Editorial
Sleep and electronic media exposure in adolescents: the rule of diminishing returns
Sono e exposição à mídia eletrônica em adolescentes: a lei dos rendimentos decrescentes
David Gozal
University of Chicago, Biological Sciences Division, Pritzker School of Medicine, Department of Pediatrics, Chicago, United States
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The issue of screen and media exposure as a potentially adverse risk factor to health has now been enunciated for quite some time,<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">1</span></a> and yet despite such ominous correlates, there is still ongoing debate as to the potential consequences of electronic media to adolescent well-being. Children in general, and more specifically adolescents, spend more time connected to media than to any other daily activity. It has been estimated that the media exposure revolves around seven hours per day.<a class="elsevierStyleCrossRefs" href="#bib0120"><span class="elsevierStyleSup">2,3</span></a> One of the major issues with such media abundance is the fact that even 12 years ago, most of the devices already resided in the bedrooms of the adolescents: two-thirds had a television set, one-half had a VCR, DVD player or video-game console, and >30% had Internet access or a computer in their bedroom. It is therefore not surprising that such plethora of bedroom devices and enhanced connectivity are likely to influence adolescent behaviors in many possible and potentially divergent directions.</p><p id="par0010" class="elsevierStylePara elsevierViewall">Increased media access will affect youth not only by reducing or compromising the time they would need to spend doing their school homework or sleeping, but also by potentially affecting their beliefs and behaviors. Social learning theory postulates that learning is predicated on observation and imitation of behaviors by peers, or even by relating to fictive situations such as movies or games. In this context, super peer theory has clearly shown that the media may operate as powerful best friends, with the caveat that risky behaviors may be misinterpreted and adopted as if they were <span class="elsevierStyleItalic">de facto</span> normative and socially acceptable.<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">4</span></a> Before generalizing the effects of media as untoward to adolescents, we should point out that exposures to media may also have important beneficial effects. Indeed, the media can exert powerful pro-social and educational effects, whereby adolescents can learn anti-violence approaches, foster empathy and tolerance behaviors toward people of other ethnicities, and also enhance the respect for their elders and other authoritative figures in their lives.<a class="elsevierStyleCrossRefs" href="#bib0130"><span class="elsevierStyleSup">4,5</span></a> Furthermore, media exposure can promote healthy behaviors, adherence to treatment in chronic disorders, and promote learning through educational programs and socially integrated web-based training opportunities. Therefore, what constitutes excessive media exposure or type of media exposure that will be detrimental to any given adolescent is reflected by the delicate balance between beneficial aspects of media weighed against the potential harmful consequences of such exposures. For example, recent studies from China have shown a small effect of screen time on the presence of mental health problems in adolescents, but also indicated that such effect is small and that no definite cut-off screen time duration can be identified.<a class="elsevierStyleCrossRefs" href="#bib0140"><span class="elsevierStyleSup">6,7</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">In this issue of the Journal, Amra et al. examined the association between portable telephone use in the late evening hours and sleep patterns as well as daytime functioning and physical activity.<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">8</span></a> The authors indicated that more extended use of the phone after 9 pm increased the risk for poorer sleep quality, more problems during daytime functioning, and reduced likelihood of engaging in physical activity. Although the study was exclusively reliant on questionnaires and did not perform any objective measurements, their overall findings are clearly aligned with those of previously published studies.<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">9</span></a> I should remark that experimental sleep restriction in adolescents and young adults is likely to translate into reduced daytime performance in the absence of the perception of somnolence,<a class="elsevierStyleCrossRefs" href="#bib0160"><span class="elsevierStyleSup">10,11</span></a> an issue that was not explored by Amra et al.<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">8</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Bright light exposure during the early night period, particularly when enriched with light in the blue spectrum, as is the case of most modern device screens, imposes immediate effects on both physiological and behavioral measures.<a class="elsevierStyleCrossRefs" href="#bib0170"><span class="elsevierStyleSup">12,13</span></a> In comparison to darkness, bright light exposure decreases sleepiness, promotes increased alertness, and also attenuates the melatonin-induced reduction in core body temperature. Such effect will lead to delayed sleep onset and curtailed sleep, at least during weekdays (<span class="elsevierStyleItalic">i.e</span>., school days) with futile attempts to catch-up during weekends. These irregular sleep patterns have been implicated in curtailed sleep duration, along with metabolic dysfunction, obesity, and excessive caffeine consumption among school-age children.<a class="elsevierStyleCrossRefs" href="#bib0180"><span class="elsevierStyleSup">14,15</span></a> Furthermore, daytime performance has also been impaired along with the emergence of daytime somnolence (not necessarily recognized and acknowledged by youth),<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">11</span></a> which further exacerbates the use of caffeinated beverages.