Screen Use Effects on Children's Sleep

(SCREENS Trial)

Overseen By Insia Raza, MPH

Age: < 18

Sex: Any

Trial Phase: Academic

Sponsor: Baylor College of Medicine

Must not be taking: Sleep medications

Disqualifiers: Blindness, Vision problems, Sleep disorder, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: 1

220 Participants Needed

Trial Summary

Will I have to stop taking my current medications?

The trial excludes children who are taking medications that impact sleep, so if your child is on such medications, they would not be eligible to participate.

What data supports the effectiveness of the treatment Calming Content, Exciting content, Filtered dim tablet screen, no screen control with dim light and calming activities, unfiltered Bright tablet screen on children's sleep?

Research shows that interventions to control children's screen use can reduce screen time by about 33 minutes per day and increase sleep duration by 11 minutes per day. This suggests that managing screen use, like using calming content and dim screens, may help improve children's sleep. ^{1 2 3 4 5}

Is it safe for children to use screens before bedtime?

Research suggests that using screens before bedtime can lead to delayed bedtimes and shorter sleep duration in children, but there is no direct evidence of harm beyond sleep disruption. Limiting screen time, especially before bed, is recommended to promote better sleep. ^{3 5 6 7 8}

How does the treatment for screen use effects on children's sleep differ from other treatments?

This treatment is unique because it focuses on reducing screen time to improve sleep in children, which is not a standard approach for sleep issues. Unlike medications or other therapies, it directly targets the behavior of screen use, aiming to advance bedtime and increase sleep duration by limiting screen exposure, especially before bed. ^{1 3 5 9 10}

What is the purpose of this trial?

The proposed project aims to disentangle the impact of evening light exposure emitted from tablet devices from the impact of arousing media content on children's sleep regulation, circadian physiology and next-day emotion regulation and executive functioning.

Research Team

Jennette P Moreno, PhD

Principal Investigator

Baylor College of Medicine

Candice A Alfano, PhD

Principal Investigator

University of Houston

Eligibility Criteria

The SCREENS study is for children aged between 8 and 11.9 years who are in the early stages of physical development, live with a parent or guardian at least half the time, and can communicate in English. It's not for kids with cognitive impairments like ADHD, sleep-affecting medical conditions, recent travelers across time zones, those with significant vision issues or diagnosed sleep/psychiatric disorders.

Inclusion Criteria

My child is between 8 and 11 years old.

My physical development is in the early stages.

I live with my parent(s) or legal guardian more than half the time.

Exclusion Criteria

Developmental or cognitive delays

Diagnosed cognitive or learning impairment affecting executive functioning (e.g., attention deficit hyperactivity disorder)

I am on medication that affects my sleep.

Timeline

Screening

Participants are screened for eligibility to participate in the trial

1 week

Baseline

Collection of baseline data including demographics and structured interviews

1 day

1 visit (virtual)

Experimental Weekend Protocol

Children participate in experimental and control conditions with screen media exposure and non-screen activities

3 days

In-home visits by research staff

Follow-up

Participants are monitored for changes in sleep, emotion regulation, and executive functioning

1 week

Treatment Details

Interventions

• Calming Content
• Exciting content
• Filtered dim tablet screen
• no screen control with dim light and calming activities
• unfiltered Bright tablet screen

Trial Overview This study tests how using tablets before bed affects children's sleep quality and next-day emotions and thinking skills. Kids will use tablets with different screen settings (dimmed vs bright) and content types (calming vs exciting), compared to no screen use at all.

Participant Groups

Group I: Group 4 Experimental Treatment 3 Interventions

Children will participate in 2 exposure conditions in their own homes (i.e., experimental and internal negative control), facilitated by research staff (one week apart, counterbalanced to control for possible order effects). The internal negative control will be the same for all groups, but the experimental exposure will differ. Both exposures will take place for 1 hour before bed in room lighting (40-50 lux). Experimental exposure: children in Group 4 will be exposed to a tablet with filtered dim screen light and calming media content (DL/CC). Internal negative control exposure: children will participate in non-screen-based quiet activities

Group II: Group 3 Experimental Treatment 3 Interventions

Children will participate in 2 exposure conditions in their own homes (i.e., experimental and internal negative control), facilitated by research staff (one week apart, counterbalanced to control for possible order effects). The internal negative control will be the same for all groups, but the experimental exposure will differ. Both exposures will take place for 1 hour before bed in room lighting (40-50 lux). Experimental exposure: children in Group 3 will be exposed to a tablet with filtered dim screen light and exciting media content (DL/EC). Internal negative control exposure: children will participate in non-screen-based quiet activities

