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Parents, educators, and clinicians express concern about whether excessive use of screen media among young people affects sleep and wellbeing. In this article, we provide an overview of the current science on screens and sleep, with a focus on recommendations to reduce the potentially problematic influence of screen time on pediatric sleep. We then review how impaired sleep in pediatric populations may lead to a range of adverse behaviors, physical health problems and well-being outcomes. We begin with a summary of the two consensus statements on child and adolescent sleep needs. Then we summarize the range of screen habits among youth, focusing on screen habits at bedtime. Next, we review current literature on evidence of the effects of youth screen habits on sleep, and the mechanisms by which screen habits may impact sleep. We conclude with evidence-based strategies to improve sleep through sleep-friendly screen-behavior recommendations and other take-home messages for families and practitioners.

Exposure to the light emitted by screens in the evening hours before and/or during bedtime is another likely mechanism by which use of screen media negatively impacts sleep. Screen-based light may affect sleep via several pathways:increasing arousal and reducing sleepiness at bedtime,

Clinicians can help families improve their sleep health and screen media habits by encouraging parenting marked by high levels of warmth and support, as well as limits that are clearly communicated, consistently applied appropriate to the child’s behavior and context, and allow for developmentally appropriate autonomy(i.e. an authoritative parenting style). Box 1) All parents should begin instilling family bedtime routines and healthy sleep habits early in life, and adjust these routines as youth mature (See Box 2). If the youth health behaviors and habits become part of the child’s own daily routine, she will be better able to take charge of her own sleep health behaviors when this becomes appropriate in later years. For younger children, these routines mean establishing household rules related to screens and sleep early on. For older children and adolescents, they involve open conversation about the core reasons for behaviors. This proactive and engaged parenting style promotes cooperation and parent-child shared goals for children’s health and well-being, and aims to help children develop self-regulation skills, and eventually increasing autonomy to govern their own behavior.

For teenagers presenting with excessive screen time, a few clinical pearls may help families to follow the recommendations laid out in Box 1 and 2, below. First, one must always focus on the chief complaint, what brought the patient to seek help in the first place. In cases of excessive nighttime screen media use, children and adolescents are often seen in the clinician’s office for poor academic performance or lack of concentration in school. Upon taking a careful history, the clinician often discovers a significant lack of sleep, often attributable to patients staying up late while using mobile devices, computers, or videogames. Clinicians must discover the underlying factors (e.g., social or family stress) which drive the patient to use the screens in the late hours. Addressing such factors directly may be essential to motivating families to achieve healthier screen habits.

The currently-supported mechanisms underlying the relationship between screen media habits and sleep outcomes include (1) displacement of time spent sleeping by time spent using screens, (2) psychological stimulation from screen-media content, and (3) alerting and circadian effects of exposure to light from screens.

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Dim ambient lights in the evening at least two to three hours before bedtime, and if you “absolutely have to use computer or other light-emitting screens, change screen light wavelength to longer ones of orange-amber,” Zee said. “Importantly, get light during the day — daylight is healthy!”

night. Electronic devices stimulate brain activity, they say, disrupting your ability to drift off to sleep. But according to the National Sleep Foundation, more than 90 percent of Americans regularly use a computer

However, it’s not just that you’re on your phone that can disrupt your sleep. It’s more what you’re doing with the technology that makes a difference, like actively using your phone.

Phone screens and sleep have a tricky relationship. The blue light from your phone is an artificial color that mimics daylight. This can be great during the day, as it can make you feel more alert, but it’s just the opposite of what you need at night when you’re winding down and ready to hit the hay.

This isn’t necessarily happening to everyone, though. “Studies that have really shown support for light’s impact on sleep onset and melatonin production are much more people using screens for two hours straight prior to bedtime,” Dr. Drerup notes.

Dr. Drerup adds that what you’re doing on your phone before bed matters more. “The content you’re looking at probably has more of an impact than the blue light from the screens,” says Dr. Drerup. “There might be people that are more sensitive to it — but it’s really much more about what you’re doing on those devices.”

You probably know what it’s like to scroll through Facebook right before bed and see something that makes you upset. Unsurprisingly, stress and anxiety are often two major reasons for disrupted sleep.

