The impact of prolonged video gaming on sleep ...

The impact of prolonged video gaming on sleep pattern in adults By Nida Usman Supervised by: Dr. Ghulam Hussein Rassool (PhD, MSc, BA, FRSPH, ILTM, Cert. Ed. Cert. Counselor)

A thesis submitted in partial fulfillment of The requirements for the degree of BACHELOR OF SCIENCE (PSYCHOLOGY) at the Islamic Online University January 2018

2

Declarations and Statements I, Nida Usman, declare that the Bachelor’s thesis entitled ‘The impact of prolonged Video Game on sleep pattern in adults’ is no more than 10,000-15,000 words in length excluding quotes and exclusive of tables, figures, appendices, bibliography, references and footnotes. I certify that this thesis does not incorporate without acknowledgment any material previously submitted for a degree or diploma in any university, in whole or in part; and that to the best of my knowledge and belief it does not contain any material previously published or written by another person except where due reference is made in the text. Except where otherwise indicated, this thesis is my own work. Nida Usman

Date: 12th December 2017 Supervisor: Professor Dr G.H. Rassool

3

Acknowledgments I would like to thank everyone who had contributed to the successful completion of this project. I would like to express my deep felt gratitude to my research supervisor Dr. G.R. Hussein for his expert and timely guidance, all faculty instructors and Islamic Online University lecturers Hannah Morris, Bela Khan, Qashmala Kasim, Saja Sajjad, Dr. Umm Yahya, Dr Farah Islam and Dr. Hooman Keshavarzi for their invaluable advice and enormous patience throughout the development of the research. Honourable mention goes to my old friend Syed Imran Ali Zaidi, who taught me SPSS and spent hours proof reading and making necessary corrections. To Aisha Siddiqa, Anita Martos Harres-Dausque, Oyinlola Oluwagbemiga as well as my classmates Adesina Ademola Yussuf, Asra Ahmad, Aaliya Bhagu, Saadatu Dahiru waziri, Khansa Amin, Ayisha Yahya and my senior Yusuf Qasim for providing invaluable suggestions and without whose encouragement and constant support, this work would not have been possible. I would like to extend my additional gratitude to the gaming community online, especially Victor Barros Alves, Minhaj Aijaz, Charelle White (BSCJ Hons) and Lucy Melocco-Imre for showing immense enthusiasm and their cordial attitude for partaking in the study and enriching my data with their fair criticism, overwhelming reception and positive feedback to contribute positively to this field. I pray foremostly to Allah to accept my work in a humble attempt at bettering myself in areas where I have myself failed and by being of any service to His Creation; solely for seeking His pleasure in the Afterlife and devoid of any academic benefit or material pursuits. May He bless me with beneficial knowledge and increase me in wisdom. I ask Him to forgive my shortcomings and thank Him for providing me this opportunity to overcome my limitations. Extending my regards and dedication to all my gamer friends and family who are facing sleep- related issues in their daily life.

4

Table of Contents Declarations and Statements ............................................................................................................ 2 Acknowledgments............................................................................................................................ 3 List of figures ................................................................................................................................... 5 List of tables..................................................................................................................................... 6 Glossary Of Abbreviations .............................................................................................................. 7 Abstract ............................................................................................................................................ 8 Chapter I: Introduction ..................................................................................................................... 1 1.1-

Background and Importance ............................................................................................ 1

1.2-

Statement of the Problem ................................................................................................. 4

1.3-Research Question ................................................................................................................. 6 1.4- Objectives of the study ......................................................................................................... 6 1.5- Hypotheses ........................................................................................................................... 6 1.6- Conceptual framework ......................................................................................................... 7 1.7- Significance of the study ...................................................................................................... 7 1.8- Operational Definition of key terms ..................................................................................... 8 Structure of Thesis ......................................................................................................................... 10 Chapter II: Review of Literature .................................................................................................... 11 2.1- Sleep: Sleep loss, importance and measuring sleep ............................................................ 11 2.2- Video game and related controversies ................................................................................ 13 2.3- Pathological gaming concerns: Impact on health and risks ................................................ 15 2.4- Impact of Video Games on sleep: Sleep pattern changes and insomnia in gamers ............ 17 2.5- Educational aspects of video games ................................................................................... 28 2.6- Gaming trends and changing lifestyle in adults .................................................................. 29 Chapter III: Research Methodology ............................................................................................... 31 3.1- Research Design ................................................................................................................. 31 3.2- Strategy and Procedure ....................................................................................................... 31 3.3- Methodology....................................................................................................................... 32 3.4- Apparatus, Materials and Analytical Methods ................................................................... 32 3.5-Target Population ................................................................................................................ 33 3.6- Sampling and size ............................................................................................................... 33 3.7- Research Instrument for Data Collection ........................................................................... 33 3.8- Method of data analysis ...................................................................................................... 34 3.9- Ethical Consideration ......................................................................................................... 35

5 Chapter IV: Results ........................................................................................................................ 36 4.1- Analysis of primary data..................................................................................................... 36 4.2- Quantitative Data Analysis ................................................................................................. 54 Key findings ............................................................................................................................... 71 Chapter V: Discussion ................................................................................................................... 76 Chapter VI: Conclusion and Recommendations ............................................................................ 78 6.1- Benefits ............................................................................................................................... 78 6.2- Limitations .......................................................................................................................... 79 6.3- Implications ........................................................................................................................ 80 6.4- Recommendations .............................................................................................................. 80 Bibliography and references .......................................................................................................... 82 Appendix A: Questionnaire for participants of the survey ........................................................... 88

List of figures Figure 1: Distribution of respondents on the basis of gender Figure 2: Distribution of respondents on the basis of age Figure 3: Distribution of respondents on the basis of place of living Figure 4: Distribution of Respondents on the basis of location Figure 5: Distribution of respondents on the basis of Educational level and qualifications Figure 6: Distribution of Respondents on the basis of Marital Status Figure 7: Distribution of Respondents on the basis of Occupation Figure 8: Distribution of Respondents on the basis of Ethnicity Figure 9: Distribution of Respondents on the basis of purchasing a game. Figure 10: Distribution of Respondents on the basis of owning video games Figure 11: Distribution of Respondents on the basis of beginning age Figure 12: Distribution of Respondents on the basis of Gamer Type Figure 13: Distribution of Respondents on the basis of Frequency of playing Figure 14: Distribution of Respondents on the basis of years playing games Figure 15: Distribution of Respondents on the basis of longitudinal comparison Figure 16: Distribution of Respondents on the basis of preferable platform Figure 17: Distribution of Respondents on the basis of screentime per day

