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Internet addiction and sleep

disturbance symptoms among
Turkish high school students
Fatih Canan, Gjergji Sinani, Osman Yıldırım

Sleep and Biological Rhythms

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Sleep and Biological Rhythms 2013; 11: 210–213 doi:10.1111/sbr.12022

SHORT PAPER

Internet addiction and sleep disturbance symptoms among

Turkish high school students

Fatih CANAN,1 Osman YILDIRIM,2 Gjergji SINANI,3 Onder OZTURK,5 Tuba Yildirim USTUNEL4 and
Ahmet ATAOGLU6
1
Psychiatry Clinic, Bolu Izzet Baysal Mental Health Hospital, 2Department of Psychiatry, School of Medicine, Abant
Izzet Baysal University, Bolu, 3Department of Psychiatry, School of Medicine, Marmara University, 4Clinical
Psychology Clinic, Emsey Hospital, Istanbul, 5Department of Child and Adolescent Psychiatry, Children’s Hospital,
Ankara and 6Department of Psychiatry, School of Medicine, Duzce University, Duzce, Turkey

Abstract
We aimed to examine the correlation between Internet addiction and sleep disturbance symptoms
among students. Internet Addiction Test (IAT) was used. The students with addictive Internet use
were more likely to have difficulty in falling asleep and night awakenings. Problematic Internet users
and addictive Internet users were found to sleep significantly less than avarage Internet users. A
significant positive correlation between daily sleep duration and IAT and weekly Internet use was
found. Linear regression analysis revealed a significant negative and independent association of IAT
with daily sleep duration. These results indicate an association between the Internet addiction and
impaired sleep.

Key words: adolescent, internet addiction, sleep disturbance.

INTRODUCTION
Excessive or problematic use of the Internet has been a
topic of discussion in the academic literature for more
than a decade. A considerable amount of literature pub-
lished so far on Internet addiction reveals that it is a
worldwide phenomenon.1 Although a standardized defi-
nition has not been uniformly agreed upon, it is gener-
ally recognized that problematic Internet use causes
progressive deterioration in work, school, social and
family functioning.2
Sleep quality is an important dimension with regard
to sleep–wake functioning, and poor sleep quality has
been found to be associated with worse academic
achievement and health, as well as increased health care
costs and absenteeism from work.3 Adolescents who
Correspondence: Dr Fatih Canan, Psychiatry Clinic, Bolu
Izzet Baysal Mental Health Hospital, 14030 Bolu, Turkey.
Email: fatihcanan@gmail.com
Accepted 21 April 2013.
spend more time using the Internet are reported to have
less sleeping time and feel higher levels of tiredness.4
Studies, however, on the relationship between Internet
overuse and physical health or sleep problems have
been rarely performed.5,6
Our first aim was to determine the frequency of Inter-
net addiction and to examine the relationship between
Internet addiction and sleep duration, difficulty in
falling asleep, and night awakenings among high school
students.
METHODS
This study is part of a research project that aims to
investigate the Internet addiction prevalence and its
relationship with sociodemographic and psychological
variables among Turkish high school students. The
target population was all high school studens in Duzce
city center (2216 students). A total of 2029 high school
students accepted to participate in the study. After oral
information and consent, all participants were asked

210 © 2013 The Authors

Sleep and Biological Rhythms © 2013 Japanese Society of Sleep Research
 Internet addiction and sleep

to complete the IAT and socidemographic information
form. Seventy-three students were excluded from the
study because of missing data resulting in an available
sample of 1956 students (92.4% of the total sample).
The study was approved by the Local Ethical Commit-
tee. The study was approved by the Ethical Committee
of Duzce University School of Medicine.
We developed a sociodemographic questionnaire
with items pertaining to age, sex, grade, and extent of
internet use. Relevant questions were asked in order to
investigate sleep quality (e.g. “Do you have difficulty in
falling asleep?”).
Internet Addiction Test (IAT)7 was used to determine
Internet addiction severity. The IAT is one of the first
standardized tests for the assessment of disturbed Inter-
net use. It contains 20 items, which ask respondents to
rate how often they show such symptoms of problem-
atic Internet use. The possible total score for each
respondent could range from 20 to 100, with higher
scores indicating greater problems associated with Inter-
net use. Scores of 20 to 39 represent “average” users,
scores of 50 to 69 represent “problematic users” and
scores over 70 are classified as “addictive users”.7 The
Turkish version of the IAS has been shown to have a
good validity and reliability with Turkish elementary
and high-school students (Cronbach a = 0.82).8
Statistical analysis
Groups (according to IAT) were compared with a one-
way analysis of variance (ANOVA) and between-group
comparisons were performed using post-hoc contrasts
with a Bonferroni adjustment for multiple comparisons.
The c2 analyses were used to compare categorical vari-
ables. Pearson correlation analysis was used to deter-
mine the correlation coefficients between the variables.
Linear regression analysis was used to assess the contri-
butions of age, gender, and Internet addiction to sleep
duration. As the IAT includes questions about sleep, the
scores of these questions were excluded when correla-
tions and regressions with IAT were performed.
RESULTS
The sample consisted of 1024 female students (52.5%)
and 932 male students (47.5%) with a mean age of
16.04 ⫾ 1.02 years (range, 14–18 years). According to
the IAT, 3.4% of the study sample were addictive Inter-
net users and 9.2% were problematic users. Fifty-six
(5.5%) girls and 95 (10.2%) boys had problematic Inter-
net use. Additionally, 22 (2.1%) females and 30 (3.2%)
males were Internet addicts, and the differences were
statistically significant (P < 0.001).
Duration of weekly Internet use, and daily sleep dura-
tion were found to be statistically different with respect
to the severity of Internet addiction. The relationship
between Internet addiction and presence of a sleep dis-
turbance symptom is presented in Table 1.
A correlation matrix showing the relationships
between age, weekly Internet use, IAT, and daily sleep
duration scores are presented in Table 2. Linear regres-
sion analysis revealed that IAT was independently and
negatively associated with daily sleep duration (partial
correlation coefficient: -0.235; P < 0.001).
The results indicated that chat rooms and Internet
messaging (yes: 7.6 ⫾ 1.5 h/day; no: 7.8 ⫾ 1.3 h/day;

