Running head: A PRIMER FOR MEDIA SCHOLARS 1

This is a post-print version.

Sleep Research: A Primer for Media Scholars

Article accepted for publication in Health Communication

Please cite as: Exelmans, L., Van den Bulck, J. (ahead of print). Sleep Research: A Primer for

Media Scholars. Health Communication. https://doi.org/10.1080/10410236.2017.1422100

A PRIMER FOR MEDIA SCHOLARS 2

Abstract

The average amount of sleep people of all ages get has declined sharply in the past fifty years.

The detrimental health effects of sleep deprivation are well documented and substantial. Even

though electronic media use often takes place in the hours before sleep, the extent to which

media use may interact with sleep is understudied and not well understood. Communication

scholars are well-positioned to contribute in this area, as a systematic, theoretical

understanding of the relationship between media and sleep is still lacking. This primer charts

the state of knowledge on electronic media and sleep and explores possible next steps. First,

we introduce the problem of sleep deprivation and describe the basic science of sleep with

relevant terminology. Then, we review the research on electronic media and sleep and offer

an agenda for research.

A PRIMER FOR MEDIA SCHOLARS 3

“Technology has decoupled us from the 24-hour day to which our bodies evolved.”

(Charles Czeisler).

The Sleep Problem

Studies have estimated that we sleep 1 to 2 hours less than 50 years ago (Bixler, 2009;

Cappuccio & Miller, 2011). More than one in three (37.1%) adults are now sleeping less than

7 hours per night (Schoenborn & Adams, 2010), an amount at which physiological and

neurobehavioral problems develop and become progressively worse under chronic conditions

(Van Dongen, Maislin, Mullington, & Dinges, 2003). The National Sleep Foundation

(Gradisar et al., 2013) reported that 6 out 10 Americans (13-64 years old) are not getting

enough sleep to function properly. A study by Pallesen et al. (2008) showed an increase in

sleep onset problems among teens between 1983 and 2005 and Matricciani, Olds, and Petkov

(2012) found rapid declines in children’s sleep duration over the course of a century. In all, it

appears that a growing number of people is struggling with sleep, facing sleep problems, or

coping with chronic sleep insufficiency.

The consequences of sleep loss can be far-reaching. It is estimated that around 20% of

serious car accidents are connected to driver sleepiness; and fatigue induced occupational

errors are thought to be partly responsible for major global disasters such as the Exxon Valdez

oil spill or the nuclear reactor meltdown in Chernobyl (Institute of Medicine, 2006). The

cumulative effects of chronic sleep deprivation stretch to a variety of physical and mental

health consequences, including reduced memory function and learning ability, negative mood

states, risk behavior, obesity, reduced immune response, hypertension, and cardiovascular

disease (Luyster, Strollo, Zee, & Walsh, 2012; Strine & Chapman, 2005) . In sum, negative

effects of poor sleep produce a ripple effect, by spreading to a wide range of health issues,

resulting in an overall reduced quality of life and increased mortality (Grandner, Hale, Moore,

& Patel, 2011).

A PRIMER FOR MEDIA SCHOLARS 4

Given sleep’s pivotal role in health, research into the predictors of poor sleep has

spiked over the past decades. There is mounting evidence that electronic media use

contributes significantly to a shorter sleep duration, sleep disruption, longer sleep latency, and

overall poorer sleep quality (Hale & Guan, 2015). While clearly an interdisciplinary topic,

research on the effects of media use on sleep has mostly been conducted by sleep researchers.

The involvement of communication scholars in this field can have a crucial impact on its

advancement, as their theories and research methods are highly relevant for and transferrable

to sleep research. Consequently, communication scholars have a potentially significant role to

play in tackling the global epidemic of sleep insufficiency.

The goal of this primer is to help bridge the gap between sleep medicine research and

media studies. To that end, we will first describe the basic mechanics of sleep, introducing

relevant vocabulary (that will be highlighted in bold). Next, we will briefly review the

evidence linking media use to sleep and summarize the three most common explanations for

these effects. Finally, we will outline an agenda for research on this topic, suggesting where

the expertise of communication scholars is most valuable.

Sleep: Basic Mechanics and Terminology

What Is Sleep?

Although sleep may seem like a biologically passive state, it involves a complex

interaction of physiological processes (Luyster et al., 2012). In general, sleep is divided into

two states: non-rapid eye movement (NREM) sleep (75-80% of total sleep time) and rapid

eye movement (REM) sleep (20-25% of total sleep time). NREM sleep is divided into three

stages, characterized by a progressive decrease in brain wave activity, eye movement, and

heart rate. NREM stage 1 refers to sleep onset, a light stage of sleep often characterized as

“drifting off”, taking up 5% of total sleep time. During stage 2 of NREM sleep, eye

movement stops, conscious awareness of our surroundings fades, and brain waves slow down.
A PRIMER FOR MEDIA SCHOLARS 5

In total, we spend 45-55% of our sleep time in stage 2. Stage 3 of NREM is called deep sleep

or slow wave sleep, characterized by extremely slow brain waves (15-25% of total sleep

time). Most of the recovery processes take place during this stage. When awakened during

deep sleep, people feel groggy and disoriented for several minutes. During the last stage -

REM sleep - muscles relax completely, heart rate and blood pressure increases and eyes move

rapidly (20-25% of total sleep time). Information processing and memorization take places.

Because of increased brain activity, we often dream during this stage. We repeat the sleep

cycle of NREM and REM sleep 3-7 times per night, each cycle lasting 90-110 minutes. After

each cycle, we approach wakefulness before drifting off to NREM 1 again. As the night

progresses, the length of deep sleep (stage 3 NREM) decreases and REM sleep increases

(Lee, 2016; Luyster et al., 2012; Markov, Goldman, & Doghramji, 2012).

What Makes Us Sleep – Or Not? Sleep Regulation Processes

The two-process model describes the timing and regulation of sleep and wakefulness as

an interaction between the homeostatic and the circadian process. The homeostatic

process refers to the need for sleep or sleep pressure, which increases the longer you stay

awake. The homeostatic drive reaches its peak in the evening, decreases during sleep and is at

its lowest upon awakening. People suffering from sleep shortage experience a greater

homeostatic drive or a tendency to make up for lost sleep, typically resulting in shorter sleep

latency and longer total sleep time. The popular term for the circadian process is one’s

biological or internal clock, which regulates our circadian rhythm (circa = about; dian = day),

i.e., all the biological variables that fluctuate in a cycle length of approximately 24 hours

(Markov et al., 2012). Apart from the sleep-wake cycle, other variables that follow a circadian

rhythm are one’s body temperature, heart rate, and hormonal regulation. While our circadian

rhythm is intrinsic, meaning that it has an endogenous clock following a 24h cycle, it is also

constantly synchronized to maintain that 24h cycle by obtaining information from the
A PRIMER FOR MEDIA SCHOLARS 6

environment, a process called entrainment. Based on the information obtained from the

environment, and its own endogenous circadian clock, the circadian system regulates the

body’s sleep and wakefulness according to the time of the day

Both processes interact to regulate sleep: the sleep pressure from the homeostatic drive

increases throughout the day but is opposed by the circadian process, which sends alerting

signals to let us stay awake. When night comes, the circadian process will abruptly stop

sending the alerting signals, which allows the homeostatic sleep drive to take over, so sleep

becomes possible (Gillette & Abbott, 2005; Luyster et al., 2012; Markov et al., 2012).

How Much Sleep Do We Need?

