Internet addiction and sleepiness

Tomorrow marks the annual Regional Sleep Medicine day conference, this year being held at Portland District Health. While reading around a case I wish to present I came across some interesting, and sobering, new research on the impact of internet addiction and sleep.

It has been suggested that internet addiction may be an epidemic in the twentyfirst century. A recent study published in the 'Psychiatry and Clinical Neurosciences (2009; 63:455-462) surveyed 2336 high school students in a particular school district in South Korea - that number representing an 87% response rate. Using Young's internet addiction test (everyone should do it just once), 2.5% of boys were found to be internet-addicted, with 53.7% possibly addicted. For girls, the figures were 1.9% and 38.7% respectively.

Excessive daytime sleepiness (EDS) was defined as an Epworth Sleepiness Scale score of more than 10 - which is pretty bad for an adolescent. Using that criterion, and controlling for duration of internet use and sleep time, age, gender, smoking status, painkiller use, symptoms of insomnia, witnessed apnoeas and nightmares the odds ratio for EDS in internet addicts was 5.2(95% CI 2.7 to 10.2) when compared with non-addicts. That means that internet addicts were 5 times more likely to be excessively sleepy in the daytime than non addicts. There was a stepwise increase in prevalence of daytime sleepiness from non-addicts to possible addicts to addicts (7.9%, 13.5% and 28.6% when controlling for the above factors respectively). The attached table shows the increased incidence when controlled for the above associated factors (black) as opposed with the raw initial data.

What has me worried more is that there was a stastically significant increase in prevalence of every sleep problem on the questionnaire, following the same 'J-curve'. This included difficulties with initiation and maintenance of sleep, wakening early in the morning, 'insomnia symptoms', snoring, witnessed apnoeas ( a huge 11% of teen internet addicts), teeth grinding and nightmares.

I think that internet addiction will turn out to be a significant marker for other sleep problems and an independent cause of daytime sleepiness - perhaps by leading to hypervigilance during sleep. Sleep specialists and GPs should consider screening all of our adolescent patients for this - provied we can back this up wth strategies to assist in countering the addiction in those who are 'addicted' and 'possibly addicted'.

Watch this space!

Andrew