Is binge-watching competing with sleep? And winning?
Jindal RD. Is binge-watching competing with sleep? And winning? J Clin Sleep Med. 2020;16(suppl_1):31S–32S.
The emergence of online streaming television services has made it easy to binge-watch multiple episodes of the same television show in a single sitting. In one of the first studies of its kind, Exelmans and Van den Bulck1 showed presleep arousal to be a putative mediator in the association between binge-watching and poorer sleep quality and daytime fatigue. The finding was particularly newsworthy because the National Sleep Foundation’s 2011 Sleep in America Poll suggested that the use of interactive technological devices (ie, computers, laptops, cell phones, video game consoles) was more strongly associated with sleep complaints than that of passive technological devices, such as television and MP3 music players.2 In an earlier study, concurrent use of multiple forms of technology was similarly shown to be more interactive and detrimental to sleep.3
Exelmans and Van den Bulck1 provided a plausible explanation that watching multiple episodes of the same show may cause a greater degree of engagement with the content and that the consequent presleep arousal may result in greater sleep impairments than regular television viewing. As the authors acknowledged, their online survey was limited by its cross-sectional design. Such datasets can provide important hypothesis-generating information about putative mechanisms and mediators, but to establish mechanisms, the hypothesis needs to be tested in longitudinal studies.4
The study results, if confirmed, will have tremendous policy implications. In 2017, the chief executive officer of Netflix, one of the popular providers of television streaming services, was quoted as saying, “You get a show or a movie you’re really dying to watch, and you end up staying up late at night, so we actually compete with sleep…. And we’re winning!”5 Given the evidence that all but establishes short sleep as a risk factor for hypertension,6 we need longitudinal studies to decide if anyone is indeed winning.
Being a recent construct, binge-watching has attracted limited systematic investigation. One challenge is the need to make a distinction between maladaptive binge-watching, which keeps a person from fulfilling obligations toward employers, coworkers, family, and friends, and presumably adaptive binge-watching, which keeps a person at home during the current pandemic and from other impulsive reactions to challenges and setbacks. There is also a need to explore the interplay between binge-watching and depression and other addictive behaviors.
If the study findings1 are confirmed in longitudinal studies among help-seeking patients with insomnia, it will be important to develop mechanism-based screening questions and motivational enhancement strategies to address problematic binge-watching. In developing therapeutic alliances, it may be helpful to provide evidence of instances where binge-watching is particularly harmful. While discussing the respiratory suppressant actions of benzodiazepines and opiates, I inform my patients that perhaps the highest risk comes from combining the 2 close to bedtime. In my experience, providing the gradient of risk conveys genuine concern as opposed to an attempt at curtailing patient autonomy.
As we investigate binge-watching more, clinicians may want to keep it in the differential of possibilities while addressing intractable insomnia. Until we develop screening questions with high sensitivity and specificity, it may be worthwhile to simply ask how many episodes of a single show a patient watches in a single sitting.
The author reports no conflicts of interest.
5. . Netflix CEO Reed Hastings: Sleep Is Our Competition [published November 6, 2017]. https://www.fastcompany.com/40491939/netflix-ceo-reed-hastings-sleep-is-our-competition. Accessed October 14, 2020.