Sleep need varies strongly between individuals (Ferrara & De Gennaro, 2001). For

example, it is well-documented that women have a greater sleep need than men and that sleep

need declines with age (Hume, Van, & Watson, 1998). Some individuals may need

significantly more or less sleep than the average and are categorized as long vs. short sleepers

(Aeschbach et al., 2003). Chronotype, or the extent to which someone can be categorized as

a morning or evening type (Roenneberg, Wirz-Justice, & Merrow, 2003), also influences our

sleep habits. Morning and evening types differ in the timing of sleep and wakefulness (i.e.,

their circadian rhythm). Morning types (referred to as “larks”) have an advanced internal

clock: they prefer earlier bedtimes and rise times, have a lower sleep need and are more alert

upon awakening. Evening types (“owls”) prefer to stay up late, tend to have a greater sleep

need, function at their peak later in the day, and have more irregular sleep schedules (Taillard,

Philip, & Bioulac, 1999). Although the common recommendation of getting 8 hours of sleep

per night represents the average sleep needed to function properly, “the amount of sleep we

need to be at our best is as individual as the amount of food we need” (Ferrara & De Gennaro,

2001, p.4).
A PRIMER FOR MEDIA SCHOLARS 7

Adolescents and Sleep: A Risk Group.

Over the course of puberty, adolescents develop sleep phase delay: compared to

children, they become increasingly inclined to stay up later at night and rise later in the

morning. They thus evolve from larks to owls. This shift in sleep phase is attributed to a

convergence of biological (such as delayed secretion of melatonin) and psychosocial (such as

increased social pressure, academic demands, and autonomy) changes during puberty

(Carskadon, 2011; Wolfson & Carskadon, 1998). However, concurrently with these changes,

there is a societal pressure on adolescents’ sleep: school’s start times function as the

predominant determinant of their rise time. School times cannot be delayed and often start

even earlier for adolescents than for their younger counterparts. While they are biologically

programmed to stay up later, school’s start times are incongruent with this shift. As a result,

sleep time becomes compressed and there is little opportunity to make up for lost sleep,

typically resulting in a tendency to compensate by sleeping late during the weekend, which

disrupts the sleep cycle further (Carskadon, 1999, 2011; Wolfson & Carskadon, 1998). While

sleep need generally declines with age, it does not change during adolescence: teens need

approximately 9 hours of sleep, the same as children. Research nonetheless shows that they

typically obtain only 6.5 to 7 hours of sleep, resulting in a severe and chronic sleep

deprivation of nearly 2h per day (Calamaro, Mason, & Ratcliffe, 2009; Hysing, Pallesen,

Stormark, Lundervold, & Sivertsen, 2013). In addition, other aspects of adolescent life, such

as academic and social pressure and stress, often interact and also lead to irregular sleep

patterns (Dahl & Lewin, 2002; Wolfson et al., 2003). In sum, adolescents experience a

dramatic sleep change as they mature. Inadequate sleep during this developmental phase can

have severe negative effects, both in the short and long term; marking adolescents as a

particular risk group in sleep research.

A PRIMER FOR MEDIA SCHOLARS 8

How Do We Measure Sleep?

Analyses of sleep involve the assessment of multiple sleep indicators, which can be

measured objectively or subjectively. The most important indicators are bedtime and rise

time, sleep duration and sleep quality. However, to capture sleep duration accurately,

additional parameters are needed, such as the time it takes to fall asleep (sleep latency) and

the frequency and duration of night wakings (sleep disturbances) (Matricciani, 2013). Sleep

quality is also partly dependent on a person’s sleep efficiency, a ratio of the time spent asleep

to the time spent in bed, and is normally around 85-90% in a healthy population (Buysse,

Reynolds, & Monk, 1989).

The gold standard in the objective measurement of sleep is polysomnography (PSG).

The “poly” in the word refers to the fact that PSG records various sleep parameters: the

electrical activity in the brain, eye movements, respiration rate, cardiac activity and limb

movements. Together, these indicators provide an accurate assessment of the diagnostic

criteria needed to determine sleep disorders, but it requires special equipment and expert

training. This method has excellent internal validity, but the fact that it is measured in the

highly artificial setting of a sleep lab reduces its external validity for media research questions

(Lee, 2016; Markov et al., 2012). Duration, type, access, content, and awareness of media use

in a laboratory setting is likely to be very different from a typical evening spent at home.

The second way of objectively measuring sleep is the use of actigraphy or ambulant

monitoring. An actigraph or accelerometer is usually worn on the wrist and will estimate

whether a subject is awake or asleep based on body movement. Actigraphy has proven to be

reliable and valid in studying sleep in healthy populations and is far less invasive, cheaper,

can be done at home, and makes longitudinal measurement possible. However, it also has
A PRIMER FOR MEDIA SCHOLARS 9

some notable disadvantages. It has an oversensitivity of scoring nocturnal movements as

wakefulness, thereby deflating the estimate of total sleep (Short, Gradisar, Lack, Wright, &

Carskadon, 2012). Moreover, it cannot discern between various sleep stages or between sleep

disorders, and becomes less reliable in clinical samples. So far, there is a large variety of

actigraphs, but there are no device standards, standardized units of measurement or analytic

methods, which make comparison across studies difficult. Therefore, the application is often

limited to monitoring the circadian rhythm, studying sleep in samples where PSG is less

feasible (such as infants or elderly people), monitoring treatment effects, and estimating

habitual sleep patterns over time (Ancoli-Israel et al., 2003; Lee, 2016; Sadeh, 2011).

In addition to these objective measurements, there exist a multitude of paper-based

self-report assessments of sleep. A meta-analysis by Hale and Guan (2015) showed that 99%

of studies on media and sleep rely on self-reports. There are several review studies on the

various self-report sleep scales that are available for research (Devine, Hakim, & Green,

2005; Spruyt & Gozal, 2011). To measure habitual nighttime sleep, the Pittsburgh Sleep

Quality Index (PSQI) (Buysse et al., 1989) is the most widely used (Lee, 2016). The

measure has undergone extensive validation and can be used in both clinical and non-clinical

samples. The PSQI integrates seven sleep components: sleep duration, subjective sleep

quality, sleep latency, sleep efficiency, use of sleep medication, sleep disturbances, and

daytime dysfunction. Both the sub scores on the components and the global score can be used

in research settings. Although the PSQI is very user friendly for both researcher and

respondent and can distinguish between patients and controls, it has received criticism too, for

instance regarding its measurement sensitivity (the usual cut-off score to discern good from

poor sleepers is argued to be too low), and that it does not pay sufficient attention to daytime

experience (Carpenter & Andrykowski, 1998). It should therefore preferably by accompanied

by a measure of fatigue, such as the Epworth Sleepiness Scale (Johns, 1991) or Flinders
A PRIMER FOR MEDIA SCHOLARS 10

Fatigue Scale (Gradisar et al., 2007) . When interested in tracking one’s experience with sleep

of having an indicator of the stability in sleep, sleep diaries are also valuable measurement

tools.

Comparison studies with diary data and objective sleep measures have shown that self-

reports offer a valid way to measure sleep variables (Monk et al., 2003; Wolfson et al., 2003),

and research concluded that diary data are superior to actigraphy when it comes to predicting

fatigue (Short et al., 2012) Nonetheless, self-report measures of sleep also have their

downsides, such as their vulnerability to recall bias (Hassan, 2005). It is also well-

documented that insomniacs, for example, underestimate their sleep duration, a phenomenon

called sleep-misperception (Harvey & Tang, 2013). Spruyt and Gozal (2011) have remarked

that there is an abundance of self-report measures for sleep that has not undergone rigorous

psychometric evaluation. There is, therefore, a big distinction between the use of published

versus validated questionnaires, a subtle difference that may escape notice when reading

journal articles or books.

