Somnologie

Somnology – Current Sleep Research and Concepts

Original studies

Somnologie 2020 · 24:253–258 Jasmin Faber1 · Indra Steinbrecher-Hocke2 · Peter Bommersbach2 ·

https://doi.org/10.1007/s11818-020-00282-5 Angelika A. Schlarb1
Published online: 10 November 2020 1
Universität Bielefeld, Bielefeld, Germany
© The Author(s) 2020 2
Eifelklinik Manderscheid, Manderscheid, Germany

Does media use before bedtime

affect the sleep of psychosomatic
rehabilitation patients?

Background The percentage, however, decreased with off. Regarding other digital devices, e.g.
age for both men and women. Only 1833 television, game consoles and listening
Patients in psychosomatic rehabilitation respondents were used forfurtherstatisti- to music/radio, no significant differences
clinics suffer from multiple physical and cal analysis because media use was stated were found. Media use did not affect
mental disorders, e.g. depression and as the sole cause of insufficient sleep. In symptoms of insomnia.
anxiety. However, sleep does not re- 96.9% of cases, the respondent used a mo- Besides the actual use of media,
ceive as much attention as needed. Yet, bile phone less than 0.5 h before sleep Custers and colleagues [7] determined
76–86.6% of German patients from psy- and 74.8% of these media produced or the influence of the availability of internet
chosomatic rehabilitation clinics report required light. The authors additionally and television in the bedroom. In face-
an impaired sleep quality at admission divided all respondents into subgroups to-face interviews, the authors gathered
and almost 70% upon discharge. Ap- based on the amount of time spent using information about the availability and
proximately 62% even meet the diagnos- media before bedtime: light users spend- use of internet and television as well
tic criteria for insomnia [12, 18]. Sleep ing less than 2.5 h, heavy users spending as on sleep parameters in 711 Belgian
quality and other sleep parameters are more or equal to 3.5 h. Analysis showed residents with a mean age of 49.35 years.
influenced by behavioural, cognitive and that 29% of light users, 39.5% of inter- Though internet availability in the bed-
emotional factors. mediate users and 53.5% of heavy users room was associated with a later bedtime
perceived media use as a cause of insuffi- on weekdays and at weekends, as well
Media use and sleep cient sleep. Sleep duration on workdays, as a later rise time on weekdays, there
on the one hand, was significantly longer was no effect of access of a TV in the
Media use, as part of sleep hygiene, in light users than in heavy users, whereas bedroom. The use of internet and TV
could also negatively affect sleep, espe- no differences were found for non-work- led to a later bedtime on weekends and
cially when using digital devices right days. a later rise time on weekends for internet
before bedtime or in bed. Over the past Later studies focused more on in-bed use. Sleep duration and tiredness were
years, various studies have investigated media use before sleep (e.g. [2, 3, 7, 8]). not predicted by the availability and use
the impact of media use on sleep in dif- For example, Brunborg and colleagues of internet and TV.
ferent age groups [3, 5, 8, 11]. However, [3] investigated the relationship between Media use before sleep might not be
studies in middle-aged and older adults in-bed media use and sleep habits on the only predicting factor for insufficient
are rare, and studies in patients, espe- weekdays and weekends/days off and sleep; night-time awakenings and me-
cially from psychosomatic rehabilitation symptoms of insomnia with completed dia use might also be associated [8]. In
clinics, are missing. data from the Norwegian national regis- an online survey, 584 adults (mean age
One of the earliest studies examined ter (N = 816; age range: 16–40 years). On 48.5 years, 18–96 years) responded to var-
media use before bedtime as a cause of in- weekdays respondents rose later when ious questionnaires. Results showed that
sufficient sleep among Japanese monitor using a computer in bed, and turned off social media shortly before bedtime was
members of an internet survey company the light later when using their mobile used by 58% on a daily basis and multiple
[19]. A total of 3406 people ranging from phone. On weekends/days off, however, times per week in 15%. Social media use
15 to 79 years completed an online ques- respondents rose later, turned off the during the night was rather rare (7.9%
tionnaire asking about sleep and causes of lights later, and slept more hours when on a daily basis, 5.8% 2–3 times a week),
insufficient sleep. More than one third of using a computer. Using a mobile phone although it significantly predicted poorer
the respondents (37.5%) reported media led to a later time of turning off the sleep quality.
use as a cause of their insufficient sleep. lights and of bedtime on weekends/days