6

Figure 18: Distribution of Respondents on the basis of screentime per week Figure 19: Distribution of Respondents on the basis of playing late Figure 20: Distribution of Respondents on the basis of night time video game usage Figure 21: Distribution of Respondents on the basis of Total Sleep Time Figure 22: Distribution of Respondents on the basis of ideal sleep time Figure 23: Distribution of Respondents on the basis of sleep time per weekend Figure 24: Distribution of Respondents on the basis of bedtime Figure 25: Distribution of Respondents on the basis of SOL Figure 26: Distribution of Respondents on the basis of wake time Figure 27: Distribution of Respondents on the basis of actual sleep hours Figure 28: Distribution of Respondents on the basis of exercise activity Figure 29: Distribution of Respondents on the basis of survey: Specific Game Experience Figure 30: Distribution of Respondents on the basis of survey: Sleep Disturbance Figure 31: Scatter plot graph of Pearson Correlation

List of tables Table 1: Distribution of respondents on the basis of gender Table 2: Distribution of respondents on the basis of age Table 3: Distribution of Respondents on the basis of Place of Living Table 4: Distribution of Respondents on the basis of Educational level and qualifications Table 5: Distribution of Respondents on the basis of Marital Status Table 6: Distribution of Respondents on the basis of Occupation Table 7: Distribution of Respondents on the basis of Ethnicity Table 8: Distribution of Respondents on the basis of survey Question No. 1 Table 9: Distribution of Respondents on the basis of survey Questions No.2 Table 10: Distribution of Respondents on the basis of survey Questions No.3 Table 11: Distribution of Respondents on the basis of survey Questions No.4 Table 12: Distribution of Respondents on the basis of survey Questions No.5 Table 13: Distribution of Respondents on the basis of survey Questions No.6 Table 14: Distribution of Respondents on the basis of survey Questions No.7 Table 15: Distribution of Respondents on the basis of survey Questions No.8 Table 16: Distribution of Respondents on the basis of survey Questions No.9

7

Table 17: Distribution of Respondents on the basis of survey Questions No.10 Table 18: Distribution of Respondents on the basis of survey Questions No.11 Table 19: Distribution of Respondents on the basis of survey Questions No.12 Table 20: Distribution of Respondents on the basis of survey Questions No.13 Table 21: Distribution of Respondents on the basis of survey Questions No.14 Table 22: Distribution of Respondents on the basis of survey Questions No.15 Table 23: Distribution of Respondents on the basis of survey Questions No.16 Table 24: Distribution of Respondents on the basis of survey Questions No.17 Table 25: Distribution of Respondents on the basis of survey Questions No.18 Table 26: Distribution of Respondents on the basis of survey Questions No.19 Table 27: Distribution of Respondents on the basis of survey Questions No.20 Table 28: Distribution of Respondents on the basis of survey Questions No.21 Table 29: Distribution of Respondents on the basis of survey Questions No.22 Table 30: Distribution of Respondents on the basis of survey Questions No.23 Table 31: Distribution of Respondents on the basis of survey Questions No.24 Table 32: Distribution of Respondents on the basis of survey Questions No.25 Table 33: Distribution of Respondents on the basis of survey Questions No.26 Table 34: Pearson Correlation between questions 17 and 25 Table 35: Inferential statistics- Independent t-testing group statistics Table 36: Inferential statistics- Independent t-testing results

Glossary Of Abbreviations ➢ ➢ ➢ ➢ ➢ ➢ ➢ ➢ ➢ ➢ ➢ ➢ ➢ ➢ ➢

SOL: sleep onset latency SPSS©: statistical package for the social sciences TST: total sleep time ST: screen time VG: Video gaming VGA: Video-Game Addiction VGP: Video-Game Playing IGD: Internet Gaming Disorder PVP: problem video game playing PVGP-R CGA :computer gaming addiction RPG: Roleplaying game FPS: First person shooter MMO: Massively Multiplayer online RTS: Real- time strategy ONG: Online Gaming

8

Abstract Background Sleep plays an important role in health and its significance is emphasized. Reduced levels of attention, retention, learning and memory are adverse outcomes of sleep disorders. Objective The present study aimed to probe the impact of prolonged video gaming on sleep pattern among an ethnically diverse sample of n=100 active, adult videogamers. The researcher hoped to find a correlation between adult gamers’ amount of video game usage and their reported quantity as well as quality of sleep. Methods The variables were measured using an online survey derived from the Pittsburg Sleep Quality Index (PSQI), Sleep Reduction Screening Questionnaire (SRSQ), Insomnia Severity Index (ISI), and Game Engagement Questionnaire (GEQ). 50 males and 50 females were selected by convenient sampling method. Data was collected using googledocs. Findings were analyzed using Pearson correlation and independent sample ttest. Survey items had acceptable internal consistency (Cronbach's alpha) at 0.858. Results Gamers had self-reported having trouble falling asleep within 30 minutes (M=1.96), were not getting enough night time sleep (M=1.73), displayed daytime sleepiness (M=1.78) and felt dissatisfied with their current sleep pattern (M=1.70). The most prevalent sleep disturbances for waking up at night were requiring to use the bathroom (36%), bad dreams (35%), feeling hot (31%), restless legs (22%), headaches (16%), pain (14%), cold (11%), night sweats (10%), coughing (6%), and snoring (2%) respectively. Anxiety (3%) due to a restless mind was also a common concern. Most played genres reported were RPG (82%), SP (75%), FPS (60%), action (56%), adventure (49%), MMORPG (45%), RTS (40%), multiplayer (44%) and stealth (39%). Pearson correlational analyses revealed a non-significant negative relationship between the total amounts of screening time an individual spent playing video games (ST) and the amount of sleep time (TST). However, during hypothesis testing, it was found that there

9

is a significant positive association with adult gamers losing hours of sleep (M= 1.86) and video gaming negatively affecting sleeping habits (M=2.07). Conclusions In agreement with previous findings, shortened sleep duration was indeed associated with prolonged video gaming intervals. Prevalence of sleep disorders was significant. Use of videogames at higher doses was associated with delayed sleep/wake schedules and wake lag, potentially impairing health outcomes. Implications Future research should examine whether interventions to reduce screen time activities among adults is effective in increasing their sleep duration.

1

Chapter I: Introduction This chapter presents the general introduction to this study. In this, background of the study, statement of problem, research questions, hypotheses, theoretical and conceptual framework, research objectives, originality and significance of the study and operational definition of key terms used are clearly discussed. Limitation of the study has been dealt separately in the concluding chapter.

