Dr. Belen Esparis has a special nightly ritual for her 10-year daughter and 13-year-old son. About an hour before bedtime, she has them place all their electronic devices — the Kindle, iPad, Nintendo and cellphones — in a basket on the floor.
As a physician specializing in sleep disorders, Esparis knows full well the damage that electronic devices can do to children before bed, affecting their sleep patterns and potentially leading to a wide variety of health problems.
“I almost had to take the door off my son’s room,” laughed Esparis, medical director of Mount Sinai Medical Center’s Sleep Disorders Center and Laboratory in Miami Beach. “He was using the Kindle under his covers.”
All joking aside, use of electronic devices and television before bedtime and even during the time children should be sleeping has become a great concern among parents, teachers and medical experts.
Studies show that use of so-called “small screens” — iPods, smartphones, tablets — as well as televisions and computers are affecting children’s sleep in two ways.
First of all, when kept in their rooms, the devices are being utilized by children well into the night as they text and take selfies when they should be sleeping.
The second concern is less obvious but no less troubling.
Studies show that use of the devices even an hour or so before bedtime stimulates kids’ brains, with the bright blue screen light having a lasting effect and preventing sleep.
The result: Children, the age group that needs sleep the most, are getting less sleep these days, which leads to irritability, lack of concentration, depression and obesity.
“It is becoming well known that use of these devices before bed reduces sleep from 17 to 45 minutes nightly,” says Dr. Leonardo Torres, assistant professor of otolaryngology of the University of Miami Health System. “It doesn’t seem like a lot, but it is significant. When they wake up, they feel not rested enough because the quality of the sleep is decreased. We are seeing this a lot in adolescents these days.”
A study from the University of California, Berkeley, published in the journal Pediatrics in February, found that kids who slept with smartphones or tablets in their rooms or beds got 21 fewer minutes of sleep than those who didn’t. Additionally, children with televisions in their bedrooms got 18 minutes less sleep than children without them.
The study, which looked at a racially diverse group of 2,048 fourth and seventh graders, was conducted to assess child obesity in Massachusetts. Lack of sleep is considered a risk factor for obesity. Over half of the children, or 57 percent, said they slept with a small screen nearby.
An earlier study, conducted in 2013 by the University of Auckland in New Zealand, examined pre-bedtime usage of the devices. The study found that kids who spent 90 minutes before bed watching television, playing video games or using the computer will likely take longer to fall asleep than those who are electronic-free.
Researchers found that, on average, kids spend about one-third of the 90 minutes before bedtime using electronic devices.
Another study cited by Torres showed that just two hours on a device reduces melatonin — a substance produced by the body and necessary for sleep — by 20 percent.
Just why do the electronic devices make it harder for children to fall asleep? It has to do with the blue screen lights affecting the circadian rhythms that dictate a person’s sleep habits. The retina is fooled into thinking the light is being produced by daylight and therefore the body does not produce the melatonin needed to trigger sleep.
“There is a type of receptor in our eye that is more sensitive to blue light in these devices,” explained Torres. “It doesn’t trigger production of melatonin. That’s a problem.”
Torres usually sees adolescents when they come to him with sleep apnea caused by obesity. He conducts a sleep study to ascertain the reason for the sleep problems, but always starts by asking patients about their electronics usage before bed.
One of Torres’ recommendations: Refrain from using the devices at least two hours before bedtime.
In addition to banning afternoon naps, recommending a warm bath or shower a half-hour before bedtime and a healthy snack, Dr. Tommy Schectman, a Palm Beach County pediatrician, sets a no-electronics rule a half hour before bedtime. He also encourages parents to keep devices and televisions out of the kids’ bedrooms.
“I don’t think there’s a hard and fast rule,” notes Schectman, president of the Florida Chapter of the American Academy of Pediatrics. “If you can take the devices out of the bedroom, that’s a huge accomplishment, or else they may be used all night. Some of them are texting all night long.”
Some parents have been making a push to start school later in the morning to accommodate the later bedtimes of adolescents.
“If you let them sleep from 1 a.m. to 11 a.m. rather than 9 p.m. to 6 a.m. in the morning, they would do that,’’ noted Dr. David Seiden, medical director of the Baptist Sleep Center at Miami Lakes and Pembroke Pines. “The problem is they have to get up early in the morning. And kids that age really need nine or 10 hours of sleep a night.’’
Esparis is seeing elementary school students who are experiencing sleep difficulty due to the devices.
“You need to take the phone and the TV out of the room. It’s no different than any other behavioral modification issue. If the temptation is right there for the child or adolescent, they won’t be able to resist it. There need to be boundaries.”
One Fort Lauderdale parent, Linda Leali, a lawyer, has another strategy to keep her 9-year-old daughter, Violet, from overusing electronics before bed. She plans on buying a special “screen time manager” that allows parents to automatically turn off electronic devices after a certain period.
“I’ve explained that it’s not healthy for her to use the devices before bedtime, but my daughter likes her TV, she likes her iPad,” Leali said. “This could be the solution I was looking for.”
Tips for getting children a good night's sleep
▪ Stop usage of electronic devices--computers, iPads, cellphones, even televisions--well before bedtime. Some doctors recommend a half hour before bedtime, some say two hours prior.
▪ Avoid long afternoon naps; they can affect a child's bedtime
▪ Present a healthy snack an hour or so before bedtime, perhaps fruit and milk. The high content of potassium, magnesium and serotonin found in bananas promotes relaxation.
▪ Do calming activities, like taking a bath, reading a story or perhaps a gentle massage before bedtime
▪ Set a routine bedtime. Children respond well to routines.
▪ Keep room temperature cool (but not cold) and dress child comfortably, keeping in mind that children often kick off their covers at night and cannot recover themselves
▪ Make sure children get enough sleep. Children need more sleep than adults, up to 10 hours a night
▪ For young children, a comforting object like a stuffed animal or special blanket can be helpful
▪ Turn on some relaxation music or try a CD designed to lull children to sleep while teaching them relaxation techniques