Somnologie 4 · 2020 253

 Original studies

50
46.1
45

40

35
Percentage

30 28

25

20

15
10.9 11.4
10

5 3.6

0
20 - 29 30 - 39 40 - 49 50 - 59 >= 60
Age group (years) Fig. 1 9 Percentage for
each age group

Occasionally, digital devices are Research question age group; 174 male and 162 female
specifically used as a sleep aid to fall asleep patients participated.
faster or relax. Exelmans and colleagues The aim of this study was to examine the
[9] investigated this relationship in 844 relationship between media use directly Instruments
adults (mean age 46 years, 18–94 years) before bedtime and various sleep param-
using face-to-face interviews. Various eters such as sleep quality, sleep onset la- Pittsburgh Sleep Quality Index
sleep aids had a significantly higher odds tency and sleep efficiency. We assumed The Pittsburgh Sleep Quality Index
ratio when available in the bedroom: tele- that more media use before bedtime neg- (PSQI) [4] was used to assess the sub-
vision (six times higher), videogames atively affects sleep parameters. jective sleep quality retrospectively over
(ten times higher), computer (3.13) and the past 4 weeks. It consists of 18 items
smartphone (1.88). A computer (83.98), Methods which are used for a quantitative analy-
tablet (2.75) or smartphone (2.92.) in sis. Patients’ responses are allocated to
the bedroom led to a higher likelihood Procedure and sample a global score, which can range between
of using the internet as a sleep aid. The null and 21, and seven subscales: sleep
authors reported no significant relation Patients from a German psychosomatic quality, sleep latency, sleep duration,
to sleep duration, however, for all media rehabilitation clinic were screened for habitual sleep efficiency, sleep distur-
types and sleep hygiene. Sleep aids, like their subjective sleep quality and in- bances, use of sleep medication and
videogames, music or internet, predicted somnia symptoms using questionnaires daytime dysfunction. Global scores be-
a later bedtime and rise time. shortly after arriving. Eligible patients low six represent good sleepers, between
Media use affects other factors as well, were then asked to complete an addi- six and ten impaired sleepers, and above
e.g. fatigue [9], daytime sleepiness, mood tional sleep log over a period of 1 week. ten chronic sleep disorders. Based on
[2] and cognitive failures [21]. Those few This study was approved by the ethics the reliability coefficients of 0.77 to 0.83
results, however, suggest that media use committee of the State Chambers of and high specificity and sensitivity for
does indeed impact one’s sleep. Nonethe- Physicians of Rhineland-Palatinate. identifying patients with sleep disorders
less, the presented studies focused on A total of 347 patients fulfilled in- (>80%), the PSQI can be classified as
healthy adults, assessing the parameters clusion criteria of an impaired sleep a valid and reliable instrument [1, 4, 20].
in cross-sectional surveys or interviews. quality and insomnia criteria using
Hence, the association between media a screening questionnaire. Mean age was Insomnia Questionnaire for Adults
use and sleep in patients with mental 49.77 years (standard deviation = 9.01; The Insomnia Questionnaire for Adults
disorders and sleep problems, especially median = 52 years) and ranged from 22 (IQ-A) [16] is a screening instrument
in rehabilitation patients, would be of to 64 years. However, data regarding which assesses insomnia criteria based
importance for research and practice. age were not available from 11 patients. on the Diagnostic and Statistical Manual
. Figure 1 shows the percentage for each of Mental Disorders, 5th edition (DSM 5).