1.1- Background and Importance

In today’s world, the trend of interactive technology has grown significantly and this has brought about major changes in the routine life of adults. The gaming industry has revolutionized and changed into a very large global market now worth billions. Today, every house has a computer a game console in order to avail entertainment during leisure time. The ratio of video game consoles owned by people in comparison to PC has hit the equality line in the 1980s and around 2011 about $17.8 billion had been allocated on video gaming merchandise. (Stamford, CT; 2011. Gartner, Inc. Market trends: gaming ecosystem, 2011.) Western media came into mainstream after technological advancements and has become an alarming danger for the ethics of today’s generation: it poses great threats in terms of addiction and problematic gameplay, but most importantly the issues regarding violent media content and how it has affected people have many controversies around it, ultimately having consequences on the cognitive behavior and the overall performance of young people’s brain. (Ferguson & Kilburn, 2010) Video gaming has become a trending activity among young people as well as adults in many countries, with about 9% of the youth following this addictive habit (Gentile, 2009). Significant growth of information technology has greatly increased the number of hours people spend on their computers during late hours. A Japanese research study on information technology (Japanese Ministry of Posts and Telecommunications Japan, 1998) found that 53.7% of the overall populace of Japan that are internet users had skipped their bed time and about 45.4% of the people started sleeping less hours per day. Another research study in Belgium probed about students from secondary school that

2

were utilizing internet to play games had been going late to bed and spent less time in bed (Van den Bulck, 2004). This presents the findings that utilization of night time for computer affects night time sleep routine, but how video gaming has affected sleep mechanism and quality has yet still been a mystery for many researchers. (Shigekazu Higuchi, 2005) A healthy lifestyle is maintained through good sleep routine. A number of problems may occur due to prolonged hours of gaming such as insomnia, less productive performance or moody behavior at work, increased level of tiredness and late routine of sleep. Less attention span, learning and memory retention skills are some of the negative effects of sleep and sleeping disorders. Many findings from research surveys have shown negative impacts on sleep due to video gaming (Eggermont and Van den Bulck, 2006; Oka et al., 2008; Schochat et al., 2010; Suganuma et al., 2007; National Sleep Foundation, 2011). The duration of sleep in youth these days have been negatively affected due to addiction of video gaming. A number of models have been presented to elaborate how the electronic media has negatively affected sleep and caused disturbing consequences in a number of ways: a. Dramatic increase in mental, emotional and psychological states due to engaging content b. Vibrant blue light exposure results in stoppage circadian rhythm by suppressing melatonin hormone. (Cain and Gradisar, 2010; Gradisar and Short, 2013) c. Disturbance in normal sleep routine Some studies have shown the effects of mental tasks and mental stress on sleep (Baekeland et al., 1968; Browman and Tepas, 1976; De Bruin et al., 2002; Germain et al., 2003; Koulack et al., 1985; Takahashi and Arito, 1994), but the results of these studies are not consistent. For example, effects of mental tasks on slow wave activity (SWA) were found in one study (Takahashi and Arito, 1994) but were not found in other studies (Browman and Tepas, 1976; De Bruin et al., 2002). There are also inconsistencies in results regarding other variables of sleep such as REM sleep and sleep latency. The effects of mental tasks on sleep seem to depend on the kind of tasks (boring/interesting and easy/difficult), amount of tasks (large/small) and time of day (early night/late night). Video games are kinds of mental task, but most of them are more exciting and interesting than mental tasks used in previous studies. It is necessary to confirm the effects of a

3

computer game on sleep because of the influence of a video game may be different from that of tasks used in previous studies. Another feature of playing a video game is that players gaze at a monitor display as a light source. It has been reported that artificial light had an effect on human physiology (Shanahan and Czeisler, 2000; Yasukouchi and Ishibashi, 2005). It is known that exposure to light during the night delays the acrophase of human circadian rhythm (Drennan et al., 1989; Hashimoto et al., 1996; Lewy et al., 1987; Minors et al., 1991) and suppresses melatonic secretion (Hashimoto et al., 1996; Higuchi et al., 2005; Zeitzer et al., 2000), and the effects of bright light before going to bed on sleep have been reported (Cajochen et al., 1992; Dijk et al., 1991; Kozaki et al., 2005). More recent studies have shown that exposure to light of relatively low intensity can affect human circadian rhythm (Boivin et al., 1996; Zeitzer et al., 2000) and that performing an exciting video display terminal (VDT) task using a bright display suppressed nocturnal salivary melatonin secretion (Higuchi et al., 2003). Furthermore, it has been reported that there is a dose–response relationship between light intensity and human alertness during the early biological night, exposure to a light of approximately 100 lx increases human alertness (Cajochen et al., 2000). These results of previous studies suggest that a bright display also may influence presleep physiological variables and sleep, although the light intensity of a computer display is not so strong. In most previous studies on the effects of mental tasks and bright light on sleep, presleep physiological variables reflecting activity levels of central and autonomic nervous were not measured despite the fact that physiological variables before sleep may affect sleep, especially the sleep onset process. For instance, Komada et al. (2000) reported that enhanced cerebral cortex activity caused by exposure to bright light affected the sleep onset process, and Kräuchi and Wirz-Justice (2001) reported that distalproximal skin temperature gradient was the best predictor of sleep onset. In addition, many studies have shown that increase in body temperature induced by using body heating before sleep increases slow-wave sleep (SWS) (Bunnell et al., 1988; Dorsey et al., 1999; Horne and Shackell, 1987; Jordan et al., 1990) and increases sleep latency (Bunnell et al., 1988), although it has been reported that there is no strong relationship between the circadian variation in core body temperature and the level of electroencephalogram (EEG) slow-wave activity (Dijk, 1999). It is possible that playing a computer game and gazing at a bright display affect presleep activity levels of central and

4

autonomic nervous system and body temperature, presleep physiological variables such as EEG activity, sleepiness, heart rate and body temperature are measured in studies. It has been reported that some physiological variables while playing a video game were affected by the kind of task (exciting or boring) and brightness of the display (bright or dark) (Higuchi et al., 2003). It was hypothesized that playing an exciting computer game using a bright display at night affects sleep variables if it alters presleep physiological variables. The effects of playing an exciting video game on presleep physiological variables and sleep variables and whether exposure to a light by gazing at a bright display affects presleep physiological variables and nocturnal sleep variables need to be further examined. Cross-sectional evidence indicates adolescents playing video games prior to sleep results in sleep disturbance. Surveys linking stimulating presleep activities to poor sleep need to be substantiated with empirical evidence (Weaver, 2010).