Joanna Cooper, M.D., a neurologist and sleep medicine specialist with the Sutter East Bay Medical Foundation, says bright screens stimulate the part of our brain designed to keep us awake. Looking at a brightly-lit screen prior to sleep can make for a restless night.

Device screens produce blue light, Dr. Cooper says, which is the part of the light spectrum most active in our sleep cycle. Stimulation of this part of the brain suppresses production of melatonin, making it difficult for many people to “turn off” their brains and fall asleep.

“The light from our screens can delay our transition to sleep, even if we are engaged in some soothing activity online,” Dr. Cooper says. “But it’s more likely that our evening texting, television shows or video games are stimulating in themselves, keeping the brain busy and wound up, and even causing adrenaline rushes instead of calm.”

There is a growing body of research showing that exposure to bright blue light can disrupt people"s sleep patterns, and this is exactly the kind of light produced by modern LCD displays such as those on smartphones and tablets.

Along with various other health-focused apps, the new version of Apple"s mobile operating system, iOS 9.3, will include the Night Shift feature. This app will use the device"s clock and geolocation to determine what time the sun sets and will automatically shift the phone"s display color to the warmer, or redder, end of the light spectrum until the following morning.

"Blue light plays havoc with your sleep by disrupting your circadian rhythms," said Anne-Marie Chang, a neuroscientist and sleep expert at Pennsylvania State University. Chang published research last January showing that evening use of e-readers disturbed users" sleep patterns and reduced their alertness the following morning.

Studies have shown that disturbing these rhythms can increase a person"s chances of developing a variety of serious diseases. "Misalignment or disruption of these rhythms may result in acute and/or chronic health problems, including obesity, diabetes, cancer risk and cardiovascular disease," Chang told Live Science.

But exposure to artificial light at unusual times can cause similar shifts that disturb natural circadian rhythms. And Chang said human retinal ganglion cells are particularly sensitive to light with shorter wavelengths at the blue end of the spectrum, such as the light produced by smartphone, computer and TV displays.

While modern LED domestic lighting is often blue-light-enriched as well, the displays on many popular gadgets are more likely to have a negative effect, Chang said. "The reason for the focus on phones, laptops, tablets and other portable light-emitting devices as causing issues with circadian rhythms is that they are light sources that the user looks directly into, as opposed to an ambient light source," she said.

In other words, our screens have become a part of us. However, it might be time to break free from our phone separation anxiety before bed. MYCHN has compiled the four reasons you need to limit screen time before bed.

Our devices are supposed to make our lives easier. In many ways, they do—however, it’s not all sunshine and rainbows. Many of us use our phones all through the day and night. Phones and screens produce radiation and can harm your eyes.

Life on this planet is adapted to the 24-hour (h) solar day. Over evolutionary time, the predictable daily cycles of light and dark have been internalized in the form of circadian rhythms. Circadian (circa = about; dies = day) rhythms allow synchronization of biological and behavioral processes to the external temporal environment. Thus, optimal timing of physiological events is coordinated by these internal timekeepers. Endogenous circadian rhythms have a period of ~24 h and are reset on a daily basis to precisely 24 h through exposure to light–dark cues. Over the past century, however, the boundaries between day and night have been obscured by the widespread adoption of electric light at night. As a result, behavioral health and psychiatric consequences of circadian disruption by light at night are becoming increasingly apparent

The economic benefits of electric lighting soon ensued as night shift work was introduced. By the end of the 20th century, technology provided people with additional sources of night-time light, including television, computer screens, e-readers, smartphones, and tablet computers. Today, >80% of humans and 99% of those living in the US or Europe experience significant night-time light pollution

In addition to light at night, circadian rhythms can be disrupted by another modern convenience, jet travel across time zones. Jet lag, also called jet lag disorder, is a transient sleep problem that arises when an individual travels across multiple time zones

Social influences on the timing of human sleep becomes apparent when comparing sleep–wake behavior on work and free days. The vast majority of people display clear differences in both sleep duration and timing; sleep duration shortens significantly (by ~2 h/night) from the age of 10–17