254 Somnologie 4 · 2020

 Abstract · Zusammenfassung

Somnologie 2020 · 24:253–258 https://doi.org/10.1007/s11818-020-00282-5

© The Author(s) 2020

J. Faber · I. Steinbrecher-Hocke · P. Bommersbach · A. A. Schlarb

Does media use before bedtime affect the sleep of psychosomatic rehabilitation patients?
Abstract
Objective. Media use can affect sleep. How- 22–64 years; median = 52 years). 57.5% of the Conclusion. This study, which is the first to
ever, research regarding various populations patients were 50 years or older. examine the relation between media use
is sparse. The objective of this study was to Results. Analysis showed that media use and and sleep in patients of a psychosomatic
examine the relationship between media use various sleep diary parameters such as total rehabilitation clinic, suggests a significant
directly before bedtime and various sleep sleep time (r = –0.386, p = 0.042; rTST2 = 0.149) association between media use and sleep
parameters in patients of a psychosomatic and sleep efficiency (r = –0.507, p = 0.006; duration as well as sleep efficiency. However,
rehabilitation clinic. rSE2 = 0.257) were significantly associated. more research is needed to investigate the
Methods. Patients from a German psycho- In detail, more media consumption was relationship between media use and sleep
somatic rehabilitation clinic were tested associated with less total sleep time and in more detail, to increase patients’ quality
regarding subjective sleep quality and a lower sleep efficiency. The same result was of life and to incorporate these findings into
insomnia symptoms based on questionnaires found for media use and sleep efficiency on the daily life of clinicians and therapists as
such as the Pittsburgh Sleep Quality Index weekdays (r = –0.544, p = 0.002; rSE2 = 0.296), well as into sleep hygiene education and sleep
(PSQI). Eligible patients also completed an but not for other sleep parameters. However, trainings.
additional sleep log over a period of 1 week. media use time and subjective sleep quality
A total of 347 insomnia patients were enrolled, were not significantly correlated, r = –0.055, Keywords
with a mean age of 49.77 years (range p = 0.768. Sleep quality · Sleep efficiency · Total sleep
time · Insomnia · Rehabilitation patients

Beeinflusst die Mediennutzung vor dem Zubettgehen den Schlaf bei Patienten der
psychosomatischen Rehabilitation?
Zusammenfassung
Ziel. Medienkonsum kann Schlaf be- (Spannbreite: 22–64 Jahre; Median: 52 Jahre) Schlussfolgerung. Die vorliegende Studie
einträchtigen. Jedoch gibt es wenige berücksichtigt. Von den Patienten waren ist eine der ersten, die den Zusammenhang
Forschungsergebnisse hinsichtlich unter- 57,5 % über 50 Jahre alt. von Mediennutzung und Schlaf bei Patienten
schiedlicher Patientengruppen. Ziel dieser Ergebnisse. Mit der Mediennutzung einer psychosomatischen Rehabilitation
Studie war es, den Zusammenhang zwischen korrelierten die Schlafdauer (r = –0,386; untersuchte. Die Ergebnisse zeigen, dass
dem Medienkonsum vor dem Zubettgehen p = 0,042; rTST2 = 0,149) und die Schlafeffi- dieser Zusammenhang zumindest für die
und Schlaf bei Patienten und Patientinnen zienz (r = –0,507; p = 0,006; rSE2 = 0,257), Schlafdauer und -effizienz signifikant ist.
einer psychosomatischen Rehabilitationsklinik gemessen mit dem Schlaftagebuch. Je Zukünftige Forschung sollte dies jedoch de-
zu untersuchen. mehr Medien direkt vor dem Schlafen taillierter untersuchen, um die Lebensqualität
Methoden. Patienten einer psychosomati- genutzt wurden, desto geringer waren der Patienten zu erhöhen und die Integration
schen Rehabilitationsklinik wurden bei der die Schlafdauer und die Schlafeffizienz. in den Therapiealltag sowie in Anleitungen
Aufnahme hinsichtlich ihrer Schlafqualität Dies galt ebenfalls für die Mediennutzung zur Schlafhygiene und in das Schlaftraining zu
und Insomniekriterien befragt. Patienten, die und die Schlafeffizienz an Wochentagen erleichtern.
über eine schlechte Schlafqualität berichteten (r = –0,544; p = 0,002; rSE2 = 0,296), jedoch
und die Insomniekriterien erfüllten, wurden nicht für andere Schlafparameter. Zwischen Schlüsselwörter
in die Studie aufgenommen und füllten ein der Mediennutzung vor dem Zubettgehen Schlafqualität · Schlafeffizienz · Schlafdauer ·
einwöchiges Schlaftagebuch aus. Insgesamt und der subjektiven Schlafqualität wurde Insomnie · Patienten der Rehabilitation
wurden die Daten von 347 Patienten mit hingegen kein signifikanter Zusammenhang
einem Durchschnittsalter von 49,77 Jahren gefunden, r = –0,055; p = 0,768.