While sleep researchers tend to take comfort in objective sleep assessment tools, it can

be argued that the subjective experience of sleep and fatigue may be at least as important, if

not more important, than objective measures, at least for some issues (Pilcher, Ginter, &

Sadowsky, 1997). This perspective is reflected in an increase in the use of subjective reports

as the outcome variable (Ancoli-Israel et al., 2003). This is further supported by the fact that

there are large individual differences in sleep need: one person will need 9 hours of sleep to

feel rested whereas the next only needs 6 hours (Ferrara & De Gennaro, 2001). In sum,

scholars have recommended, if the use of PSG is not feasible or advisable, to use actigraphy

in concert with subjective data to obtain a full and accurate assessment of sleep (Lee, 2016;

Sadeh, 2011). For complete self-reported research, it is advised to measure multiple

A PRIMER FOR MEDIA SCHOLARS 11

parameters of sleep, including bedtime, sleep latency, rise time, night awakenings, sleep

quality, and to separate weekdays from weekend days (Cain & Gradisar, 2010).

What about sleep apps?

In recent years, a staggering number of mobile phone apps have emerged that claim to

accurately register sleep related data. Some of these provide digital diaries to monitor sleep

habits (such as Sleep Journal or Yawnlog); while others track movement in bed to measure

sleep and thus require people to keep their phone on the bed (such as Sleep Cycle or Sleep

Bot). Van den Bulck (2014) argued that sleep apps have the potential to expand the field by

introducing a cost-effective way to obtain an unprecedented access to sleep data. There is,

however, a multitude of devices available and a lack of validation studies to assess whether

sleep apps and other wearables can accurately and consistently assess sleep parameters. Given

these limitations concerning the measurement validity of apps, sleep researchers have been

wary of their use in research settings (Behar, Roebuck, Domingos, Gederi, & Clifford, 2013;

Van den Bulck, 2014).

Electronic Media & Sleep: State of the Art

In addition to societal changes, such as longer working hours, shift work schedules,

and the idea that sleep can be easily missed out on, sleep insufficiency is exacerbated by

technology use (Bixler, 2009; Cappuccio & Miller, 2011). The shift towards poor sleep has

coincided with technological revolutions that have intensified media usage. Total daily media

use amounts to approximately 6 hours per day for 8-12 year olds and 9 hours per day for 13-

18 year olds (Common Sense Media, 2015). . In addition, electronic media have gravitated

towards our bedroom over the years (Bovill & Livingstone, 2001), which has been known to
A PRIMER FOR MEDIA SCHOLARS 12

stimulate evening usage (Cain & Gradisar, 2010). In all, we devote as much time to our

screens as we should be to sleeping.

Over the past decade, a growing number of scholars have studied the interplay

between electronic media and sleep. The most recent review study covered a total of 67

studies (Hale & Guan, 2015). While we cannot provide a comprehensive review of all the

research in this area, we will attempt to give an overview of the main findings on electronic

media and sleep and, most importantly, outline an agenda for future research. Readers who

are interested in a more extensive review are redirected to the meta-analyses by Cain and

Gradisar (2010) and Hale and Guan (2015).

Electronic Media as Inhibitors of Sleep

A poll by the National Sleep Foundation (2011) indicated that 95% of 1508

respondents (13-64 years old) used electronic media within the hour before bed. In another

study, almost 70% of teens indicated that electronic media use was their final evening activity

(Kubiszewski, Fontaine, Rusch, & Hazouard, 2013). The large majority of studies (90%) on

electronic media document negative effects of media use on numerous sleep parameters, such

as delayed bedtime (e.g., Kubiszewski et al., 2013; Oka, Suzuki, & Inoue, 2008; Woods &

Scott, 2016), shorter sleep time (e.g., Arora, Broglia, Thomas, & Taheri, 2014; Paavonen,

Pennonen, Roine, Valkonen, & Lahikainen, 2006), longer sleep latency (e.g., Dworak,

Schierl, Bruns, & Strüder, 2007; King et al., 2013), increased daytime fatigue (e;g., Lemola,

Perkinson-Gloor, Brand, Dewald-Kaufmann, & Grob, 2015; Li et al., 2007), and night

awakenings and nightmares (Van den Bulck, 2004a; Van den Bulck, Çetin, Terzi, &

Bushman, 2016). Such results have been replicated across media devices, and have been

found in cross-sectional, longitudinal and experimental designs. The presence of media in the

bedroom appears to exacerbate the problem: those with media in the bedroom report increased

usage (Christakis, Ebel, Rivara, & Zimmerman, 2004), and sleep duration was significantly
A PRIMER FOR MEDIA SCHOLARS 13

lower among teens who had four or more devices in their bedroom (National Sleep

Foundation, 2014). Although variations in effects can be found across cultures based on the

access to media and culturally related sleep problems (Owens, 2004), the negative effects of

technology use on sleep are a worldwide phenomenon.

Electronic Media as Facilitators of Sleep

One of the most common reasons parents have reported for having a television in a

child’s bedroom was the hope that it would help the child fall asleep (Rideout & Hamel,

2006). There has also been an increase in the development of content specifically designed to

help children calm down and transition to sleep at the end of the day (Zimmerman, 2008).

Significant proportions of adolescents (Eggermont &Van den Bulck, 2006), and adults

(Exelmans & Van den Bulck, 2016b) have reported using various media as a sleep aid.

Gooneratne et al. (2011) reported that the most common method of self-treating sleep

problems among older adults was watching television and Harmat, Takacs, and Bodizs (2008)

found that listening to relaxing classical music can reduce sleep problems in students. Overall,

the few studies that have investigated the idea that media may also be beneficial for sleep,

suggest that the practice of using media as a sleep aid appears to be counterproductive: those

who report using media as a sleep aid, also report poorer sleep (Eggermont & Van den Bulck,

2006; Exelmans & Van den Bulck, 2016b).

Underlying Mechanisms

The existing research on electronic media and sleep has mostly focused on charting

the effects, and less on investigating the underlying mechanisms that explain them. Cain and

Gradisar (2010) summarized them in a framework that contains three explanations for the

observed effects.

(Blue) light.
A PRIMER FOR MEDIA SCHOLARS 14

To attain optimal sleep quality and duration, the circadian clock is aligned with the

sleep-wake cycle. Our internal circadian clock resides in the hypothalamus, just above the

point where optic nerves cross, and, therefore, the most potent external time cue or

“zeitgeber” (zeit = time; geber = giver) for this synchronization is light. The signals received

by our internal clock are sent through various regions of the brain, including the pineal gland,

which responds by reducing the output of melatonin. Melatonin is often called the sleep

hormone, because its levels usually increase when darkness falls, making us sleepy. In

addition, the internal clock will regulate our heart rate, body temperature, and arousal levels to

attain an optimal sleep mood (Luyster et al., 2012; Markov et al., 2012).

Exposure to artificial light may result in misalignment between the sleep-wake cycle

and the internal clock. Exposure to light late in the day or early in the night will slow down

the internal clock, creating a fluctuation rate that exceeds 24 h. Light exposure in the evening

has been found to increase alertness and arousal levels, suppress melatonin production

(Wood, Rea, Plitnick, & Figueiro, 2012), and induce phase delay in the circadian clock (i.e.

delay sleep time) (Cajochen et al., 2011; Wood et al., 2012). The effects of light on the

secretion of melatonin are acute and can extend for hours beyond the light exposure (Berson,

Dunn, & Takao, 2002).