1.2-

Statement of the Problem

63% of US households contain atleast one “frequent gamer”, a trait nonexistent a few generations ago. People are struggling to find a healthy balance. Researchers are still attempting to understand this activity’s risks and effects as it has recently become a common past time. Most literature on the relationship between video gaming and sleep disturbances has looked at children and adolescents. There is little research on such a relationship in adult samples. (Bulck, 2014) Effects of pre-sleep video-gaming has not been wellunderstood and experimental studies are necessary to understand the cause-and-effect relationship between video game technology use and sleep which surprisingly have documented smaller than expected effects (Ivarsson et al., 2009). So far, only four experimental studies have investigated video gaming and sleep. Although the effects of video-gaming on sleep architecture appear to be minimal (Dworak et al., 2007; Higuchi et al., 2005) or negligible (Weaver et al., 2010), it has been noted that the relatively low level of exposure to video-gaming (i.e. 60 min) may be insufficient to produce discernible effects (King, 2012). Although several studies have established an association between disturbed sleep and electronic media use, there has been little work using controlled experimental designs to quantify the impact of video-game play on subsequent sleep, using objective and subjective measures (Kyle, 2012). How computer games affect the time at which gamers go to bed is of growing research interest; however, the intrinsic individual and extrinsic sociocultural factors

5

mediating the relationship between gaming and sleep have received minimal attention. (Smith, 2017) Sleep is a quiescent state that permits physiological recording with a minimum of environmental interference. Earlier studies have shown that gaming in general can generate prolonged sleep onset and fatigue caused by shorter time in bed. The current study also takes into account how game habits and game content are associated with sleep. According to Kerstedt and coworkers, good sleep quality is a matter of time to fall asleep and subjective feeling of good or poor sleep. High versus low experience of violent gaming seems to be related to different physiological, emotional, and sleep-related processes at exposure to videogaming. These processes seem to proceed concurrently across various systems. Still, it is not knon if they are related to behavior changes, which stand out as a question of interest for future research just as more deep-going analyses to chisel out the mechanisms underlying the different patterns (Ivarsson M, 2009). Video game addiction now has a tentative diagnosis in the DSM-5. Patients discussed sacrificing sleep to maintain their video gaming activities. Additional research is indicated to determine if excessive video gaming and IGD are associated with sleep deprivation and insomnia. (Hale, 2015) In a research study conducted on U.S. Marine Corps by military medicine, all the gamers shared sleep deprivation associated with 30 to 60 hours of video gaming online per week. The sleep deprivation because of excessive video gaming appears associated with daytime drowsiness, fatigue, poor concentration, irritability, poor work performance, expressed anger, and blunted affect. The patients also exhibited craving, anger, and irritability when not able to play video games. Patients discussed sacrificing sleep to maintain their video gaming activities. Additional research is indicated to determine if excessive video gaming and IGD are associated with sleep deprivation and insomnia. (Eickhoff, 2015) Long duration of gaming is significantly associated with prolonged SOL (Alexandru, 2006). While SOL increased and gamers reported subjectively poorer sleep quality, differences were minor in contrast to expectations. As this study related to moderate VGP, further studies are required to analyze the influence of VGA on sleeping habits and subsequent effects on health indicators. (Loton, 2014) More research is needed to determine whether factors like disruption of sleep patterns act as mechanisms of change and this is where this study picks up from in order to further contribute to it by exploiting the gaps in existent literature.

6

1.3-Research Question The research questions guiding the scope of this study include: R1: How often will the subjects lose sleep due to playing video games? R2: Does the content of the video game genre have any effect on the sleep quality? R3: What are the main reasons for sleep deprivation due to gaming among individuals?

1.4- Objectives of the study The aim of the present study is to examine the impact of prolonged (i.e., excessive) video gaming on sleep. This research will focus on measuring the impact of video game usage on sleep disturbances and changes in sleep patterns depending on the hours of time spent video-gaming before bed-time. It will be done in order to raise awareness about the various impacts that prolonged exposure to violent and non- violent video gaming can have on individuals. The findings will help elucidate a link between video gaming and insomnia so as to improve sleep quality despite the compulsive gaming habit. Furthermore, it will also help probe additional findings that will further clarify the relation between gaming and sleep patterns of individuals. The aim of this study was to investigate the effects of singular excessive computer game consumption on sleep patterns and to determine the association of sleep disturbances with excessive video game playing in adults.

1.5- Hypotheses ▪

Prolonged exposure (150 min) to a novel violent video-game before bedtime would be more disruptive to sleep than shorter-duration.

▪

Prolonged video-gaming would result in an increase in Sleep Onset Latency (SOL) and subjective alertness before sleep, and a reduction in total sleep time (TST)

H0: There will be significant effect of gaming on the sleep pattern of individuals. H1: There will be a significant effect of gaming on the sleep pattern of individuals.

7

1.6- Conceptual framework Previous research has indicated that prolonged exposure to gaming and increased screentime correlates to lesser hours being dedicated to sleeptime. If that indeed holds true, it should be observed that heavy gamers infact sleep lesser than the minimum hours required by an adult to properly function without the screetime seen as problematic or interfering with their daily life activities. The variables involved in this study were: Independent variable: Screen time (in hours). Excessive/ Non-excessive Dependent variable: Total sleep time (in hours). Adequate/Inadequate Independent variable

Dependent variable

Screen time hours spent gaming

Total Sleep Time (TST)

Level 1: 1-2 hour Level 2: 3-4 hour Level 3: 5 and above

Average amount of sleep required for adults: 7- 9 hours

If TST fits the average range, null hypothesis is accepted. There is no effect on sleep. H1 If TST doesn’t fit the average range, null hypothesis rejected. There is effect on sleep. H0

1.7- Significance of the study The previously conducted researches have focused on finding links of video gaming effects on aggression, academic performance, attention, social relationships, empathy, desensitization, immersion and mood but never before has there been significant attempt to overcoming insomnia in adults by regulating the frequency and duration of optimal time spent video-gaming before bed-time. This research study intends to fill that gap by creating an original questionnaire. It will benefit the society to study this matter extensively in order to identify the problematic grey areas. Because video gaming is something that cannot be eradicated entirely in the contemporary world, so the best we can do is to identify these issues and mitigate their ill-effects. Previously, research had been fixated on school students and adolescent males as males were found to be more actively involved in gaming than females. This work

8

focuses on adult males and females equally. This is the new addition to the existing field that may benefit society at large so if there are any sleep disorders related to gaming, adults may accordingly rectify their sleep patterns to become more productive and alert.

1.8- Operational Definition of key terms Term

Meaning

Video game

A game played by electronically manipulating images produced by a computer program on a monitor or other display (Oxford, n.d.).When discussing various types of computer and video games, “digital games” may be used. This phrase refers to any type of game played on a computer or videogame console.

Gamers

A worldwide, standardized term used for players engaged in video games.

Videogame

It is described as an impulse control disorder, which does

addiction (VGA)

not involve use of an intoxicating drug and is very similar to pathological gambling. It is also referred to as video game overuse, pathological or compulsive/excessive use of computer games (Gentile, 2009).

Screen time

The number of hours the young people reported watching television, playing videogames, or using a computer. “Screen time” refers to the amount of time a person spends in front of any type of technology including a computer or television screen.

Nocturnal technology use

Technology usage between the hours of 10pm and 6am.

General technology use

Technology usage at any time of the day or night.

Displacement

Ability to give up other activities in order to play their games (Palaus, 2017).

Total Sleep Time

(TST) represents the entire time spent sleeping and is the sum of the Deep Sleep Duration, Light Sleep Duration and REM Sleep Duration in a sleep episode.