This questionnaire consists of 11 items Sleep log ing everyday coping, napping, physical
with a dichotomous scale (yes or no). In The sleep log is an instrument which as- activity, substance and media use, as well
order to determine whether an insom- sesses various sleep parameters. Patients as the practice of relaxation techniques.
nia diagnosis is fulfilled, the impairment in this study filled in a one-week sleep log. Based on data from the sleep log, sleep
due to and the duration of the insom- A sleep log is divided into a morning and parameters such as overall sleep duration,
nia symptoms must be present. Further- evening section. The morning section sleep onset latency and sleep efficiency
more, at least one of the following symp- includes eight questions regarding rising were calculated. The number of minutes
toms must be present: problems initiat- and bedtime, sleep onset latency, awak- using digital devices before bedtime was
ing sleep, maintaining sleep and/or early enings during the night, medication use, used as the variable for media use.
wake up. nightmares and restfulness. The evening
section consists of ten questions regard-

Somnologie 4 · 2020 255

 Original studies

Table 1 Correlations between media use and sleep parameters from sleep log has shown the importance of media use
1 2 3 4 5 6 during the week with a significant corre-
1 Media use – – – – – – lation of media use and sleep efficiency,
2 SOL 0.257 – – – – –
though this was not found for other sleep
parameters.
3 TIB 0.003 0.185 – – – –
These findings are mostly in contrast
4 TST –0.386* –0.392* 0.656** – – –
to previous studies, which reported an
5 SE –0.507** –0.709*** –0.240 0.563** – – effect of in-bed media use and later rise
6 WASO 0.305 0.09 0.029 –0.326 –0.518** – and bedtime while using a computer or
SOL sleep onset latency, TIB time in bed, TST total sleep time, SE sleep efficiency, WASO wake after smartphone [3, 7]. However, both studies
sleep onset showed no effect on sleep duration. On
*p < 0.05, **p < 0.01
the one hand, these different results can
be affiliated to the different samples. Pre-
Statistical analysis fore bedtime was associated with a lower vious studies investigated the relationship
total sleep time. In addition, more me- between media use and sleep in healthy
Statistical analyses were carried out with dia time was also significantly associated individuals, whereas the study at hand
IBM SPSS Statistics 25 (IBM Corp., Ar- with lower sleep efficiency—both results focused on patients from a psychoso-
monk, NY, USA). The P-value was set to with medium effect sizes (rTST2 = 0.149, matic rehabilitation clinic. Most of these
p < 0.05. Missing data were not substi- rSE2 = 0.257). However, media use was patients suffer from impaired sleep qual-
tuted. A minimum of four nights from not significantly related to other sleep ity on admission [12, 18]. Most of them
the sleep log was assumed as valid and parameters such as sleep onset latency even fulfilled symptoms of insomnia [18].
eligible data. The relationship between or wake after sleep onset. See . Table 1 In addition, our sample was older than
media use and sleep parameters was ver- for all correlations. most other samples. As light sensitivity
ified using the Pearson correlation. Ef- increases with age, media consumption
fect sizes are reported as r2 with r2 < 0.10 Differences between weekdays might be kept in mind as a further and
as a small effect, r2 = 0.10–0.30 as small and weekends more important risk factor for persons
to medium effect and r2 = 0.30–0.50 as with higher age [15].
a medium to large effect. T-tests for in- In another step, correlations were con- Brunborg and colleagues [3] found in
dependent samples were used for group ducted for weekdays and the weekend their sample that media use does not af-
comparisons. Hereby, the effect size Co- separately. Analysis showed a signif- fect symptoms of insomnia; however, an
hen’s d is reported (d = 0.20 small effect, icant relation between media use and impaired sleep quality and insomnia dis-
d = 0.50 medium effect, d = 0.80 large ef- sleep efficiency on weekdays (r = –0.544, order were part of the inclusion criteria in
fect). p = 0.002), which counts as a medium ef- the present study and therefore required
fect (rSE2 = 0.296). More precisely, longer for valid participation. Besides, it could
Results duration of media use was related to be discussed that media use might not
lower sleep efficiency during the week. be the leading cause of psychosomatic
Sleep quality Other correlations were not significant. patients’ impaired sleep quality and in-
A group comparison of media use dur- somnia symptoms. Other factors, e.g.
The total score of the PSQI and the mean ing the week and at the weekend revealed physical and mental health, stress and
time of media use were used to investi- no significant difference, t(295) = –0.751, medication, might be of more impor-
gate the relationship between sleep qual- p = 0.459. tance. Beyond this, most of our patients
ity and media use. There was no sig- were older than 50 years and might there-
nificant correlation between these two Discussion fore have multiple impairments regarding
variables, r = –0.055, p = 0.768. mental and physical health [13].
The aim of the present study was to ex- On the other hand, the studies by
Sleep diary amine the relationship between media Brunborg et al. [3] and Custers et al. [7]
use directly before bedtime and various focused on in-bed media use, whereas the
The following sleep parameters were de- sleep parameters in a specific population. study at hand did not specifically differ-
rived from the sleep log: sleep onset la- Significant relationships were found for entiate between in-bed and outside-bed
tency (SOL), time in bed (TIB), total the duration of media use before bedtime media use. These circumstances might
sleep time (TST), sleep efficiency (SE) and total sleep time and sleep efficiency have led to the non-significant results
and wake after sleep onset (WASO). The for the overall week. However, this was regarding media use and sleep onset la-
mean time of media use over 1 week was not the case for other sleep parameters, tency, and wake after sleep onset. Some
significantly related to TST (r = –0.386, such as sleep quality, sleep onset latency, patients probably used their digital de-
p = 0.042) and SE (r = –0.507, p = 0.006). time in bed and wake after sleep onset. vices outside of the bed and other factors
In detail, longer duration of media use be- Furthermore, a more detailed analysis have more influence on patients’ sleep.