Research highlights that the effects of light on melatonin output and alertness may

vary depending on the (1) light level and spectrum, (2) duration of exposure, (3) size and

proximity to the screen, and (4) type of task. Shortwave length or blue light is most disruptive

to melatonin production. This is commonly the type of light emitted by media screens

(Cajochen et al., 2011). Wood et al. (2012) observed melatonin suppression after 1h of using

self-luminous tablets in young adults. They measured variations of light intensity during such

usage, and found that certain tasks on tablets are more harmful to sleep than others. Chang

and colleagues (2015) found that, compared to reading a printed book, reading a book on a
A PRIMER FOR MEDIA SCHOLARS 15

light-emitting e-reader before bedtime decreased subjective sleepiness, suppressed melatonin

production, prolonged sleep latency by 10 minutes, and impaired morning alertness. Overall,

these results point at a phase delay of the circadian clock, associated with increased risk of

developing chronic sleep deficiency, or sleep disorders such as delayed sleep phase disorder

or sleep onset insomnia.

Sleep displacement.

To date, the most commonly reported effects of electronic media on sleep are delayed

bedtime, prolonged sleep latency and decreased sleep duration (Cain & Gradisar, 2010).

These findings support the displacement hypothesis, which postulates that the time spent

using media replaces time that would otherwise be spent sleeping (Van den Bulck, 2000). An

early explanation of this process used Kubey's (1986) concept of media use and unstructured

time. Media use takes place during leisure time and has no predefined beginning or end

points. Van den Bulck (2000) argued that unstructured activities are most likely to displace

activities that are similarly unstructured, such as sleep. Indeed, the start and endpoint of sleep

are largely a matter of choice, with the exception, perhaps, of sleep policing attempts by

parents. As media use peaks before bedtime, sleep is vulnerable to displacement by the media

(Cain & Gradisar, 2010; Van den Bulck, 2004b).

According to Exelmans and Van den Bulck (2017a) sleep displacement has evolved

into a two-step process. The first step of sleep displacement occurs when people postpone

going to bed because they prefer spending time using the media. This is the most commonly

used meaning of the concept. People are, however, using media increasingly often and for

increasing amounts of time while already in bed. Consequently, people may not only be

putting off going to bed, but also delaying going to sleep once in bed. In their survey among
A PRIMER FOR MEDIA SCHOLARS 16

338 young adults, there were almost 40 minutes between people’s bedtime (the time at which

they went to bed) and what they referred to as shuteye-time (the time at which they decided

to try to sleep). The authors defined this second stage of sleep displacement (i.e., between

bedtime and shuteye time) as shuteye latency (Figure 1). Using customary self-reported

sleep measures, half of their participants would have had to be categorized as having sleep

onset insomnia (i.e., they were awake for longer than 30 minutes after going to bed). The

study shows, however, that this particular group spent this time in bed on other activities than

trying to go to sleep. Notably, media use was identified as an important driver of shuteye-

latency: a considerable proportion of the behaviors people reported engaging in in bed

involved media. In sum, the authors concluded that the fast-paced changes in media

necessitate a continuous reevaluation and update of existing survey questions in light of new

trends in both media consumption and sleep behavior (Exelmans & Van den Bulck, 2015,

2017a).

It is worth noting that the displacement hypothesis so far appears to hold exclusively

in young samples. For adults, research shows that media use is associated with later bedtimes,

but also with later rise times, and that, consequently, sleep duration does not appear to suffer.

This process is referred to as time-shifting. It has been hypothesized that many adults have

more control over their daytime schedule, which allows them to adjust both their shuteye- and

rise time to their media use (Custers & Van den Bulck, 2012; Exelmans & Van den Bulck,

2014, 2016a).

[FIGURE 1 AROUND HERE]

Arousal.

Violent and sexual content are as omnipresent in the media as they have ever been

(Brown et al., 2006; Huesmann & Taylor, 2006). It has been shown that exposure to such

content may induce excitement, fright, and stress reactions in children (Harrison & Cantor,
A PRIMER FOR MEDIA SCHOLARS 17

1999). The heightened arousal resulting from this exposure may be associated with difficulties

falling asleep or poor sleep quality. Paavonen et al. (2006) reported that children who had

viewed adult-targeted programs had a significantly higher risk of having sleep problems. A

more recent study showed that violent daytime media exposure was associated with increased

sleep problems, while this was not true for nonviolent daytime media use (Garrison, Liekweg,

& Christakis, 2011). Viewing frightening content may coincide with having nightmares and

night wakings, thus reducing sleep quality (Van den Bulck, 2004a; Van den Bulck et al.,

2016). An intervention study by Garrison and Christakis (2012) found that young children

whose parents had replaced violent media content with prosocial content reported improved

sleep during follow-up. While there are only a limited number of studies taking into account

the content of the media consumption, they suggest that the type of content may exert a

significant impact on sleep quality, presumably through its effect on arousal.

Agenda for Research

Identifying Sleep Correlates of Types of Media & Usage Styles

The topic of media and sleep covers a wide range of effects, given the wide range of

devices and outcome variables. While there is now a considerable body of research on the

effects of television, video games, and the internet, more recently introduced media such as

smartphones and social networking sites have received less attention. It has been hypothesized

that interactive media are more detrimental than “passive” media (Dworak et al., 2007;

Gradisar et al., 2013). In part this is because social interaction capabilities mean that the

devices have the potential to re-engage the user, even at night, when that user has decided to

stop using them (Arora et al., 2014; Van den Bulck, 2003; Woods & Scott, 2016). The

likelihood of displacing sleep in one user could also be higher when the termination of media

use is partly dependent on another user at the other end of the communication. In all, the

literature remains inconclusive on (1) which aspects of sleep are affected most by media use
A PRIMER FOR MEDIA SCHOLARS 18

and (2) whether some sleep parameters are more affected by some media than others (Cain &

Gradisar, 2010).

Few studies so far have considered differences in media usage styles. Although media-

multitasking is a well-known topic in media research, it has received scant attention in sleep

research. Calamaro and colleagues (2009) referred to a multitasking index in their study, but

merely divided the time spent on various media by the time frame they were interested in. As

such, the effects of simultaneously using different media devices have not yet been covered.

In addition, the research regarding the effects of television viewing on sleep has yielded

inconsistent findings (Hale & Guan, 2014) leading Bartel and colleagues (2015) to conclude

that television was not a significant risk factor for sleep. The practice of television viewing

has, however, undergone tremendous changes, that warrant a timely update of its

measurement strategy in sleep research. Binge viewing effects on sleep, for instance, are a

particular concern, considering the prevalence of consuming television in drenches rather than

drips (Matrix, 2014). One study reported that binge viewing frequency was associated with

poorer sleep quality, a relationship that was fully mediated by increased cognitive pre-sleep

arousal (Exelmans & Van den Bulck, in press). Excessive or compulsive usage of media or

so-called media addictions are also understudied topics. Finally, there could be merit in

looking at the differential impact of work-related vs. recreational media use.

Improving Measurement of Media Use

Sleep research has focused predominantly on the frequency and duration of media

usage when predicting the effects on sleep. To chart and understand the processes that are

involved in the interaction between media use and sleep, a number of refinements should be

considered. First, measures of media use should include when and where those media were

used, because research shows nightly or in-bed media use has a stronger impact on sleep than

overall media use (Exelmans & Van den Bulck, 2016a; Lemola et al., 2015; Woods & Scott,
A PRIMER FOR MEDIA SCHOLARS 19

2016). Second, while researched in an only limited number of studies (37% according to Hale

and Guan, 2015), researchers should also study the social context of use. It can be

hypothesized that a partner, parent, or child likely co-determine the termination of media

usage or the timing of lights out. Third, little is known about differences in effects of media

use depending on the content. Relaxing, (negatively or positively) arousing, or frightening

types of content are likely to have a different effect on sleep outcomes. Moreover, in the era

of streaming services and digital television, content is hyper-personalized and viewers are

increasingly exposed to sophisticated narrative structures that are aimed at tying the viewer to

the screen (Jenner, 2014, 2015). For social media or smartphones, there is virtually no

research differentiating between the various activities done on the screen or active vs. passive

usage of a social networking site. Fourth, we found only two studies that have examined the

role of media engagement in predicting the effects on sleep: Smith, Gradisar, King, and Short

(2017) demonstrated that increased flow significantly predicted bedtime delay among gamers

and Woods and Scott (2016) found that those who were more emotionally invested in social

media use experienced poorer sleep quality. It would be interesting to study the association

between arousal originating from increased investment in media use (i.e., flow, transportation,

fear of missing out), and pre-sleep arousal. Fifth, a recent study by Exelmans and Van den

Bulck (2017b) led to unexpected results when taking into account media habits. Strong media

habits appeared to prevent bedtime delay. More research on habit formation, habit strength,

regarding the same and other media would further advance our knowledge of the processes

leading to media displacement and time shifting. Six, based on the findings regarding the

effect of blue light emitted by screens, researchers could look at the technical characteristics

of the device such as the proximity, size and color composition of the screen. In all,

developing a systematic understanding of the characteristics in media usage patterns that are

most harmful to sleep could benefit the development of targeted interventions.

