How sleep might mitigate worst symptoms of internet gaming disorder

The World Health Organization defines IGD as a pattern of persistent or recurrent gaming behavior that takes precedence over other life interests and activities, resulting in significant impairment or distress.

Treatment centers for IGD have seen a steady increase in patient referrals with common presenting issues being family conflict, social isolation, and gaming-related interference with other activities.

With IGD can come executive dysfunction—cognitive and behavioral symptoms that disrupt a person’s ability to manage their own thoughts, emotions and actions. This is common with certain mental health conditions, especially addictions, behavioral disorders, brain development disorders and mood disorders.

Impairments in healthy executive functioning, a crucial part of brain developmental during childhood and adolescence, can have far-reaching implications for socio-economic status, including academic success, school dropout rates, overall health and quality of life.

New research published in the Journal of Medical Internet Research looks at how sleep quality in teens with IGD might impact attention and impulse problems, two key facets of executive function.

“Our research suggests that sleep quality is a key factor in the link between gaming problems and executive problems in teens,” says Michoel Moshel, lead author of the paper, “Sleep Quality as a Mediator of Internet Gaming Disorder and Executive Dysfunction in Adolescents: A Cross-Sectional Questionnaire Study.”

“Sleep has not generally been considered as a treatment for disordered screen use. But we find it may offer a way forward.”

What’s more, the result that most surprised Moshel and his co-authors was that sleep is a two-way street.

The first model researchers found looked like this: IGD → Poor Sleep → Executive problems. “This means poor sleep partially explains how IGD leads to executive dysfunction,” says Moshel.

“We tested the reverse and found: Executive dysfunction → Poor Sleep → IGD. So, it’s also possible that executive dysfunction contributes to IGD through poor sleep.

“But when teens had good sleep, the link between IGD and executive dysfunction problems disappeared. When sleep was average or poor, the link was significant.”

The balancing act

While the Macquarie research focused on traits such as inattention and behavioral inhibitions, executive functioning also encompasses working memory, cognitive flexibility and higher-order processes such as decision-making and problem-solving.

In other research, adolescents exhibiting problematic gaming behaviors showed greater cognitive-affective imbalance than age-matched controls. This imbalance was marked by alterations in brain regions associated with identity formation, social cognition, personality formation and mentalizing—key processes during this developmental period.

“Although establishing a causal mechanism between problematic gaming behaviors and executive dysfunction is challenging, it is possible that secondary effects resulting from gaming and executive dysfunction, such as sleep, may be mediating this relationship,” says Moshel.

Previous studies have highlighted the crucial role sleep plays in cognitive functioning as well as in the development of IGD, he says.

“For instance, addicted gamers reported significantly higher rates of daytime sleepiness and sleep deprivation, with the use of screens more generally being associated with symptoms of insomnia.”

Research has shown that sleep quality is lowest in children who game for more than six hours a day and highest for those gaming only one to two hours a day. A meta-analysis found that problematic gamers reported more adverse sleep status, including sleep duration, sleep quality, sleep problems, and daytime sleepiness, than non-problematic gamers.

One study has found that sleep mediated the relationship between media exposure (measured by screen time) and attentional problems in children, supporting the “displacement hypothesis,” which posits that screen time displaces time spent on more beneficial activities such sleep.

How to wrangle sleep

Considering the high prevalence of IGD among adolescents and the crucial role that executive functioning plays in their development, mitigating adverse impacts is key.

Patients presenting with IGD may benefit from a routine assessment of sleep quality during triage, says Moshel. Regarding treatment, interventions aimed at improving sleep quality, such as cognitive-behavioral therapy for insomnia, sleep hygiene education, and relaxation techniques, may be particularly beneficial for individuals with IGD and executive dysfunction.

“Programs that include structured guidance on optimizing sleep routines, such as minimizing screen exposure before bedtime, establishing consistent sleep-wake schedules, and implementing behavioral techniques to reinforce healthier sleep habits could be beneficial.

“Ensuring adequate and restful sleep may also reduce the risk of developing or exacerbating IGD and executive dysfunction.

“Encouraging healthy lifestyle habits that promote better sleep (for example, regular sleep schedules, reduced screen time, physical activity, and blue light filters before bed) can serve as preventive and mitigating measures.”