Sleep

Onset

Latency It is the amount of time it takes to fall asleep after the lights

(SOL)

have been turned off (Brandon Peters, 2017).

Insomnia

A sleep disorder characterized by difficulty falling and/or

9

staying asleep.

10

Structure of Thesis The formatting of this thesis follows the publication manual of the American Psychological Association 6th edition (APA 6th). Chapter 1 Introduction presents a brief background, problem statement, the research questions, objectives, hypothesis, theoretical framework, significance and technical terms. Chapter 2 presents a literature review of sleep and morbid effects of video game play. It reviewed the available research literatures related to problematic videogameplay and addictions, with particular reference to reasons for sleep deprivation in adults. Chapter 3 is the research method, detailing procedures, measures, design, data collection, sample, procedure of data analysis, and ethics are clearly discussed in this chapter. Chapter 4 details the findings of the research and presents them in graphs and tables. Frequency, mean, standard deviation and percentage tables for demographic information, the prevalence of problematic gaming behaviours among the respondents, the distribution of sleep loss within gender and age groups, reasons for sleep deprivation, game genre choice of the respondents and the results of the relationship between TST and screentime have been presented. Chapter 5 discusses the results of the study. This chapter converses the principal findings of the results, discussion of findings and the relationship and highlights differences between the previous research results and the findings of this study. Chapter 6 is the epilogue, summarising the results of the thesis, limitations of the study, and considers the implications of the findings for future researches in order to curb the problem of sleep deprivation and insomnia in adults.

11

Chapter II: Review of Literature 2.1- Sleep: Sleep loss, importance and measuring sleep Lay conceptualisations of sleep describe sleep typically as a unitary period where we fall asleep and remain asleep until either body or alarm clock transitions into wakefulness. (Moorcroft & Belcher, 2003). However, sleep is not a distinct block and consists of many stages including non REM stages 1-5 and REM sleep, between which periods of wakefulness may occur. (Carskadon & Dement, 2011). Stages of sleep include non-rapid eye movement (NREM) and rapid eye movement (REM). Sleep can be measured using objective measures (polysomnography, actigraphy) and subjective measures (questionnaires and sleep diaries). According to National Sleep Foundation, the ideal time of sleep for adults aged 18-64 is 7-9 hours (recommended) and 6-11 hours (appropriate). According to several researches, the purpose of sleep follows three main functions: 1) consolidating memories (Born, Rasch & Gais, 2006; Sejnowski & Destexche, 2000; Wagner, Gais, Haider, Verleger, & Born, 2004); 2) restoring the organism both physiologically and psychologically (Bonnet & Arand, 1996; Irwin, 2002); and 3) conserving energy for organic functions (Maquet, 1995). As sleep re-energizes the body and helps the mind consolidate memory, thus a lack of sleep or disrupted sleep can easily affect one’s ability to function the next day. Poor sleep hygiene is considered a big indicator of sleep deprivation. Sleep loss has the potential to impact not just the individual but has societal implications like health morbidities and motor accidents that have a high influence on overall population health. Sleep deprivation varies within populations based on age, race, income, occupation factors. Adolescents and young adults are most sleep deprived groups in the US (Forquer, Camden, Gabriau, & Johnson, 2008). Individuals with more than one job (37.7%) have disproportionate sleep deprivation rates than those with one job (29.4%). It also significantly impacts those who work more than 40 hours (36.2%) a week than those who work lesser (27.7%). Overall this a great concern for adults and an average civilian employed US adult (30%) report less than 6 hours sleep per day (Luckhaupt, 2012).

12

2.1- Health consequences of sleep loss and sleep deprivation The significance of sleep for health and functional capacity is emphasized. The functions of sleep is essential for the proper functioning of the body and sleep deprivation has been linked to several impairments, such as 1) reduced immunity, 2) memory impairments and retrograde amnesia, 3) increased sleepiness during the day, 4) mood disorders such as depression, psychosis-like symptoms in healthy individuals and 5) the loss of concentration, cognitive symptoms that mimic ADHD. Besides causing subjective discomfort such as excessive daytime sleepiness, sleep disorders are associated with increased risk for metabolic and cardiovascular diseases in adults. 2.1.1- Stress: It is a major side effect of sleep deprivation. Pilcher and Walters (1997) study indicated that stress indicators, confusion, fatigue are caused due to it and the symptoms correlate. Studies also assessed stress as a consequence of deprivation. Britz & Pappas (2014) conducted a study at James Madison University with 124 college students, 50% of who reported high stress levels related to academic workload and time management linking to unhealthy behaviours like decreased sleep. 57% students reported sleeping 6-7 hours per night and those who obtained 7 hours (less than recommended amount of sleep per night) reported higher stress levels. It was also found that stress is connected to reduced general relaxing time. Time management is a challenge for sleep deprived students thus these individuals are more prone to stress. 2.1. 2- Memory & cognitive impairment: According to a study led by Jiang, restraining sleep in young adults, of 18 to 20 years, for 5 days or more, may not significantly impair accuracy in working memory tasks, but does impair reaction times on such tasks (Jiang et al., 2011). Curcio Ferrara and De Gennaro (2006) found that sleep plays a vital role in learning and memory. Their study observed a corresponding relationship between them and synaptic plasticity (Curcio, Ferrara, and De Gennaro, 2006). For memory retention and sleep loss, researched to conduct a series of cognitive tasks (like concentration and estimated performance) completed by self-reported questionnaire participants on the amount of effort perceivably used in the test. Sleep deprived subjects performed cognitive tasks worse than regular participants while they rated their concentration and effort level higher. Students also reported their estimated performance significantly higher but their

13

self-perceived notions contradict actual findings that they infact perform worse. (Pilcher and Walters, 1997) 2.1.3- Sleep Duration and Obesity in Adults and Young Adults: Significance of link between sleep duration and BMI seems to decrease with age. A review showcases that majority of adult population based studies (in 17 out of 23 cross sectional and 3 out of 3 longitudinal studies) confirm the link exists. A cross-sectional analysis examined association between them in a young adult’s sample of mean age 25. BMI, overweight status and obesity were inversely associated with sleep duration among men with no significant associations found among women. Methodological research studies focusing on body mass and sleep duration concluded that generalizations come from studies with individuals receiving less sleep ( .9 – Excellent, _ > .8 – Good, _ > .7 – Acceptable, _> .6 – Questionable, _ > .5 – Poor and_ < .5 – Unacceptable” (p. 231). Reliability score: Cronbach Alpha Reliability Statistics

Cronbach's Alpha Cronbach's Based on Standardized Alpha Items .864 .858

N of Items 26

It helped the researcher to gather quantitative data in from of statistics and information relevant to the research study. The aim of the questionnaire was to gather rich data from participants. This method is commonly known as a “questionnaire” that is usually used to collect the data from the respondents with a proper consent.

