Social media interferes with pediatric sleep health with downstream consequences for mental health and other developmental outcomes. Based on the literature on screen use and sleep, social media likely affects sleep through the following proposed mechanisms: activity displacement, content-related arousal, alerting effects of light, and disruptions from noises and vibrations. Future research on this topic should improve measurement of both social media use and sleep health. Scalable, sustainable, and effective interventions should be developed and evaluated. We offer clinical recommendations for reducing the negative effects of social media on pediatric sleep health.
Key points
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Social media, especially in the evening and during the night, interferes with pediatric sleep health.
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Proposed mechanisms for these effects include: activity displacement, arousal from content, alerting effects of light, and disruptions from noises and vibrations at night.
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Effective scalable interventions should be developed and evaluated.
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Clinicians and parents should work with youth to reduce the negative effects of social media use on sleep health.
Introduction
Social media permeates the daily lives of many children and adolescents. , Youth frequently use smartphones and other mobile devices during the evening and nighttime hours, interfering with sleep health. In this article, we provide current evidence on the importance of sleep health among pediatric populations, and what recent research reveals about the relationship between social media use and sleep. We discuss limitations of the existing research and conclude with recommendations for youth, families, and clinicians to help mitigate the possible adverse effects of social media use on sleep.
Pediatric sleep health affects mental health and other developmental outcomes
Sleep serves numerous physiologic functions among pediatric populations, including regulation and maintenance of cardiovascular, metabolic, immune, cognitive, behavioral, and mental health. Decades of research indicate that sufficient restorative sleep is an essential part of healthy development, impacting cognitive (executive functioning and academic performance), , emotional (emotional regulation, internalizing, and externalizing behaviors), , and physical outcomes (growth trajectories, obesity, and other cardiovascular risk factors) from birth to adolescence. Expert consensus panels recommend that school-aged children require between 9 and 12 h of sleep per night and that teenagers require 8 to 10 h per night for optimal development. , However, recent surveys reveal that the average amount of sleep among adolescents have declined over the last 2 decades. In the United States (US), 75% of youth report they sleep less than 8 h on school nights. , In Europe, less than half of the children and adolescents meet sleep recommendations. , Several characteristics of digital media access among youth consistently correlate with changes in sleep parameters, including bedtime, sleep onset, and total sleep duration. Location, duration, and timing of access to digital media have the strongest impact with sleep problems. Effective clinical interventions for sleep problems in youth must address maladaptive patterns of media use.
Current State of Research on Social Media and Pediatric Sleep Health
Multiple systematic literature reviews document a widespread and consistent positive association between greater digital media use and poor sleep health among youth, ranging from pre-school-aged children through adolescents. These studies demonstrate that more digital media use is associated with delayed bedtimes, longer sleep-onset latency, shorter total sleep time, and more daytime sleepiness among children and adolescents. The association between the presence of digital media in children’s bedrooms and increased prevalence of sleep problems is a strong, consistent finding.
When looking specifically at the association between social media and sleep health, similar patterns emerge. More interactive types of digital media (eg, social media, messaging) and smartphones that interrupt nighttime sleep are associated with a range of negative sleep outcomes including later bedtimes, longer sleep onset latency, shorter sleep duration, and poorer sleep quality. , , For example, using the data from nearly 12,000 adolescents (13–15 year olds) in the Millennium Cohort Study, Scott and colleagues shows a dose-response relationship between duration of social media use and later sleep onset, later wake times, and insomnia symptoms. In contrast, more passive types of media use (eg, streaming video content and watching television) show less consistent associations with sleep health outcomes. ,
Social Media Before Bed and During the Night Adversely Affects Sleep
Both timing of the exposure and content of social media relate to sleep health. Bedtime and nighttime use of screens may have an even greater impact on poor sleep outcomes. , , A 2016 meta-analysis including 20 cross-sectional studies from greater than 125,000 children found bedtime mobile phone use was associated with higher rates of insufficient sleep duration (odds ration[OR] = 2.17, 95% confidence interval [CI] 1.42–3.32), poor sleep quality (OR = 1.46, 95% CI 1.14–1.88), and excessive daytime sleepiness (OR = 2.72, 95% CI, 1.32–5.61). In contrast to pre-sleep and nighttime screen use, studies of screen use (or social media specifically) during the day and/or further from bedtime have more inconsistent effects. Several intervention studies demonstrate limiting screen use in the hours before bed significantly improves sleep health. , For example, Perrault and colleagues found that limiting screen time after 9:00 pm in a sample of 569 adolescents resulted in earlier bedtimes and greater sleep duration. Bartel and colleagues, showed similar benefits for 63 adolescents asked to put their phones away in the hour before bed. Screen media restrictions are challenging for parents to enforce and some intervention studies restricting screen use failed to show significant improvements in sleep health. ,
Proposed Mechanisms that Explain the Link Between Social Media and Sleep Health
The association between screen-based digital media use and sleep health outcomes is often attributed to 4 plausible pathways, briefly described as follows, with a focus on social media effects on sleep.