<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">16</span></a> Such patterns are particularly prominent during weekdays during the school year, when the earlier class start times appear to be an additional burden to the cumulative sleep debt that is pervasively present among adolescents.<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">17</span></a> As mentioned earlier, the potential consequences of sleep restriction in adolescents have been extensively explored in experimental settings.<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">18</span></a> Although adolescents showed the anticipated emergence of sleepiness following sleep restriction, reduced performance was detected in only a subset of complex neurocognitive functions, including abstract problem solving, verbal fluency, and creativity, as well as computational processing speed. However, simpler tasks or routine tasks, such as sustained auditory and visual attention and short-term verbal memory, remained intact. Notwithstanding, difficulty with multi-tasking and enhanced susceptibility to depressive mood states and increased risk for motor vehicle and other accidents may well represent the challenges typically encountered in adolescents’ daily lives, and performance may be challenged in the context of curtailed sleep.<a class="elsevierStyleCrossRefs" href="#bib0205"><span class="elsevierStyleSup">19,20</span></a> When these variables are considered together, no easily implementable solutions come to mind. There is no doubt that efforts to limit or reduce screen time exposures, especially around bedtime hours, should be recommended at the individual level.<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">21</span></a> In addition, the implementation of school start times and schedules aiming to address some of the issues revolving around adolescent sleep and its modifiers should prove a step in the right direction.<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">22</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">In summary, there is no doubt that the more reductions in sleep occur in the life of any adolescents in the context of a misguided effort to increase their social engagements, educational performance or any other laudable goal, the less “bang for the buck” they will reap – the rule of diminishing returns! Sleep health awareness and implementation are achievable, but they are not one late evening portable phone call away…</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of interest</span><p id="par0030" class="elsevierStylePara elsevierViewall">The author declares no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Conflicts of interest" ] 1 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:2 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Gozal D. Sleep and electronic media exposure in adolescents: the rule of diminishing returns. J Pediatr (Rio J). 2017;93:545–7.</p>" ] 1 => array:2 [ "etiqueta" => "☆☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0010">See paper by Amra et al. in pages 560–7.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:22 [ 0 => array:3 [ "identificador" => "bib0115" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Electronic media use and sleep in school-aged children and adolescents: a review" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "N. Cain" 1 => "M. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 12 | 4 | 16 |
| 2024 October | 45 | 27 | 72 |
| 2024 September | 49 | 29 | 78 |
| 2024 August | 45 | 38 | 83 |
| 2024 July | 25 | 33 | 58 |
| 2024 June | 19 | 26 | 45 |
| 2024 May | 14 | 26 | 40 |
| 2024 April | 18 | 20 | 38 |
| 2024 March | 22 | 14 | 36 |
| 2024 February | 14 | 24 | 38 |
| 2024 January | 15 | 27 | 42 |
| 2023 December | 13 | 20 | 33 |
| 2023 November | 16 | 24 | 40 |
| 2023 October | 18 | 27 | 45 |
| 2023 September | 16 | 33 | 49 |
| 2023 August | 16 | 17 | 33 |
| 2023 July | 20 | 16 | 36 |
| 2023 June | 12 | 15 | 27 |
| 2023 May | 17 | 16 | 33 |
| 2023 April | 11 | 11 | 22 |
| 2023 March | 21 | 18 | 39 |
| 2023 February | 9 | 14 | 23 |
| 2023 January | 22 | 16 | 38 |
| 2022 December | 32 | 22 | 54 |
| 2022 November | 28 | 23 | 51 |
| 2022 October | 41 | 31 | 72 |
| 2022 September | 18 | 29 | 47 |
| 2022 August | 17 | 29 | 46 |
| 2022 July | 22 | 25 | 47 |
| 2022 June | 16 | 26 | 42 |
| 2022 May | 27 | 27 | 54 |
| 2022 April | 48 | 29 | 77 |
| 2022 March | 36 | 39 | 75 |
| 2022 February | 14 | 24 | 38 |
| 2022 January | 13 | 18 | 31 |
| 2021 December | 19 | 25 | 44 |
| 2021 November | 8 | 18 | 26 |
| 2021 October | 17 | 27 | 44 |
| 2021 September | 6 | 6 | 12 |
| 2021 August | 5 | 11 | 16 |
| 2021 July | 4 | 9 | 13 |
| 2021 June | 9 | 14 | 23 |
| 2021 May | 8 | 16 | 24 |
| 2021 April | 16 | 4 | 20 |
| 2021 March | 14 | 13 | 27 |
| 2021 February | 6 | 9 | 15 |
| 2021 January | 6 | 6 | 12 |
| 2020 December | 9 | 9 | 18 |
| 2020 November | 8 | 11 | 19 |
| 2020 October | 9 | 4 | 13 |
| 2020 September | 9 | 10 | 19 |
| 2020 August | 4 | 4 | 8 |
| 2020 July | 6 | 7 | 13 |
| 2020 June | 8 | 6 | 14 |
| 2020 May | 13 | 4 | 17 |
| 2020 April | 8 | 10 | 18 |
| 2020 March | 9 | 3 | 12 |
| 2020 February | 20 | 13 | 33 |
| 2020 January | 18 | 15 | 33 |
| 2019 December | 9 | 4 | 13 |
| 2019 November | 3 | 13 | 16 |
| 2019 October | 13 | 9 | 22 |
| 2019 September | 13 | 6 | 19 |
| 2019 August | 13 | 12 | 25 |
| 2019 July | 21 | 9 | 30 |
| 2019 June | 17 | 20 | 37 |
| 2019 May | 11 | 10 | 21 |
| 2019 April | 19 | 12 | 31 |
| 2019 March | 12 | 12 | 24 |
| 2019 February | 9 | 7 | 16 |
| 2019 January | 7 | 6 | 13 |
| 2018 December | 8 | 2 | 10 |
| 2018 November | 30 | 6 | 36 |
| 2018 October | 70 | 16 | 86 |
| 2018 September | 12 | 8 | 20 |
| 2018 August | 10 | 5 | 15 |
| 2018 July | 10 | 3 | 13 |
| 2018 June | 10 | 2 | 12 |
| 2018 May | 27 | 19 | 46 |
| 2018 April | 10 | 3 | 13 |
| 2018 March | 18 | 5 | 23 |
| 2018 February | 19 | 4 | 23 |
| 2018 January | 28 | 9 | 37 |
| 2017 December | 27 | 19 | 46 |
| 2017 November | 37 | 16 | 53 |
| 2017 October | 2 | 7 | 9 |
| 2017 September | 1 | 8 | 9 |
| 2017 August | 1 | 3 | 4 |
| 2017 July | 1 | 3 | 4 |
| 2017 June | 1 | 4 | 5 |
| 2017 May | 0 | 10 | 10 |
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