A PRIMER FOR MEDIA SCHOLARS 20

Increasing Diversity in Research Samples

Most studies on the relationship between media use and sleep behavior have been

conducted among children and adolescents, which is unsurprising. In addition to being a risk

group for sleep deprivation, children and teens are far more preoccupied with media than

adults are assumed to be. It seems that adolescents are being set up to fail and become stuck in

a cycle of dysregulation where their unhealthy sleep behavior stimulates increased media

usage and vice versa. The particular concerns over the disruptive effects of media on sleep

aimed at young children and adolescents are therefore certainly justified.

However, this reasoning should not imply that studies among adults are unjustified or less
worthwhile. 90% of people aged 13-64 yrs old use technology around bedtime (Gradisar, Wolfson,
Harvey et al., 2013).
For example, the proportion of video gamers has been found to diminish with age, yet

the average gamer is not an adolescent, but an adult (between 30 and 35 years old). The

frequency of gaming even increases with age (Lenhart, Jones, & Macgill, 2008). It would be

wrong to assume that the potential effects of video games are therefore an issue in adolescents

only. Similarly, it has been hypothesized that sleep quality and duration are progressively

declining because our daytime schedules have become more crammed (Bixler, 2009). In

comparison with children and teens, adults are juggling far more responsibilities, putting more

pressure on their sleep. For instance, most research has looked at entertainment and leisure

media. Work-related late night media use (such as e-mail) has not yet been studied in relation

to sleep. Finally, adults are responsible for their own sleep schedule, while children’s sleep is

often being watched over by their parents. Given these arguments and the fact that sleep

varies highly depending on age, findings from young samples should not be extrapolated to

adults (or vice versa) without further research.

Most research is conducted in normative samples. There is merit in conducting

research in clinical samples or in case-control studies that allow an accurate comparison of the

functionalities of media use between normative and clinical samples. Media use, selection,
A PRIMER FOR MEDIA SCHOLARS 21

and motives can be entirely different for those coping with a sleep problem. We have argued

earlier in this paper that people often believe that media can be used as a sleep aid, and Mood

Management Theory (Zillmann, 1988) supports the assertion that engaging in media may aid

to recover from aversive mood, stress or strain. The use of media and their functionalities in

clinical samples is an interesting avenue for future research.

Clinical Relevance

While the research on media and sleep has produced mostly significant findings, the

question that often remains unanswered is whether and to what extent these findings are

clinically relevant. For example, one study found that each additional hour of video gaming

significantly delayed bedtime by 6.9 minutes and rise time by 13.8 minutes. While video

gaming was related to more daytime fatigue, but it was not clear whether this delay also

coincided with other noticeable health impairment (Exelmans & Van den Bulck, 2014). There

are some starting points in the literature, nonetheless. King et al. (2013) found that prolonged

violent video gaming (150 min) led to a 7% decrease in adolescents’ sleep efficiency score, a

reduction that categorized these gamers below the established cut-off score (85%) used to

identify sleep disorders such as insomnia. Oka et al. (2008) found that those who played

video gaming or used the internet before bedtime slept two hours longer on weekend nights

than on weeknights, , a discrepancy designated as clinically significant by the American

Academy of Sleep Medicine (2005). To date, experimental research that determines whether

reductions in media use or other evidence-based interventions can clinically improve sleep is

extremely rare.

Explore Causality Issues

Most studies on media and sleep have relied on cross-sectional data. Some scholars

therefore wonder whether the relationship between media and sleep might also be reversed

(sleep difficulties lead to more media use) or even be bidirectional (i.e. media use has a
A PRIMER FOR MEDIA SCHOLARS 22

negative effect on sleep, which is associated with increased media use). Results from

longitudinal studies are mixed. Johnson, Cohen, Kasen, First, and Brook (2004) indicated that

television viewing (>3h per day) during adolescence was associated with a significantly

higher risk of having sleep problems during early adulthood and a two-wave study by

Nuutinen, Ray, and Roos (2013) found that computer use, television viewing and the presence

of media in the bedroom reduced sleep duration in children. A 3-year longitudinal study by

Tavernier & Willoughby (2014) among university students, however, found that media use

was an outcome of sleep problems instead of the reverse. They explained these unexpected

effects by hypothesizing that the relationship between media use and sleep quality evolves

across the life span. The results of Johnson et al. (2004) suggested a positive effect of reduced

media use at age 14 on reduced sleep problems at age 16, but no effect of reduced media use

at age 16 on reduced sleep problems at age 22. Research on the use of media as sleep aid

emphasized the necessity of a longitudinal design to ascertain whether those who use

electronic media to aid sleep may be even more tired if they did not do so. In sum, more

longitudinal studies are needed to examine the temporal or cyclical relationship between

media and sleep (Hysing, Stormark, Jakobsen, & Lundervold, 2015).

Conclusion

Sleep and media use both compete for a similar slice of our time. More and more, one cannot

increase without limiting the time available for the other. The growing availability,

portability, and even wearability of today’s “old” and “new” media exacerbate the issues. At

the crossroads where media uses and effects research and sleep medicine meet, fascinating

new insights await for both disciplines.

A PRIMER FOR MEDIA SCHOLARS 23

References

Aeschbach, D., Sher, L., Postolache, T. T., Matthews, J. R., Jackson, M. A., & Wehr, T. A.

(2003). A longer biological night in long sleepers than in short sleepers. Journal of

Clinical Endocrinology and Metabolism, 88, 26–30. https://doi.org/10.1210/jc.2002-

020827

American Academy of Sleep Medicine. (2005). The international classification of sleep

disorders diagnostic and coding manual. Westchester, IL: American

Ancoli-Israel, S., Cole, R., Alessi, C., Chambers, M., Moorcroft, W., & Pollak, C. P. (2003).

The role of actigraphy in the study of sleep and circadian rhythms. Sleep, 26, 342–

392.

Arora, T., Broglia, E., Thomas, G. N., & Taheri, S. (2014). Associations between specific

technologies and adolescent sleep quantity, sleep quality, and parasomnias. Sleep

Medicine, 15, 240–247. https://doi.org/10.1016/j.sleep.2013.08.799

Bartel, K. A., Gradisar, M., & Williamson, P. (2015). Protective and risk factors for

adolescent sleep: A meta-analytic review. Sleep Medicine Reviews, 21, 72–85.

https://doi.org/10.1016/j.smrv.2014.08.002

Behar, J., Roebuck, A., Domingos, J. S., Gederi, E., & Clifford, G. D. (2013). A review of

current sleeps screening applications for smartphones. Physiological Measurement,

34, R29-46. https://doi.org/10.1088/0967-3334/34/7/R29

Berson, D. M., Dunn, F. A., & Takao, M. (2002). Phototransduction by retinal ganglion cells

that set the circadian clock. Science, 295, 1070–1073.

https://doi.org/10.1126/science.1067262

Bixler, E. (2009). Sleep and society: An epidemiological perspective. Sleep Medicine, 10, S3-

6. https://doi.org/10.1016/j.sleep.2009.07.005
A PRIMER FOR MEDIA SCHOLARS 24

Bovill, M., & Livingstone, S. M. (2001). Bedroom culture and the privatization of media use.