In sum, lifestyle changes that have occurred in response to technological advances over the past century have resulted in unprecedented changes in the timing and duration of light exposure, which in turn has the potential to desynchronize circadian rhythms; increased prevalence of disrupted circadian rhythms strongly correlates with the increased incidence of mood disorders

Most of the evidence supporting the effects of atypical light exposure on affective responses has been gleaned from animal models, particularly rodents, because of the ease with which light exposure can be controlled. One advantage of using rodents is that the most common lab species are nocturnal, and so exposure to light at night occurs during their active and awake phase. Thus, light at night does not directly alter sleep in nocturnal species. This is important because most effects of disrupted circadian rhythms on human mood are attributed to sleep disruption, but studies using nocturnal species demonstrate that this is not the only cause as sleep remains intact when animals are exposed to dim light at night

There are few human studies that have examined the link between circadian disruption and MDD specifically, as most human data combine all types of depression. Nonetheless, studies examining the association between shift work and MDD have produced varied results

There is ample basic science evidence to support an association between disrupted circadian rhythms and depressive-like behavior. To assess the role of the SCN in regulating depressive-like behavior, Tataroglu and colleagues bilaterally lesioned the SCN and examined the effect on depressive-like behavior via forced swim tests

Similar effects of increased depressive-like responses have been demonstrated in other rodent models of circadian disruption. Rats exposed to 8 weeks of constant light exhibit increased depressive-like behavior concurrent with loss of diurnal rhythms in activity, melatonin, and corticosterone

Studies of rodents revealed relationships among the circadian system and anxiety-like disorders. For instance, targeted disruption of canonical molecular clock components alerts anxiety-like behavior. Mice with a Δ19 mutation in the Clock gene display reduced anxiety-like behavior and are less fearful of aversive stimuli than wild-type miceClock gene is sufficient to induce manic-like behaviorsPer1 and Per2 display elevated anxiety-like behavior, whereas mice lack either Per1 or Per2 do not have altered anxiety-like responsesPer1/Per2 expression in the nucleus accumbens (NAc) of wild-type mice also produces anxiety-like behavior, suggesting a causal role for these core clock components in the NAc for regulating anxiety.

Other studies have investigated how environmental disruption of circadian rhythms (e.g., via exposure to light at night) contributes to the development of anxiety-like behavior. For example, housing adult rats chronically in constant light induces anxiety-like behavioral responses

Circadian disruption in the form of jet lag has been reported to induce bipolar episodes in susceptible people who fly across multiple time zones; east to west travelers with BD who then experience a phase delay in circadian rhythms at their destination are more likely to develop depression, whereas those traveling west to east who then experience a phase advance in their circadian rhythms are more likely to develop mania

Historically, treatment for BD symptoms has been discovered by serendipity (lithium) or informed by treatments developed for other disorders with shared state, such as depression (described above). Early studies reported that BD patients have a ‘fast running’ circadian clock, likely leading to chronic circadian disruption; treatment with lithium, which slows the molecular circadian clock, ameliorates the symptoms and stabilizes circadian rhythmicity

In sum, disrupted circadian rhythms appear to be both a state marker and a trait of BD. These disruptions of circadian rhythms can arise either via internal desynchrony or environmental desynchrony and can both predispose one to BD, as well as induce bipolar episodes, dependent on the phase relationship between the internal and external circadian rhythms. Resynchronization and normalization of circadian rhythms (chronotherapy) has proven effective in prevention and treatment of bipolar episodes.

There is a paucity of animal studies of BD mainly because there are no animal models that satisfy the validity criteria for modeling this complex multifactorial disorderClockΔ19 mutant mouse, has a fundamentally disrupted molecular circadian clock and restoration of a functional molecular circadian clock to the VTA, likely restoring dopaminergic regulation, ameliorates the mania-like behaviorsClockΔ19 mutant mice have a genetically disrupted circadian clock and already recapitulate many mania-like behaviors based on their inherent internal circadian desynchrony, this model does not lend itself well to studying the effects of environmental circadian disruption on bipolar mania.