Group III: Group 2 Experimental Treatment 3 Interventions

Children will participate in 2 exposure conditions in their own homes (i.e., experimental and internal negative control), facilitated by research staff (one week apart, counterbalanced to control for possible order effects). The internal negative control will be the same for all groups, but the experimental exposure will differ. Both exposures will take place for 1 hour before bed in room lighting (40-50 lux). Experimental exposure: children in Group 2 will be exposed to a tablet with unfiltered bright screen light and calming media content (BL/CC). Internal negative control exposure: children will participate in non-screen-based quiet activities

Group IV: Group 1 Experimental Treatment 3 Interventions

Children will participate in 2 exposure conditions in their own homes (i.e., experimental and internal negative control), facilitated by research staff (one week apart, counterbalanced to control for possible order effects). The internal negative control will be the same for all groups, but the experimental exposure will differ. Both exposures will take place for 1 hour before bed in room lighting (40-50 lux). Experimental exposure: children in Group 1 will be exposed to a tablet with unfiltered bright screen light and exciting media content (BL/EC). Internal negative control exposure: children will participate in non-screen-based quiet activities

Who Is Running the Clinical Trial?

Baylor College of Medicine

Lead Sponsor

Trials

1,044

Recruited

6,031,000+

Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD)

Collaborator

Trials

2,103

Recruited

2,760,000+

Findings from Research

In a study of 10,280 early adolescents aged 10-14, it was found that having a television or internet-connected device in the bedroom significantly increased the risk of sleep disturbances, with a 27% higher risk of trouble falling asleep.

Engaging in various screen activities before bed, such as streaming movies or using social media, was linked to greater sleep disturbances, suggesting that specific bedtime screen behaviors should be addressed to improve sleep quality in adolescents.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Bedtime screen use behaviors and sleep outcomes: Findings from the Adolescent Brain Cognitive Development (ABCD) Study. Nagata, JM., Singh, G., Yang, JH., et al.[2023]

Adolescents aged 12-18 who used technology devices like phones and laptops for 30 minutes before bed experienced delays in their bedtimes, with phone use causing a 9-minute delay and laptops causing a similar delay.

Using devices such as gaming consoles and watching YouTube was linked to a higher likelihood of insufficient sleep (≤7 hours) and increased daytime sleepiness, indicating that these activities may negatively impact sleep quality for adolescents.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

What's "app"-ning to adolescent sleep? Links between device, app use, and sleep outcomes. Pillion, M., Gradisar, M., Bartel, K., et al.[2023]

In a study of 736 Finnish preschool children, each additional hour of screen time was linked to a bedtime that was 11 minutes later and a sleep duration that was 10 minutes shorter, indicating a negative impact on sleep.

Different types of screen use, including TV, tablets, and computers, were all associated with later bedtimes and shorter sleep durations, highlighting the need for promoting balanced screen time and healthy sleep habits in young children.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Relationship between screen time and sleep among Finnish preschool children: results from the DAGIS study. Hiltunen, P., Leppänen, MH., Ray, C., et al.[2021]

In a study of 467 children and adolescents in Hong Kong, those who woke up due to smart device notifications experienced lower sleep efficiency and longer wake times after initially falling asleep, indicating a negative impact on their sleep quality.

Interestingly, these individuals compensated for their disrupted sleep by increasing their total sleeping time, suggesting that while smart device usage can affect sleep patterns, some children may adjust their sleep duration to make up for lost sleep.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Bedtime smart device usage and accelerometer-measured sleep outcomes in children and adolescents. Lee, PH., Tse, ACY., Cheung, T., et al.[2022]

Interventions aimed at controlling screen use in children aged 2-14 years resulted in a mean reduction of screen time by about 33 minutes per day and an increase in sleep duration by approximately 11 minutes per day, based on a systematic review of 11 studies involving 4,656 children.

While the findings suggest that reducing screen time may lead to small improvements in sleep duration, the evidence is not strong enough to confirm a direct causal relationship due to methodological limitations and variability among the studies.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Interventions to control children's screen use and their effect on sleep: A systematic review and meta-analysis. Martin, KB., Bednarz, JM., Aromataris, EC.[2021]

Children aged 4-8 who used three or more media devices, excluding TV/DVDs, were more likely to have delayed bedtimes, indicating a link between excessive device use and sleep disruption.