In M. Bovill, & S.M. Livingstone (Eds). Children and Their Changing Media

Environment: A European Comparative Study, (pp.179–200). Mahwah, NJ: Lawrence

Erlbaum Associates.

Brown, J. D., L’Engle, K. L., Pardun, C. J., Guo, G., Kenneavy, K., & Jackson, C. (2006).

Sexy media matter: Exposure to sexual content in music, movies, television, and

magazines predicts black and white adolescents’ sexual behavior. Pediatrics, 117,

1018–1027. https://doi.org/10.1542/peds.2005-1406

Buysse, D. J., Reynolds, C., & Monk, T. (1989). The Pittsburgh Sleep Quality Index: A new

instrument for psychiatric practice and research. Psychiatry Research, 28, 193–213.

https://doi.org/http://dx.doi.org/10.1016/0165-1781(89)90047-4

Cain, N., & Gradisar, M. (2010). Electronic media use and sleep in school-aged children and

adolescents: A review. Sleep Medicine, 11, 735–742.

https://doi.org/10.1016/j.sleep.2010.02.006

Cajochen, C., Frey, S., Anders, D., Späti, J., Bues, M., Pross, A., … Stefani, O. (2011).

Evening exposure to a light emitting diodes (LED)-backlit computer screen affects

circadian physiology and cognitive performance. Journal of Applied Physiology, 110,

1432–1438. https://doi.org/10.1152/japplphysiol.00165.2011

Calamaro, C. J., Mason, T. B. A., & Ratcliffe, S. J. (2009). Adolescents living the 24/7

lifestyle: Effects of caffeine and technology on sleep duration and daytime

functioning. Pediatrics, 123, e1005-10. https://doi.org/10.1542/peds.2008-3641

Cappuccio, F. P., & Miller, M. A. (2011). Is prolonged lack of sleep associated with obesity?

BMJ, 10–12. https://doi.org/10.1136/bmj.d3306

A PRIMER FOR MEDIA SCHOLARS 25

Carpenter, J. S., & Andrykowski, M. A. (1998). Psychometric evaluation of the Pittsburgh

Sleep Quality Index. Journal of Psychosomatic Research, 45, 5–13.

https://doi.org/10.1016/S0022-3999(97)00298-5

Carskadon, M. A. (1999). When worlds collide: Adolescent need for sleep versus societal

demands. Phi Delta Kappan, 80, 348–353.

Carskadon, M. A. (2011). Sleep in adolescents: The perfect storm. Pediatric Clinics of North

America, 58, 637–647. https://doi.org/10.1038/jid.2014.371

Chang, A., Aeschbach, D., Duffy, J. F., & Czeisler, C. A. (2015). Evening use of light-

emitting eReaders negatively affects sleep, circadian timing , and next-morning

alertness. Proceedings of the National Academy of Sciences, 112, 1232–1237.

https://doi.org/10.1073/pnas.1418490112

Christakis, D. A., Ebel, B. E., Rivara, F. P., & Zimmerman, F. J. (2004). Television, video,

and computer game usage in children under 11 years of age. The Journal of

Pediatrics, 145, 652–656. https://doi.org/10.1016/j.jpeds.2004.06.078

Custers, K., & Van den Bulck, J. (2012). Television viewing, internet use, and self-reported

bedtime and rise time in adults: Implications for sleep hygiene recommendations from

an exploratory cross-sectional study. Behavioral Sleep Medicine, 10, 96–105.

https://doi.org/10.1080/15402002.2011.596599

Dahl, R. E., & Lewin, D. S. (2002). Pathways to adolescent health: Sleep regulation and

behavior. The Journal of Adolescent Health, 31, 175–84. Retrieved from

http://www.ncbi.nlm.nih.gov/pubmed/12470913

Devine, E. B., Hakim, Z., & Green, J. (2005). A systematic review of patient-reported

outcome instruments measuring sleep dysfunction in adults. PharmacoEconomics, 23,

889–912. https://doi.org/10.2165/00019053-200523090-00003
A PRIMER FOR MEDIA SCHOLARS 26

Dworak, M., Schierl, T., Bruns, T., & Strüder, H. K. (2007). Impact of singular excessive

computer game and television exposure on sleep patterns and memory performance of

school-aged children. Pediatrics, 120, 978–85. https://doi.org/10.1542/peds.2007-0476

Eggermont, S., & Van den Bulck, J. (2006). Nodding off or switching off? The use of popular

media as a sleep aid in secondary-school children. Journal of Paediatrics and Child

Health, 42, 428–33. https://doi.org/10.1111/j.1440-1754.2006.00892.x

Exelmans, L., & Van den Bulck, J. (2014). Sleep quality is negatively related to video gaming

volume in adults. Journal of Sleep Research, 24, 189–196.

https://doi.org/10.1111/jsr.12255

Exelmans, L., & Van den Bulck, J. (2015). Technology and sleep: How electronic media

exposure has impacted core concepts of sleep medicine. Behavioral Sleep Medicine,

13, 439–441. https://doi.org/10.1080/15402002.2015.1083025

Exelmans, L., & Van den Bulck, J. (2016a). Bedtime mobile phone use and sleep in adults.

Social Science & Medicine, 148, 93–101.

https://doi.org/10.1016/j.socscimed.2015.11.037

Exelmans, L., & Van den Bulck, J. (2016b). The use of media as a sleep aid in adults.

Behavioral Sleep Medicine, 14, 121–133.

https://doi.org/10.1080/15402002.2014.963582

Exelmans, L., & Van den Bulck, J. (2017a). Bedtime, shuteye time and electronic media:

Sleep displacement is a two-step process. Journal of Sleep Research, 26, 363-370.

https://doi.org/10.1111/jsr.12510

Exelmans, L., & Van den Bulck, J. (in press). Binge viewing, sleep and the role of pre-sleep

arousal. Journal of Clinical Sleep Medicine.

A PRIMER FOR MEDIA SCHOLARS 27

Exelmans, L., & Van den Bulck, J. (2017b). “Glued to the tube”: The interplay between self-

control, evening television viewing, and bedtime procrastination. Communication

Research. https://doi.org/10.1177/0093650216686877

Ferrara, M., & De Gennaro, L. (2001). How much sleep do we need? Sleep Medicine

Reviews, 5, 155–179. https://doi.org/10.1053/smrv.2000.0138

Garrison, M. M., & Christakis, D. A. (2012). The impact of a healthy media use intervention

on sleep in preschool children. Pediatrics, 130, 492–9.

https://doi.org/10.1542/peds.2011-3153

Garrison, M. M., Liekweg, K., & Christakis, D. A. (2011). Media use and child sleep: The

impact of content, timing, and environment. Pediatrics, 128, 29–35.

https://doi.org/10.1542/peds.2010-3304

Gillette, M. U., & Abbott, S. M. (2005). Basic mechanisms of circadian rhythms and their

relation to the sleep/wake cycle. In D. P. Cardinali & S. R. Pandi-Perumal (Eds.),

Neuroendocrine Correlates of Sleep/Wakefulness (pp. 19–40). Springer US.