3.5-Target Population All the individuals that are active gamers were the focus of this research study. But due to time and resource constraint, a selective amount of n=100 respondents were used to generalize the whole population of gamers. The tool was administered among participants around the world to further gain rich as well as diverse data.

3.6- Sampling and size A total of 100 respondents (50 male and 50 female) were selected through nonprobability sampling technique. Convenience sampling was used for the research study. Convenience sampling is a non-probability sampling technique where subjects are selected because of their convenient accessibility and proximity to the researcher (Convenience Sampling, n.d.). The respondents were approached on various social media websites/ gaming network forums. All respondents for the research study were active gamers that play video games on any preferable platform. Demographic data such as age, gender and country etc. had been recorded to make the research more credible. The sampling for the research study was scrutinized through several phases before finalizing the desired respondents.

3.7- Research Instrument for Data Collection The tool for the research that was implemented by the researcher for this study was an adapted scale. It had been validated through content validity while for the purpose of

34

reliability; the adapted scale was piloted on 10 students, taken from the population. The final scale matched the objectives of the research study. (See Appendix) The sleep quality component of the PSQI has been shown to be a sensitive measure of maladaptive behavior such as excessive video game-playing in adults (Exelmans and Van Den Bulck, 2015) The survey used was divided into four sections: demographic information, general gaming habits, general sleep habits, and a 3- point likert scale questionnaire. The demographic information section contained primary, non-sensitive data of the respondents which included sex, age, location, educational level, marital status and occupation. The gaming, sleep and likert chart sections contained thirteen, nine, and twenty six items respectively. The questions were asked on a range of semi-open ended MCQ options while items were scored as 1=Agree, 2= Neutral, 3= Disagree. This scale was used to record the general habits of the gamers and the extent of their relative agreement or disagreement to the statements on the impact of prolonged gaming on their sleeping styles.

3.8- Method of data analysis This research study, which focuses on the effect of prolonged video games on sleep pattern of adults, made use of primary data which were gathered from respondents using a well-structured, semi open-ended questionnaire. Descriptive quantitative (frequency, percentage table, mean, standard deviation) and inferential (Pearson coefficient of correlation, independent sample t-test) statistical analysis were employed in analyzing the data. The analysis was done with the aid of statistical software known as IBM SPSS version 22. The overwhelming responses exceeded expectations reaching 260, so after handpicking 100 participants and deleting the rest, the survey presented graphs and representative figures of distribution of the responses. The responses were then documented on Microsoft Excel sheet and accordingly inserted into SPSS. The responses were later selected for testing hypothesis. The questions concerning total sleep time and total screentime were compared using Pearson Correlation to gain a significant coefficient. Pearson coefficient of correlation is a test which measures the strength and relationship between variables.

35

For independent t-test, two determining questions “Video games have negatively affected my sleep habits” and “I lose hours of sleep due to gaming” were selected. This gave a general idea of whether or not gamers attributed sleep deprivation to their prolonged gaming hours.

3.9- Ethical Consideration In order to consider ethical domains, all the participants were provided with a proper consent prior to the questionnaire. This was to verify the willingness of the participant for their response recorded through the survey. All the data recorded through the survey was solely for the purpose of research and none of the data was revealed to any second person. Any information collected in connection to the research study and that related to them were kept utmost confidential. The information was used for research purpose and not for personal use by disclosing it in any manner. The results of this study were used in reports, papers, presentations, and publications; however, any identifying information were omitted or disguised to ensure confidentiality and anonymity. Participants were asked to create a unique code used to identify the data in case they wished to withdraw from the study. Password protected accounts stored the data which were only accessible to the researcher. All the data were destroyed in 2 weeks following the study completion. All the responses were only used for the current study.

36

Chapter IV: Results In this chapter of the research study, highlighting the frequency and cumulative percentage tables of the demographics comes first. Additionally, pie charts for the PSQI tool items will be added as well as mean and standard deviation will be represented in the table for the Adapted from the Pittsburg Sleep Quality Index (Buysse, Reynolds, Monk, Berman, & Kupfer 1989). This chapter will also shed light on the other tools: Sleep Reduction Screening Questionnaire (van Maanen et al., 2014), Insomnia Severity Index (Morin et al., 2011) and Game Engagement Questionnaire (Brockmyer et al., 2009). The conclusion of the chapter will present the discussion and results from analysis of the data.

4.1- Analysis of primary data In the previous chapters, introduction, literature review and research methodology is discussed. In this chapter, data is analyzed using tables, graphs and tests.

Section 1A: Biographical Information Table 1: Distribution of respondents on the basis of gender Gender

Valid Female Male Total

Frequency 50 50 100

Valid Cumulativ Percent Percent e Percent 50.0 50.0 50.0 50.0 50.0 100.0 100.0 100.0

Figure 1: Distribution of respondents on the basis of gender

37

➢ Equal respondents of male and female sample were chosen. Table 2: Distribution of respondents on the basis of age Age Frequency Percent Valid 18-25 years 49 49.0 25-40 years 48 48.0 40-60 years 3 3.0 Total 100 100.0

Valid Cumulative Percent Percent 49.0 49.0 48.0 97.0 3.0 100.0 100.0

Figure 2: Distribution of respondents on the basis of age

➢ Majority of respondents were in the age range of 18-40 years. Table 3: Distribution of Respondents on the basis of Place of Living Place of Living

Valid Rural Semi-Urban Urban Total

Valid Cumulative Frequency Percent Percent Percent 17 17.0 17.0 17.0 29 54 100

29.0 54.0 100.0

29.0 54.0 100.0

46.0 100.0

Figure 3: Distribution of respondents on the basis of place of living

38

➢ Majority of respondents were from an Urban and Semi-urban place of living. Figure 4: Distribution of Respondents on the basis of location

Table 4: Distribution of Respondents on the basis of Educational level and qualifications Education Level and Qualification Valid Cumulative Frequency Percent Percent Percent Valid Diploma/ Associate 19 19.0 19.0 19.0 Doctoral Degree (PhD) 2 2.0 2.0 21.0 High School 26 26.0 26.0 47.0 Master's 1 1.0 1.0 48.0

39

Master's Degree (MA/ MSc) Post Graduate Professional qualification Undergraduate degree Vocational/Technical training Total

14

14.0

14.0

62.0

6

6.0

6.0

68.0

4

4.0

4.0

72.0

22

22.0

22.0

94.0

6

6.0

6.0

100.0

100

100.0

100.0

➢ The surveys reached gamers of various class standing classifications. Most students who responded were High School graduates or undergraduates.