Smartphone use, even for just 0.1-1 hour per day, was associated with delayed bedtimes, particularly when used for gaming, highlighting the need for families to limit screen time to promote better sleep in young children.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Association between Media Use and Bedtime Delays in Young Children: An Adjunct Study of the Japan Environment and Children's Study. Yamamoto, M., Mezawa, H., Sakurai, K., et al.[2022]

In a study of 16 healthy adolescents, using a bright tablet screen before bedtime resulted in slightly faster reaction times and improved accuracy on a task compared to a dim screen, but these differences were minimal and likely not clinically significant.

No significant effects were observed on sleep onset or quality, indicating that short-term exposure to bright screens may not have a major impact on sleep for adolescents, suggesting the need for further research on longer screen usage durations.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Does one hour of bright or short-wavelength filtered tablet screenlight have a meaningful effect on adolescents' pre-bedtime alertness, sleep, and daytime functioning? Heath, M., Sutherland, C., Bartel, K., et al.[2015]

A literature review revealed that 90% of studies found a link between screen media use and both delayed bedtimes and reduced total sleep time in children and adolescents.

The widespread issue of sleep loss due to screen media has significant health implications, highlighting the need for further research to promote healthy sleep habits among youth and inform parents, teachers, and clinicians.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Youth Screen Media Habits and Sleep: Sleep-Friendly Screen Behavior Recommendations for Clinicians, Educators, and Parents. Hale, L., Kirschen, GW., LeBourgeois, MK., et al.[2019]

The review identified 36 studies examining the impact of electronic media on sleep in school-aged children and adolescents, highlighting that media use is consistently linked to delayed bedtimes and shorter total sleep duration.

A proposed model of how electronic media affects sleep is discussed, suggesting pathways for future research to explore these relationships further.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Electronic media use and sleep in school-aged children and adolescents: A review. Cain, N., Gradisar, M.[2022]

In a study of 3,011 school-age children in Sweden, those who slept less than the median reported significantly lower enjoyment of school, highlighting the importance of adequate sleep for positive school experiences.

Short sleep duration was linked to having a TV in the bedroom and spending over 2 hours daily on screens, which contributed to feelings of tiredness and difficulties in waking up, suggesting that media habits can negatively impact sleep and learning.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Sleep and television and computer habits of Swedish school-age children. Garmy, P., Nyberg, P., Jakobsson, U.[2022]

References

1. United States pubmed.ncbi.nlm.nih.gov

Bedtime screen use behaviors and sleep outcomes: Findings from the Adolescent Brain Cognitive Development (ABCD) Study. [2023]

2. Netherlands pubmed.ncbi.nlm.nih.gov

What's "app"-ning to adolescent sleep? Links between device, app use, and sleep outcomes. [2023]

3. Netherlands pubmed.ncbi.nlm.nih.gov

Relationship between screen time and sleep among Finnish preschool children: results from the DAGIS study. [2021]

4. Germany pubmed.ncbi.nlm.nih.gov

Bedtime smart device usage and accelerometer-measured sleep outcomes in children and adolescents. [2022]

5. England pubmed.ncbi.nlm.nih.gov

Interventions to control children's screen use and their effect on sleep: A systematic review and meta-analysis. [2021]

6. Switzerland pubmed.ncbi.nlm.nih.gov

Association between Media Use and Bedtime Delays in Young Children: An Adjunct Study of the Japan Environment and Children's Study. [2022]

7. England pubmed.ncbi.nlm.nih.gov

Does one hour of bright or short-wavelength filtered tablet screenlight have a meaningful effect on adolescents' pre-bedtime alertness, sleep, and daytime functioning? [2015]

8. United States pubmed.ncbi.nlm.nih.gov

Youth Screen Media Habits and Sleep: Sleep-Friendly Screen Behavior Recommendations for Clinicians, Educators, and Parents. [2019]

9. Netherlands pubmed.ncbi.nlm.nih.gov

Electronic media use and sleep in school-aged children and adolescents: A review. [2022]

10. United States pubmed.ncbi.nlm.nih.gov

Sleep and television and computer habits of Swedish school-age children. [2022]