256 Somnologie 4 · 2020

Hier steht eine Anzeige.

K
 Original studies

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typical for insomnia patients and might Universität Bielefeld NguyenKT, OlginJE, PletcherMJ, MarcusGM(2016)
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house patients. A short sleep in the age tations-Forschungsnetzwerk. Open Access funding recommendations from an exploratory cross-
group 55 years and above with less than enabled and organized by Projekt DEAL. sectional study. Behav Sleep Med 10(2):96–105
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Conflict of interest. J. Faber, I. Steinbrecher-Hocke, Evening light exposure to computer screens
First, data on media use before bedtime P. Bommersbach and A. A. Schlarb declare that they disrupts human sleep, biological rhythms, and
was collected via a sleep log. Based on have no competing interests. attention abilities. Chronobiol Int 34(7):855–865
this method, information about media 11. Levenson JC, Shensa A, Sidani JE, Colditz JB,
All procedures performed in studies involving hu- Primack BA (2016) The association between social
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media, the place of media use (in bed vs. dance with the ethical standards of the institutional adults. Prev Med 85:36–41
and/or national research committee and with the 12. Linden M (2015) Institutional prevalence and
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beim alten Menschen. Somnologie 22:240–244
though it is one of the first studies to Open Access. This article is licensed under a Creative 14. Richter K, Miloseva L, Köck M, Hillemacher T,
examine the relation between media use Commons Attribution 4.0 International License, which Weeß HG (2018) Verhaltenstherapeutische Be-
permits use, sharing, adaptation, distribution and re- handlung von Insomnie im Alter – wann und wie
and sleep in patients of a rehabilitation production in any medium or format, as long as you behandeln? Somnologie 22:245–250
clinic, there might be other factors which give appropriate credit to the original author(s) and 15. Rubiño JA, Gamundí A, Akaarir M, Cañellas F, Rial R,
should be taken into account. the source, provide a link to the Creative Commons li- BallesterN, Nicolau MC(2017)Effectsofdifferences
cence, and indicate if changes were made. The images in the availability of light upon the circadian
or other third party material in this article are included rhythms of institutionalized elderly. Chronobiol Int
Conclusion in the article’s Creative Commons licence, unless in- 34:1197–1210
dicated otherwise in a credit line to the material. If 16. Schlarb AA, Faber J (2020) Insomnia Questionnaire
material is not included in the article’s Creative Com- for Adults (IQ-A)
Despite the limitations, the present study mons licence and your intended use is not permitted 17. Šmotek M, Fárková E, Manková D, Kopřivová J
is the first to examine the relationship by statutory regulation or exceeds the permitted use, (2020) Evening and night exposure to screens of
between media use and sleep in patients you will need to obtain permission directly from the media devices and its association with subjectively
copyright holder. To view a copy of this licence, visit perceived sleep: Should “light hygiene” be given
of a psychosomatic rehabilitation clinic. http://creativecommons.org/licenses/by/4.0/. more attention? Sleep Health 6(4):498–505
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258 Somnologie 4 · 2020