Gooneratne, N. S., Tavaria, A., Patel, N., Madhusudan, L., Nadaraja, D., Onen, F., &

Richards, K. C. (2011). Perceived effectiveness of diverse sleep treatments in older

adults. Journal of the American Geriatrics Society, 59, 297–303.

https://doi.org/10.1111/j.1532-5415.2010.03247.x

Gradisar, M., Ph, D., Lack, L., Richards, H., Hon, B. P., Harris, J., & Gallasch, J. (2007). The

Flinders Fatigue Scale: Preliminary psychometric properties and clinical sensitivity of

a new scale for measuring daytime fatigue associated with insomnia. Journal of

Clinical Sleep Medicine, 3, 722–728.

Gradisar, M., Wolfson, A. R., Harvey, A. G., Hale, L., Rosenberg, R., & Czeisler, C. A.

(2013). The sleep and technology use of Americans: Findings from the National Sleep
A PRIMER FOR MEDIA SCHOLARS 28

Foundation’s 2011 Sleep in America Poll. Journal of Clinical Sleep Medicine, 9,

1291–1299. https://doi.org/10.5664/jcsm.3272

Grandner, M. A., Hale, L., Moore, M., & Patel, N. P. (2011). Mortality associated with short

sleep duration: The evidence, the possible mechanism and the future. Sleep Medicine

Reviews, 14, 191–203. https://doi.org/10.1016/j.smrv.2009.07.006.Mortality

Hale, L., & Guan, S. (2015). Screen time and sleep among school-aged children and

adolescents: A systematic literature review. Sleep Medicine Reviews, 21, 50–58.

https://doi.org/10.1016/j.smrv.2014.07.007

Harmat, L., Takacs, J., & Bodizs, R. (2008). Music improves sleep quality in students.

Journal of Advanced Nursing, 62, 327–336. https://doi.org/10.1111/j.1365-

2648.2008.04602.x

Harrison, K., & Cantor, J. (1999). Tales from the screen: Enduring fright reactions to scary

media. Media Psychology, 1, 97–116. https://doi.org/10.1207/s1532785xmep0102_1

Harvey, A. G., & Tang, N. (2013). (Mis)perception of sleep in insomnia: A puzzle and a

resolution. Psychological Bulletin, 138, 77–101. https://doi.org/10.1037/a0025730.

(Mis)Perception

Hassan, E. (2005). Recall bias can be a threat to retrospective and prospective research

designs. The Internet Journal of Epidemiology, 3, 1–11. https://doi.org/10.5580/2732

Huesmann, L. R., & Taylor, L. D. (2006). The role of media violence in violent behavior.

Annual Review of Public Health, 27, 393–415.

https://doi.org/10.1146/annurev.publhealth.26.021304.144640

Hume, K. I., Van, F., & Watson, A. (1998). A field study of age and gender differences in

habitual adult sleep. Journal of Sleep Research, 7, 85–94.

A PRIMER FOR MEDIA SCHOLARS 29

Hysing, M., Pallesen, S., Stormark, K. M., Lundervold, A. J., & Sivertsen, B. (2013). Sleep

patterns and insomnia among adolescents: A population-based study. Journal of Sleep

Research, 22, 549–556. https://doi.org/10.1111/jsr.12055

Hysing, M., Stormark, K. M., Jakobsen, R., & Lundervold, A. J. (2015). Sleep and use of

electronic devices in adolescence: Results from a large population-based study. BMJ

Open, 5, 1–8. https://doi.org/10.1136/bmjopen-2014-006748

Institute of Medicine. Sleep Disorders and Sleep Deprivation: An Unmet Public Health

Problem. Washington, DC: The National Academies Press; 2006.

Jenner, M. (2014). Is this TVIV? On Netflix, TVIII and binge-watching. New Media &

Society, , 1–17. https://doi.org/10.1177/1461444814541523

Jenner, M. (2015). Binge-watching: Video-on-demand, quality TV and mainstreaming

fandom. International Journal of Cultural Studies, 20, 304-320.

https://doi.org/10.1177/1367877915606485

Johns, M. (1991). A new method for measuring daytime sleepiness: the Epworth Sleepiness

Scale. Sleep, 14, 540–545. Retrieved from http://epworthsleepinessscale.com/wp-

content/uploads/2008/12/a-new-method-for-measuring-daytime-sleepiness-the-

epworth-sleepiness-scale2.pdf

Johnson, J. G., Cohen, P., Kasen, S., First, M. B., & Brook, J. S. (2004). Association between

television viewing and sleep problems during adolescence and early adulthood.

Archives of Pediatrics & Adolescent Medicine, 158, 562–568.

https://doi.org/10.1001/archpedi.158.6.562

King, D. L., Gradisar, M., Drummond, A., Lovato, N., Wessel, J., Micic, G., … Delfabbro, P.

(2013). The impact of prolonged violent video-gaming on adolescent sleep: An

experimental study. Journal of Sleep Research, 22, 137–43.

https://doi.org/10.1111/j.1365-2869.2012.01060.x
A PRIMER FOR MEDIA SCHOLARS 30

Kubey, R. (1986). Television use in everyday life: Coping with unstructured time. Journal of

Communication, 36, 108–123. https://doi.org/10.1111/j.1460-2466.1986.tb01441.x

Kubiszewski, V., Fontaine, R., Rusch, E., & Hazouard, E. (2013). Association between

electronic media use and sleep habits: An eight-day follow-up study. International

Journal of Adolescence and Youth, 19, 395–407.

https://doi.org/10.1080/02673843.2012.751039

Lee, D. R. (2016). Teaching the world to sleep. Psychological and behavioural assessment

and treatment strategies for people with sleeping problems and insomnia. London:

Karnac Books.

Lemola, S., Perkinson-Gloor, N., Brand, S., Dewald-Kaufmann, J. F., & Grob, A. (2015).

Adolescents’ electronic media use at night, sleep disturbance, and depressive

symptoms in the smartphone age. Journal of Youth and Adolescence, 44, 405–418.

https://doi.org/10.1007/s10964-014-0176-x

Lenhart, A., Jones, S., & Macgill, A. R. (2008). Adults and video games. Pew internet project

data memo.

Li, S., Jin, X., Wu, S., Jiang, F., Yan, C., & Shen, X. (2007). The impact of media use on

sleep patterns and sleep disorders among school-aged children in China. Sleep, 30,

361–367.

Luyster, F. S., Strollo, P. J., Zee, P. C., & Walsh, J. K. (2012). Sleep: A health imperative.

Sleep, 35, 727–34. https://doi.org/10.5665/sleep.1846

Markov, D., Goldman, M., & Doghramji, K. (2012). Normal sleep and circadian rhythms.

Sleep Medicine Clinics, 7, 417–426. https://doi.org/10.1016/j.jsmc.2012.06.015

Matricciani, L. (2013). Subjective reports of children’s sleep duration: Does the question

matter? A literature review. Sleep Medicine, 14, 303–311.

https://doi.org/10.1016/j.sleep.2013.01.002
A PRIMER FOR MEDIA SCHOLARS 31

Matricciani, L., Olds, T., & Petkov, J. (2012). In search of lost sleep: Secular trends in the

sleep time of school-aged children and adolescents. Sleep Medicine Reviews, 16, 203–

11. https://doi.org/10.1016/j.smrv.2011.03.005

Matrix, S. (2014). The Netflix effect: Teens, binge watching, and on-demand digital media

trend. Jeunesse: Your People, Texts, Cultures, 6.

Monk, T. H., Buysse, D. J., Kennedy, K. S., Pods, J. M., DeGrazia, J. M., & Miewald, J. M.

(2003). Measuring sleep habits without using a diary: The Sleep Timing

Questionnaire. Sleep, 26, 208–12. Retrieved from

http://www.ncbi.nlm.nih.gov/pubmed/12683481

National Sleep Foundation. (2014). 2014 Sleep in America Poll: Sleep in the modern family.