Circadian disruption by sleep deprivation can induce a manic-like phenotype in mice (increased aggression and hyperlocomotion), yet these effects are transient and behaviors return to baseline within 24 h

As mentioned, there is a strong genetic component to SZ, and given the extensive disruption of circadian rhythms in this mood disorder, it is not surprising that several core clock genes have been implicated. In a study that examined 276 single nucleotide polymorphisms (SNPs) at 21 circadian genes, significant associations were detected for 8 SNPs from 4 circadian-related genes (Retinoic acid-related orphan receptor (RORβ), Per2, Per3, and Neuronal Pas domain protein 2), however, no associations remained significant after correcting for multiple comparisons, suggesting these individual polymorphisms in clock genes are unlikely to confer sizeable (>1.5 OR) risk for SZ

Although light at night from modern electronic devices may be responsible for the circadian disruption affecting the psychiatric diseases discussed above, these devices might also provide the data to help resolve some disease states and improve outcomes. A recent study analyzing digital logon data from nearly 15,000 students reported that circadian disruption (social jet lag) negatively affects learning outcomes, and furthermore that these data could be used to time educational activities to minimize impairments in performance caused by circadian disruption at the individual and population levels

Additionally, future studies should focus on expanding both the clinical and basic science literature in relation to circadian disruption and behavioral health. There are numerous studies in humans examining the effects of shift work on behavioral and psychiatric health, however, the number of studies examining the effects of jet lag on mental health are modest. In 2017, commercial airlines carried more than 4 billion passengers (>50% of the world’s population). Hence, modern air travel has greatly increased the likelihood of experiencing disruption in circadian rhythms. Clinical and basic science research should reflect the increased prospect of experiencing circadian disruption via jet lag. Studies examining the effects of social jet lag on mental health are even more scarce. As noted, ~80% of the population suffers from social jet lag. Thus, it is essential to understand the consequences of social jet lag on behavioral health and appropriately manage them. Ultimately, the expansion of research in this field will broaden our knowledge and may result in novel treatments to improve patients’ quality of life and outcomes.

Insomnia, disrupted sleep, and daily burnout are linked to a heightened risk of not only  becoming infected with coronavirus, but also having more severe disease and a longer recovery period, suggests an international study of healthcare workers, published in the online journal BMJ Nutrition Prevention & Health.

Disrupted/insufficient sleep and work burnout have been linked to a heightened risk of viral and bacterial infections, but it’s not clear if these are also risk factors for COVID-19, say the researchers.

“Disruptions to the sleep-wake cycle can affect metabolic, immune and even psychological health,” she adds. “And sleep deprivation can make calorie dense foods, higher in fat, sugar and salt, more appealing, particularly during times of stress and/or difficult shift patterns, all of which takes a toll on overall health and wellbeing.”

Dim ambient lights in the evening at least two to three hours before bedtime, and if you “absolutely have to use computer or other light-emitting screens, change screen light wavelength to longer ones of orange-amber,” Zee said. “Importantly, get light during the day — daylight is healthy!”

For example, maybe you"re using sleeping pills or alcohol to fall asleep, which disrupts sleep even more over the long-term. Or maybe you drink excessive amounts of coffee during the day, making it harder to fall asleep later. Other daytime habits that can negatively impact your ability to sleep at night include having an irregular sleep schedule, napping, eating sugary foods or heavy meals too close to bedtime, and not getting enough exercise or exercising too late in the day.

Turn off all screens at least an hour before bed. Electronic screens emit a blue light that disrupts your body"s production of melatonin and combats sleepiness. So instead of watching TV or spending time on your phone, tablet, or computer, choose another relaxing activity, such as reading a book or listening to soft music.

Do a quiet, non-stimulating activity. If you"ve been awake for more than 20 minutes, get out of bed and do a quiet, non-stimulating activity, such as reading a book. Keep the lights dim and avoid screens so as not to cue your body that it"s time to wake up.

Green, A., Cohen-Zion, M., Haim, A., & Dagan, Y. (2017). Evening light exposure to computer screens disrupts human sleep, biological rhythms, and attention abilities. Chronobiology International, 34(7), 855–865. https://doi.org/10.1080/07420528.2017.1324878