The Impact of Bedtime Smartphone Usage on Sleep Quality among Undergraduate Medical Students

INTRODUCTION

The melding of smartphones in our daily lives in these recent years has brought about a significant change in our lifestyle by offering easy accessibility, affordability, and an array of limitless functionalities. This technological revolution has been especially underscored during the COVID era, following which technology and gadgets have become indispensable in our daily lives. However, this sudden and expansive incorporation of smartphones into our daily routine has raised a new concern. The excessive dependence on these devices has emerged as a “lifestyle pandemic.” Studies have highlighted that the blue light emitted from smartphones, computer screens, LED lamps, LCDs, and various other sources, which has a wavelength of 460 nanometers, and it can profoundly affect sleeping patterns by suppressing melatonin production and subsequently, detrimentally affecting our circadian rhythm.¹ This considerable surge in the usage of smartphones has resulted in a decline in the quality of sleep, especially among young adults and medical students. Research indicates that medical students, in particular, experience a significantly higher prevalence of poor sleep quality compared to other student groups.² Sleep is not just a matter of comfort; it’s an essential physiological activity with critical implications for normal metabolic functioning, memory processing, immune system repair, and more. Sleep deprivation and poor sleep quality can lead to a plethora of health issues, including vision disturbances, an increased risk of cardiovascular diseases, obesity, diabetes, and insulin resistance.^3,4 This overdependence on smartphones has drawn comparisons to addiction, with people exhibiting symptoms of dependency like anxiety and irritability when their smartphones are inaccessible. Increased smartphone usage has also been linked to decreased productivity and lower academic performance among students. Studies even suggest that those who lean toward smartphone addiction are more likely to experience poor sleep quality, creating a vicious cycle that further hampers their productivity.^5,6 In this era of unprecedented connectivity and technology, it’s crucial to examine the profound impacts of our smartphone-centric lives on our well-being, both physical and psychological. This multifaceted issue sparks concerns about how to strike a healthy balance between the incredible advantages of smartphone technology and the need for a restful and healthy night’s sleep. This study aimed to evaluate the extent of bedtime smartphone usage among MBBS students at a teaching hospital in central Rajasthan and its implications on sleep quality. The primary objectives were to gauge the prevalence of smartphone use at bedtime and to explore the potential links between such usage and the overall quality of sleep among the students.

MATERIALS AND METHODS

RESULTS

DISCUSSION

As per the National Sleep Foundation Guidelines, a young adult aged 18–25 years requires 7–9 hours of sleep every night.⁴ We observed that 58% of the respondents slept for 6–7 hours at night, whereas Datta et al. in their study conducted in Tripura observed 70.9% slept for 4–6 hours at night during college working days.⁹ Giri et al. found that 68% of medical students of a medical college in Maharashtra slept for 6–7 hours.¹⁰

In our study, 92.05% used their phones at bedtime, with 35.29% using it between 16 and 30 min and 43.94% using it for browsing social media. 52.98% were poor sleepers as per PSQI. Around 6.3% reported having taken medication at least once to initiate sleep in the past week. Students using phones for >60 min at bedtime were at 33.92 times increased risk of being poor sleepers. Similar observations have been reported by Krishnan et al., who reported that those using smartphones for more than 2 hours at bedtime tend to have increased sleep latency, reduced sleep duration, sleep inefficiency, and increased daytime sleep disturbances.⁵ Datta et al. reported 37.9% used their phone before sleeping.⁹ The study by Giri et al. also suggested a strong positive correlation between bedtime smartphone use and poor sleep quality.¹⁰ Nowreen and Ahad conducted similar research among medical students of Jammu and Kashmir, where 34.4% of students were reported to have smartphone addiction, while 50.9% were using it for browsing social media, and 62.7% were poor sleepers.¹¹

In our study it was observed that 90.65% reported some sort of daytime dysfunction, with the majority of them suffering from excessive daytime sleepiness and 17.93% reporting decreased productivity. Krishnan et al. also found that among the students who use their phone at bedtime for more than 2 hours, 14.89% had reported very severe daytime dysfunction problems, when compared to 9.82% in group I. Difficulty in engaging in daily activities was the most common daytime dysfunction.⁵ Sohn et al. did a similar study in the UK, where young adults who used smartphones for more than 3 hours reported to have 48.4% smartphone addiction. Using a phone at bedtime was associated with poor sleep quality and subsequently with significant daytime dysfunction. Smartphone use at 1 a.m. or later was associated with a four times increased risk of smartphone addiction.⁶ In the study by Datta et al. 87.2% reported daytime sleepiness.⁹ Alshobaili et al. conducted a similar study in Saudi Arabia that reported that about 43% of participants who use their smartphones at bedtime think that it does not affect them the next day, while 37.4% do not know if it affects them or not. Of those who think that bedtime usage of smartphones affects them the next day, 63% think that they get tired the next day, while about 40% report having a headache.¹²