Figure 5: Distribution of respondents on the basis of Educational level and qualifications

Table 5: Distribution of Respondents on the basis ofMarital Status Marital Status Frequency Percent Valid Current partner lives elsewhere Divorced Living with another Married Separated Unmarried Total

Valid Percent

Cumulative Percent

6

6.0

6.0

6.0

3 6 12 1 72 100

3.0 6.0 12.0 1.0 72.0 100.0

3.0 6.0 12.0 1.0 72.0 100.0

9.0 15.0 27.0 28.0 100.0

40

Figure 6: Distribution of Respondents on the basis of Marital Status

➢ Majority of the respondents were unmarried. Table 6: Distribution of Respondents on the basis of Occupation Occupation Frequency Percent Valid NonWorking/Unemployed Retired Self-Employed Student Working/Employed Total

Valid Percent

Cumulative Percent

15

15.0

15.0

15.0

1 5 33 46 100

1.0 5.0 33.0 46.0 100.0

1.0 5.0 33.0 46.0 100.0

16.0 21.0 54.0 100.0

➢ Majority of the respondents were working/employed or student.

Figure 7: Distribution of Respondents on the basis of Occupation

41

Table 7: Distribution of Respondents on the basis of Ethnicity Ethnicity

Valid Arab Asian Caribbean Cherokee/Irish Chinese Hispanic Mixed South Asian White/Caucasian White/Caucasian/Native Total

Frequency Percent 2 2.0 10 10.0 1 1.0 1 1.0 1 1 4 1 78 1 100

Valid Cumulative Percent Percent 2.0 2.0 10.0 12.0 1.0 13.0 1.0 14.0

1.0 1.0 4.0 1.0 78.0 1.0 100.0

Figure 8: Distribution of Respondents on the basis of Ethnicity

1.0 1.0 4.0 1.0 78.0 1.0 100.0

15.0 16.0 20.0 21.0 99.0 100.0

42

➢ Majority of the respondents were White/Caucasian and Asian in origin Survey respondents varied in race and ethnicity identities. Most respondents identified as Non-Hispanic White with 80% of the response rate. Asian had the second highest response rate with 9% of the response rate.

Figure 9: Distribution of Respondents on the basis of purchasing a game.

43

➢ All respondents reported owing a game.

Figure 10: Distribution of Respondents on the basis of owning video games

➢ Majority of the respondents owned more than 30 games.

Figure 11: Distribution of Respondents on the basis of beginning age

44

➢ Majority of respondents said they began playing at an early age (around 5 years).

Figure 12: Distribution of Respondents on the basis of Gamer Type ➢ Majority considered themselves a frequent/core/specialist video gamers.

Figure 13: Distribution of Respondents on the basis of Frequency of playing

45

➢ Majority said they played everyday or several times per week.

Figure 14: Distribution of Respondents on the basis of years playing games

➢ Majority said they played games for 7 years and are still playing them.

Figure 15: Distribution of Respondents on the basis of longitudinal comparison

46

➢ Majority said they play games less frequently now.

Figure 16: Distribution of Respondents on the basis of preferable platform

➢ Majority said they preferred playing on Personal Computer or consoles.

Figure 17: Distribution of Respondents on the basis of screentime per day

47

➢ Majority said they play games between 2-5 hours daily.

Figure 18: Distribution of Respondents on the basis of screentime per week

➢ Majority said they play more than 22 hours a week.

Figure 19: Distribution of Respondents on the basis of playing late

48

➢ Majority said they play several times a week or every day.

Figure 20: Distribution of Respondents on the basis of night time video game usage ➢ Majority reported owning a gaming system in their bedroom.

Figure 21: Distribution of Respondents on the basis of Total Sleep Time

49

➢ Majority reported sleeping for 6 hours at night.

Figure 22: Distribution of Respondents on the basis of ideal sleep time ➢ Majority reported they require 7-8 hours of sleep to function daily.

Figure 23: Distribution of Respondents on the basis of sleep time per weekend

50

➢ Majority reported they sleep for 6-8 hours during weekdays.

Figure 24: Distribution of Respondents on the basis of bedtime ➢ Majority reported they have gone to bed only after mid-night or past sunrise.

Figure 25: Distribution of Respondents on the basis of SOL

51

➢ Majority reported falling asleep within 5-10 minutes every night.

Figure 26: Distribution of Respondents on the basis of wake time ➢ Majority reported getting up in the morning at various time during the day.

Figure 27: Distribution of Respondents on the basis of actual sleep hours

52

➢ Majority reported getting 6 hours of actual sleep per night.

Figure 28: Distribution of Respondents on the basis of exercise activity ➢ Majority reported getting no exercise or little exercise pointing towards a sedentary lifestyle. Figure29: Distribution of Respondents on the basis of survey: Specific Game Experience

53

From figure29, it can be derived that majority of the respondents selected single player role-playing while minority of the respondents selected sports or educational games. Figure30: Distribution of Respondents on the basis of survey: Sleep Disturbance

➢ Majority of the respondents said they had to use the bathroom, had bad dreams and/or complained of feeling too hot/cold. Reasons for waking up in the night varied from anxiety to restless mind.

54

4.2- Quantitative Data Analysis Figure: I am immediately wide awake when I wake up

22% Agree Neutral

56%

Disagree

22%

Table 8: Distribution of Respondents on the basis of survey Question No. 1: I am immediately wide awake when I wake up

Valid Agree Neutral Disagree Total

Frequency Percent 22 22.0 22 56 100

22.0 56.0 100.0

Valid Cumulative Mean Percent Percent 22.0 22.0 22.0 56.0 100.0

44.0 100.0

S.D.

2.34

.819

56 % of the respondents selected Disagree, while 22 % of the respondents selected Neutral and 22% chose agree. The total mean calculated for question 1 was calculated as 2.34, whereas standard deviation as 0.819.

Figure: I have trouble getting up in the morning

50%

56%

Agree Neutral Disagree

18%

55

Table 9: Distribution of Respondents on the basis of survey Questions No.2: I have trouble getting up in the morning

Frequency Percent Valid Agree 50 50.0 Neutral 18 18.0 Disagree 32 32.0 Total 100 100.0

Valid Cumulative Mean Percent Percent 50.0 50.0 18.0 68.0 1.82 32.0 100.0 100.0

S.D

.892

50% of the respondents selected Agree, while 32% of the respondents selected Disagree. The total mean calculated for question 2 was calculated as 1.82, whereas standard deviation as 0.892.

Figure: During the hour before bedtime, I do things that make me feel very awake (like playing video games)

13% Agree 32%

Neutral 55%

Disagree

Table 10: Distribution of Respondents on the basis of survey Questions No.3: During the hour before bedtime, I do things that make me feel very awake (like playing video games)



S.D .713

56

55 % of the respondents selected Agree, while 32 % of the respondents selected Neutral. The total mean calculated for question 3 was calculated as 1.58, whereas standard deviation as 0.713.