Table 1 Comparison of age (years), weekly Internet use (hours), Internet Addiction Test (IAT), daily sleep duration (h), and
sleep disturbance symptoms according to Internet addiction severity
Average user Problematic user Addictive user
(n = 1709) (n = 180) (n = 67) P-value
Age (mean ⫾ SD)† 16.0 ⫾ 1.0 16.1 ⫾ 0.9 16.3 ⫾ 1.0 0.139
Weekly Internet use (mean ⫾ SD)† 3.2 ⫾ 2.6a 11.0 ⫾ 5.4b 20.6 ⫾ 10.2c <0.001
IAT (mean ⫾ SD)† 25.2 ⫾ 7.7a 56.7 ⫾ 6.7b 84.3 ⫾ 8.3c <0.001
Daily sleep duration (mean ⫾ SD)† 7.8 ⫾ 1.5a 7.3 ⫾ 1.3d 6.9 ⫾ 1.5d <0.001
Difficulty in falling asleep‡ Yes (n = 758) 647 (37.9%) 70 (38.9%) 41 (61.2%) <0.001
No (n = 1198) 1062 (62.1%) 110 (61.1%) 26 (38.8%)
Night awakenings‡ Yes (n = 729) 616 (36%) 77 (42.8%) 32 (47.8%) <0.05
No (n = 1227) 1093 (64%) 103 (57.2%) 35 (52.2%)
Early morning awakenings‡ Yes (n = 323) 276 (16.1%) 31 (17.2%) 16 (23.9%) 0.238
No (n = 1633) 1433 (83.9%) 149 (82.8%) 51 (76.1%)
†
One-way analysis of variance (ANOVA); ‡c2 test. Pairwise comparisons: aP < 0.05 versus problematic user and addicted, bP < 0.05 versus
avarage user and addicted, cP < 0.05 versus avarage user and problematic user, dP < 0.05 versus avarage user.

© 2013 The Authors 211

Sleep and Biological Rhythms © 2013 Japanese Society of Sleep Research
F Canan et al.
Table 2 Pearson’s correlation coefficient analysis for Inter-
net Addiction Test (IAT), age, weekly Internet use, and sleep
duration
Weekly
Internet
IAT use
Age .037 .078†
IAT 1 .776†
Weekly Internet use 1 -.085†
Sleep duration
†
Correlation is significant at the 0.01 level (two-tailed). ‡Correlation
is significant at the 0.05 level (two-tailed).
t = -2.118), Web surfing (yes: 7.5 ⫾ 1.5 h/day; no: 7.7
⫾ 1.4 h/day; t = -2.124), and playing online games
(yes: 7.6 ⫾ 1.4 h/day; yes: 7.8 ⫾ 1.4 h/day; t = -2.939)
were significantly associated with decreased sleep dura-
tion (P < 0.05). In contrast, using the Internet for aca-
demic activities was associated with increased sleep
duration (yes: 7.8 ⫾ 1.3 h/day vs 7.5 ⫾ 1.4 h/day;
t = 2.213, P < 0.05). Other Internet activities such
as e-mail checking (t = 1.112), reading online news
(t = -0.613), watching online videos (t = -1.055), and
shopping (t = 0.719) were not associated with sleep
duration (P > 0.05).
DISCUSSION
The relationship between Internet use and sleep prob-
lems has been reported previously. Excessive use of
computer or online games has been reported to be asso-
ciated with later bedtimes on weekend days,4 later
waking times on weekend days,4,9 and longer sleep
onset latency.10
To the best of our knowledge, only one study in
the English literature has mentioned the relationship
between sleep disturbance and “Internet addiction”
among adolescents. In that study, Choi et al.6 evaluated
2336 Korean high school students and found that dura-
tion of sleep was significantly less in students with Inter-
net addiction than in possible addicts and non-addicts.
They have showed that the prevalence of sleep problems
(difficulty in initiating sleep, difficulty in maintaining
sleep, early morning awakening, insomnia, apnea, teeth
grinding, and nightmares) was highest in Internet
addicts, middle in possible addicts, and lowest in non-
addicts. Our findings are in line with the findings
reported by Choi et al.6 demonstrating an increased rate
of sleep problems among more severely Internet-
212
addicted students. Additionally, we have found that chat
rooms and Internet messaging, Web surfing, and playing
online games were associated with decreased sleep dura-
tion, whereas using the Internet for academic activities
Sleep was associated with increased sleep duration. According
duration to these patterns, not only Internet use but also the type
of Internet activities are significative in terms of sleep
-.053‡
-.132†
duration.
The most important limitation of our study is not
1 having been able to show the causality of the relation-
ship between Internet addiction and sleep disturbance
because of the cross-sectional structure. Second, sleep
disturbance of the participants was not evaluated with
structured interviews or sleep quality scales. Third,
excessive daytime sleepiness was not queried. Finally,
students’ other technology-related habits such as televi-
son viewing and cellular phone using were not queried.
In the current study, Internet addiction was found
to be related to impaired sleep among adolescents.
The relationship between problematic Internet use, the
importance of which is increasing with developing
Internet-related technology, and an important health
problem, sleep disturbance, should be examined with
particular focus on the causality. Research about this
relationship and taking possible precautions are highly
important for adolescence and young adult populations
who are more sensitive to Internet addiction.
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