Activity displacement
The first proposed mechanism is about time use—specifically that time spent on social media displaces sleep by delaying both the times youth get into bed and when they shut their eyes (which may distinct if the phone is brought into bed), thus shortening overall sleep duration. The time spent using social media would otherwise be used for preparing for sleep (eg, reading from a book, getting ready for the next morning) or actually sleeping. Similarly, social media and other screen use may displace other health behaviors beneficial for sleep, such as daytime exposure to outdoor light and physical activity. Support for the activity displacement hypothesis is provided by long shut-eye latency periods in which adolescents get in bed, but delay shutting their eyes for a long time in order to engage with screen media. ,
Psychologic stimulation from social media content
The second proposed pathway involves content-related stimulation that increases alertness and therefore impairs the ability to fall asleep. This could include arousal from social media or messaging, , with related experiences of social comparison, as well as online conflict and aggression, both of which may lead to negative thoughts, emotions, and memories. , Van der Schurr shows that social media stress is associated with longer sleep latency and daytime sleepiness. Research by Vernon and colleagues , demonstrates a positive association between problematic social media use and sleep disruptions. Independent of psychologic arousal, physiologic arousal associated with video gaming has been shown to correlate with changes to sleep architecture by delaying sleep onset, shortening sleep duration, and reducing sleep efficiency. ,
Effects of nighttime light exposure on circadian physiology and alertness
The light emitted by screens, particularly when it contains short-wavelength blue light, disrupt sleep by suppressing release of the sleep-promoting hormone melatonin, delaying the timing of the circadian clock, and decreasing nighttime sleepiness. , These effects may be particularly strong in children, who have both clearer lenses and larger pupils than adults, allowing more light into the eye to stimulate the retina. However, studies using light-adjusting software that alters the spectrum light emitted by screen devices in order to be less stimulating to the circadian system have reported little to no effects on sleep outcomes or melatonin secretion. In an experimental study with young adults, participants viewed either their own or a mock Facebook page on a tablet with either blue-filtered or full wavelength light. The combination of blue-filtered light and the “low arousal” non-personal account resulted in significantly better subjective sleep quality than either manipulation alone, suggesting that media interventions, which address multiple underlying pathways to sleep health, are more likely successful.
Nighttime sleep disruption
Sleep may be disrupted by noises and vibrations from cell phone notifications, as well as unease related to fear of missing out (FOMO) on social interactions. A 2019 report indicated that more than one-third of teens use their phones during the night for activities other than checking the time, most frequently because they received a notification (54%) or to check social media (51%). In a study of undergraduate students, nighttime cell phone notifications significantly predicted self-reported global sleep problems and sleep disruptions, while a greater compulsion to check notifications at night predicted poorer sleep quality. FOMO can contribute to short sleep duration in adolescence by increasing both nighttime social media use and pre-sleep cognitive arousal, leading to delayed bedtimes and a longer time to fall asleep.
Limitations
Although cross-sectional, observational research studies consistently demonstrate a strong association between increased social media use and poor sleep health, experimental studies establishing a causal relationship are lacking. The majority of studies to date employ either self- or parent-report measures of screen use and sleep, which may be subject to bias. Objective measures of social media use (eg, passive sensing) and sleep duration/timing (eg, actigraphy, polysomnography) may more accurately assess how patterns and characteristics of social media use (timing, duration, frequency, and content) affect sleep. Finally, further research is needed to develop feasible, sustainable, and effective interventions to help youth regulate their social media use in order to promote sleep health, particularly in light of findings that social media use can have both positive and negative impacts on adolescents’ well-being. A 2017 focus group of adolescents and young adults (aged 16–25 years) found that most wished to improve their sleep behavior, but had experienced limited success due in part to difficulty curtailing technology and social media use. A systematic review and meta-analysis examining the efficacy of interventions to reduce children’s screen use and enhance sleep suggests that modest declines in media use and related improvements in sleep health can be achieved. Across 11 studies which included children aged 2 to 13 years, interventions resulted in an average reduction in screen use of 33 min per day and average sleep duration increased by 11 min per day. Limitations of the analysis include the large variability across the intervention strategies and type of media use targeted (eg, TV, video games, and overall screen use), as well as the primary focus of several interventions on outcomes other than media reduction and sleep (eg, weight-related behaviors). The association between the presence of digital media in children’s bedrooms and increased prevalence of sleep problems is a strong, consistent finding.
Clinical implications and recommendations for youth, families, and clinicians
Recommendations
We offer the following public-facing recommendations to youth, families, teachers, coaches, clinicians, and policy makers. These are based on the most recent research and build upon our prior recommendations and those endorsed by the American Academy of Pediatrics (AAP).
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Prioritize sleep: Discussions with children regarding the importance of sleep and expectations for health sleep should be conducted in multiple settings (eg, homes, classrooms, after-school activities, and doctor visits).
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Maintain bedtime routines, which avoid disruptive digital media use and focus on calming activities.
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Remove all digital media from youths’ bedrooms: smartphones, televisions, video games, computers, and tablets.
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To prevent children from surreptitiously using screen media at night, consider disconnecting or disabling Wi-Fi router at bedtime, charging children’s tablets and phones in the parents’ bedroom, and setting device parental controls to disallow nighttime use.
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For youth with sleep problems, ensure the steps above are observed before using sleep medication.
Clinics care points
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Prioritize sleep: Discuss with children and families the importance of sleep and make recommendations for healthy sleep including those listed above.
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Encourage families to limit duration of electronic media access as endorsed by AAP.
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Encourage families to limit or restrict electronic media access within 1 to 2 h of bedtime.
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Screen for sleep problems in youth with mood or behavioral problems, as insufficient sleep may be a contributing factor.
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For youth with sleep problems, ensure the steps above are observed before prescribing sleep medication.
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