CONCLUSION

In conclusion, our study has highlighted the harmful consequences of screen time exposure at bedtime on sleep quality and daytime functioning among medical undergraduate students. The association between smartphone usage at bedtime and poor sleep quality is established, with a more pronounced impact observed when the duration of smartphone usage exceeds 60 min. These results underscore the importance of recognizing the potential risks associated with prolonged smartphone use before sleep. Such habits may predispose students to poor sleep quality and increased daytime dysfunction. The findings of our study emphasize the need for interventions and educational initiatives aimed at promoting healthy sleep practices, particularly among young adults and medical undergraduates, in particular, to ensure their well-being and academic performance. Promoting digital literacy and fostering a balanced use of technology are essential components of addressing the challenges associated with increased use of technology. Equipping individuals with the knowledge and skills to make informed choices regarding their digital habits can help to mitigate the potential negative impacts on sleep quality and overall well-being. Striking a balance between the benefits and potential drawbacks of technology is key to maintaining a healthy and productive lifestyle, especially in the context of academic demands.

ORCID

Moksharthi Sharma https://orcid.org/0009-0009-3260-9252

Renu Bedi https://orcid.org/0000-0001-7570-6313

Mahendra Khanna https://orcid.org/0009-0006-0108-8472

Bheru L Jat https://orcid.org/0009-0007-3018-919X

REFERENCES

1. West KE, Jablonski MR, Warfield B, et al. Blue light from light-emitting diodes elicits a dose-dependent suppression of melatonin in humans. J Appl Physiol 2011;110:619–626. DOI: 10.1152/japplphysiol.01413.2009.

2. Azad MC, Fraser K, Rumana N, et al. Sleep disturbances among medical students: A global perspective. J Clin Sleep Med 2015;11:69–74. DOI: 10.5664/jcsm.4370.

3. Stevens RG, Brainard GC, Blask DE, et al. Adverse health effects of night time lighting. Am J Prev Med 2013;45:343–346. DOI: 10.1016/j.amepre.2013.04.011.

4. Hirshkowitz M, Whiton K, Albert SM, et al. The National Sleep Foundations sleep time duration recommendations: Methodology and results summary. Sleep Health 2015;1:40–43. DOI: 10.1016/j.sleh.2014.12.010.

5. Krishnan B, Sanjeev RK, Latti RG. Quality of sleep among bedtime smartphone users. Int J Prev Med 2020;11:114. DOI: 10.4103/ijpvm.IJPVM_266_19.

6. Sohn SY, Krasnoff L, Rees P, et al. The association between smartphone addiction and sleep: A UK cross-sectional study of young adults. Front Psychiatry 2021;12:629407. DOI: 10.3389/fpsyt.2021.629407.

7. Buysse DJ, Reynolds CF, Monk TH, et al. The pittsburgh sleep quality index (PSQI): A new instrument for psychiatric research and practice. Psychiatry Research 28(2);193–213. Available from: https://www.med.upenn.edu/cbti/assets/usercontent/documents/Pittsburgh%20Sleep%20Quality%20Index%20(PSQI).pdf.

8. Gradisar M, Wolfson AR, Harvey AG, et al. The sleep and technology use of Americans: Findings from the National Sleep Foundation’s 2011 Sleep in America poll. J Clin Sleep Med 2013;9:1291–1299. DOI: 10.5664/jcsm.3272.

9. Datta A, Nag K, Karmakar N, et al. Sleep disturbance and its effect on academic performance among students of a medical college of Tripura. Int J Community Med Public Health 2019;6:293–298. DOI: 10.18203/2394-6040.ijcmph20185261.

10. Giri PA, Baviskar MP, Phalke DB. Study of sleep habits and sleep problems among medical students of Pravara Institute of Medical Sciences Loni Western Maharashtra India. Ann Med Health Sci Res 2013;3:51–54. DOI: 10.4103/2141-9248.109488.

11. Nowreen N, Ahad F. Effect of smartphone usage on quality of sleep in medical students. Natl J Physiol Pharm Pharmacol. 2018;8:1366–1370. DOI: 10.5455/njppp.2018.8.0620009062018.

12. Alshobaili FA, AlYousefi NA. The effect of smartphone usage at bedtime on sleep quality among Saudi non-medical staff at King Saud University Medical City. J Family Med Prim Care 2019;8:1953–1957. DOI: 10.4103/jfmpc.jfmpc_269_19.