped for a few minutes in the traffic?
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.
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.
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.
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.
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.
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.
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)