Washington, DC.

Nuutinen, T., Ray, C., & Roos, E. (2013). Do computer use, TV viewing, and the presence of

the media in the bedroom predict school-aged children’s sleep habits in a longitudinal

study? BMC Public Health, 13, 684. https://doi.org/10.1186/1471-2458-13-684

Oka, Y., Suzuki, S., & Inoue, Y. (2008). Bedtime activities, sleep environment, and

sleep/wake patterns of Japanese elementary school children. Behavioral Sleep

Medicine, 6, 220–233. https://doi.org/10.1080/15402000802371338

Owens, J. A. (2004). Sleep in children: Cross-cultural perspectives. Sleep and Biological

Rhythms, 2, 165–173. https://doi.org/10.1111/j.1479-8425.2004.00147.x

Paavonen, E. J., Pennonen, M., Roine, M., Valkonen, S., & Lahikainen, A. R. (2006). TV

exposure associated with sleep disturbances in 5 - to 6-year-old children. Journal of

Sleep Research, 15, 154–61. https://doi.org/10.1111/j.1365-2869.2006.00525.x

Pallesen, S., Hetland, J., Sivertsen, B., Samdal, O., Torsheim, T., & Nordhus, I. H. (2008).

Time trends in sleep-onset difficulties among Norwegian adolescents: 1983--2005.

A PRIMER FOR MEDIA SCHOLARS 32

Scandinavian Journal of Public Health, 36, 889–895.

https://doi.org/10.1177/1403494808095953

Pilcher, J. J., Ginter, D. R., & Sadowsky, B. (1997). Sleep quality versus sleep quantity:

Relationships between sleep and measures of health, well-being and sleepiness in

college students. Journal of Psychosomatic Research, 42, 583–96.

Rideout, V., & Hamel, E. (2006). The media family: Electronic media in the lives of infants,

toddlers, preschoolers and their parents. Menlo Park, CA: Kaiser Family Foundation.

Rideout, V. (2015). The common sense census: Media use by tweens and teens. San

Francisco, CA: Common Sense Media. Retrieved from https://www.

commonsensemedia.org/research/the-common-sense-census-media-use-bytweens-and-

teens

Roenneberg, T., Wirz-Justice, A., & Merrow, M. (2003). Life between clocks: daily temporal

patterns of human chronotypes. Journal of Biological Rhythms, 18, 80–90.

https://doi.org/10.1177/0748730402239679

Sadeh, A. (2011). The role and validity of actigraphy in sleep medicine: An update. Sleep

Medicine Reviews, 15, 259–267. https://doi.org/10.1016/j.smrv.2010.10.001

Schoenborn, C.A., Adams, P.F. (2010) Health behaviors of adults: United States, 2005–2007.

National Center for Health Statistics. Retrieved from

https://www.cdc.gov/nchs/data/series/sr_10/sr10_245.pdf

Short, M. A., Gradisar, M., Lack, L. C., Wright, H., & Carskadon, M. A. (2012). The

discrepancy between actigraphic and sleep diary measures of sleep in adolescents.

Sleep Medicine, 13, 378–384. https://doi.org/10.1016/j.sleep.2011.11.005

Smith, L. J., Gradisar, M., King, D. L., & Short, M. (2017). Intrinsic and extrinsic predictors

of video gaming behavior and adolescent bedtimes : The influence of flow states, self-
A PRIMER FOR MEDIA SCHOLARS 33

perceived risk-taking, device accessibility, parental-regulation of media and bedtime.

Sleep Medicine, 30, 64-70. http://dx.doi.org/10.1016/j.sleep.2016.01.009

Spruyt, K., & Gozal, D. (2011). Pediatric sleep questionnaires as diagnostic or

epidemiological tools: A review of currently available instruments. Sleep Medicine

Reviews, 15, 19–32. https://doi.org/10.1016/j.smrv.2010.07.005

Strine, T. W., & Chapman, D. P. (2005). Associations of frequent sleep insufficiency with

health-related quality of life and health behaviors. Sleep Medicine, 6, 23–27.

https://doi.org/10.1016/j.sleep.2004.06.003

Taillard, J., Philip, P., & Bioulac, B. (1999). Morningness/eveningness and the need for sleep.

Journal of Sleep Research, 8, 291–295. https://doi.org/10.1046/j.1365-

2869.1999.00176.x

Tavernier, R., & Willoughby, T. (2014). Sleep problems: Predictor or outcome of media use

among emerging adults at university? Journal of Sleep Research, 23, 389–396.

https://doi.org/10.1111/jsr.12132

Van den Bulck, J. (2000). Is television bad for your health? Behavior and body image of the

adolescent “couch potato.” Journal of Youth and Adolescence, 29, 273–288.

https://doi.org/10.1023/A:1005102523848

Van den Bulck, J. (2003). Text messaging as a cause of sleep interruption in adolescents,

evidence from a cross-sectional study. Journal of Sleep Research, 12, 263–263.

Van den Bulck, J. (2004a). Media use and dreaming: The relationship among television

viewing, computer game play, and nightmares or pleasant dreams. Dreaming, 14, 43–

49. https://doi.org/10.1037/1053-0797.14.1.43

Van den Bulck, J. (2004b). Television viewing, computer game playing, and internet use and

self-reported time to bed and time out of bed in secondary-school children. Sleep, 27,

101–104.
A PRIMER FOR MEDIA SCHOLARS 34

Van den Bulck, J. (2014). Sleep apps and the quantified self: Blessing or curse? Journal of

Sleep Research, 1–3. https://doi.org/10.1111/jsr.12270

Van den Bulck, J., Çetin, Y., Terzi, Ö., & Bushman, B. J. (2016). Violence, sex, and dreams:

Violent and sexual media content infiltrate our dreams at night. Dreaming, 26, 271–

279. https://doi.org/10.1037/drm0000036

Van Dongen, H. P. A., Maislin, G., Mullington, J. M., & Dinges, D. F. (2003). The

Cumulative cost of additional wakefulness: dose-response effects on neurobehavioral

functions and sleep physiology from chronic sleep restriction and total sleep

deprivation. Sleep, 26, 117–126. https://doi.org/10.1001/archsurg.2011.121

Wolfson, A. R., & Carskadon, M. A. (1998). Sleep schedules and daytime functioning in

adolescents. Child Development, 69, 875–887.

Wolfson, A. R., Carskadon, M. A., Acebo, C., Seifer, R., Fallone, G., Labyak, S. E., &

Martin, J. L. (2003). Evidence for the validity of a Sleep Habits Survey for

adolescents. Sleep, 26, 213–6.

Wood, B., Rea, M. S., Plitnick, B., & Figueiro, M. G. (2012). Light level and duration of

exposure determine the impact of self-luminous tablets on melatonin suppression.

Applied Ergonomics, 44, 237–40. https://doi.org/10.1016/j.apergo.2012.07.008

Woods, H. C., & Scott, H. (2016). #Sleepyteens: Social media use in adolescence is

associated with poor sleep quality, anxiety, depression and low self-esteem. Journal of

Adolescence, 51, 41–49. https://doi.org/10.1016/j.adolescence.2016.05.008

Zillmann, D. (1988). Mood management through communication choices. American

Behavioral Scientist, 31, 327–340. https://doi.org/10.1177/000276488031003005

Zimmerman, F. (2008). Children’s media use and sleep problems: Issues and unanswered

questions. Research brief. Menlo Park, CA: Kaiser Family Foundation.

A PRIMER FOR MEDIA SCHOLARS 35

Figure 1

A. Traditional Sleep Displacement Model

B. E

xe

mans & Van den Bulck (2017a) Sleep Displacement Model