Figure: I use my bed for things other than sleep (such as gaming or using a handheld device)

Agree

33%

Neutral

53%

Disagree

14%

Table 11: Distribution of Respondents on the basis of survey Questions No.4: I use my bed for things other than sleep (such as gaming or using a handheld device)



S.D .910

53% of the respondents selected Agree, while 33% of the respondents selected Disagree. The total mean calculated for question 4 was calculated as 1.80, whereas standard deviation as 0.91. Figure: I fall asleep immediately after turning off the light

16% Agree 22% 62%

Neutral Disagree

57

Table 12: Distribution of Respondents on the basis of survey Questions No.5: I fall asleep immediately after turning off the light



Mean

S.D

2.46

.758

62 % of the respondents selected Disagree, while 22 % of the respondents selected Neutral. The total mean calculated for question 5 was calculated as 2.46, whereas standard deviation as 0.758. Figure: I have trouble falling asleep within 30 minutes

36%

40%


24%

Table 13: Distribution of Respondents on the basis of survey Questions No.6: I have trouble falling asleep within 30 minutes



S.D

.875

40 % of the respondents selected Agree, while 36 % of the respondents selected Disagree. The total mean calculated for question 6 was calculated as 1.96, whereas standard deviation as 0.875.

58

Figure: I have difficulty staying asleep because I wake up in the middle of the night or early morning

27%

Agree

47%

Neutral Disagree 26%

Table 14: Distribution of Respondents on the basis of survey Questions No.7: I have difficulty staying asleep because I wake up in the middle of the night or early morning

Frequency Percent Valid Agree 27 27.0 Neutral 26 26.0 Disagree 47 47.0 Total

100

Valid Cumulative Mean S.D Percent Percent 27.0 27.0 26.0 53.0 2.20 .841 47.0 100.0

100.0

100.0

47 % of the respondents selected Disagree, while 27% of the respondents selected Agree. The total mean calculated for question 7 was calculated as 2.20, whereas standard deviation as 0.841. Figure: I often wake up too early before I intend to and cannot get back to sleep

26%

Agree Neutral

58%

16%

Disagree

Table 15: Distribution of Respondents on the basis of survey Questions No.8: I often wake up too early before I intend to and cannot get back to sleep

59



S.D .863

58 % of the respondents selected Disagree, while 26% of the respondents selected Agree. The total mean calculated for question 8 was calculated as 2.32, whereas standard deviation as 0.863. Figure: I take substance (prescribed or over the counter medicine) to help me sleep at night

9% 8%


83%

Table 16: Distribution of Respondents on the basis of survey Questions No.9: I take substance (prescribed or over the counter medicine) to help me sleep at night

Frequency Percent Valid Agree Neutral Disagree Total

9 8 83 100

9.0 8.0 83.0 100.0

Valid Percent 9.0 8.0 83.0 100.0

Cumulative Percent 9.0 17.0 100.0

Mean 2.74

S.D .613

83% of the respondents selected Disagree, while 9% of the respondents selected Agree. The total mean calculated for question 9 was calculated as 2.74, whereas standard deviation as 0.613.

60

Figure: My sleeping schedule is consistent

30%

38%


32%

Table 17: Distribution of Respondents on the basis of survey Questions No.10: My sleeping schedule is consistent



S.D

.825

38% of the respondents selected Disagree, while 32% of the respondents selected Neutral. The total mean calculated for question 10 was calculated as 2.08, whereas standard deviation as0.825. Figure: I am a person who does not get enough sleep

22%

Agree 49%

29%

Neutral Disagree

Table 18: Distribution of Respondents on the basis of survey Questions No.11: I am a person who does not get enough sleep

61



S.D

.802

49% of the respondents selected Agree, while 29% of the respondents selected Neutral. The total mean calculated for question 11 was calculated as1.73, whereas standard deviation as 0.802. Figure: I am DISSATISFIED with my CURRENT sleep pattern

22%

Agree Neutral

52%

Disagree

26%

Table 19: Distribution of Respondents on the basis of survey Questions No.12: I am DISSATISFIED with my CURRENT sleep pattern


Frequency Percent 52 52.0 26 26.0 22 100

22.0 100.0

Valid Cumulative Mean Percent Percent 52.0 52.0 26.0 78.0 1.70 22.0 100.0

S.D

.810

100.0

52% of the respondents selected Agree, while 26% of the respondents selected Neutral. The total mean calculated for question 12 was calculated as1.70, whereas standard deviation as 0.810.

62

Figure: I consider my sleep problem to INTERFERE with my daily functioning (e.g. daytime fatigue, mood, ability to function at work/daily chores, concentration, memory, mood, etc.) CURRENTLY

29%

Agree 43%

Neutral

28%

Disagree

Table 20: Distribution of Respondents on the basis of survey Questions No.13: I consider my sleep problem to INTERFERE with my daily functioning (e.g. daytime fatigue, mood, ability to function at work/daily chores, concentration, memory, mood, etc.) CURRENTLY


Frequency Percent 43 43.0 28 28.0 29 100

Valid Cumulative Mean Percent Percent 43.0 43.0 28.0 71.0 1.86

29.0 100.0

29.0 100.0

S.D

.841

100.0

43% of the respondents selected Agree, while 29% of the respondents selected Disagree. The total mean calculated for question 13 was calculated as 1.86, whereas standard deviation as 0.841. Figure: It is difficult for me to wake up and get out of bed on weekdays

29%

Agree 50%

Neutral Disagree

21%

Table 21: Distribution of Respondents on the basis of survey Questions No.14: It is difficult for me to wake up and get out of bed on weekdays

63



Mean

S.D

1.79

.868

50% of the respondents selected Agree, while 29% of the respondents selected Disagree. The total mean calculated for question 14 was calculated as1.79, whereas standard deviation as 0.868.

Figure: I feel sleepy during the day

23% 45%


32%

Table 22: Distribution of Respondents on the basis of survey Questions No.15: I feel sleepy during the day



S.D

.799

45% of the respondents selected agree, while 32% of the respondents selected Neutral. The total mean calculated for question 15 was calculated as 1.78, whereas standard deviation as 0.799.

64

Figure: I often need to take naps to get through the day

25%

Agree Neutral

58%

17%

Disagree

Table 23: Distribution of Respondents on the basis of survey Questions No.16: I often need to take naps to get through the day


100

Valid Cumulative Mean Percent Percent 25.0 25.0 17.0 42.0 2.33 58.0 100.0

100.0

S.D

.853

100.0

58% of the respondents selected Disagree, while 25% of the respondents selected Agree. The total mean calculated for question 16 was calculated as 2.33, whereas standard deviation as 0.853. Figure: I lose hours of sleep to gaming

34%

Agree 48%

Neutral Disagree

18%

Table 24: Distribution of Respondents on the basis of survey Questions No.17: I lose hours of sleep to gaming

65



Mean

S.D

1.86

.899

48% of the respondents selected Agree, while 24% of the respondents selected Disagree. The total mean calculated for question 17 was calculated as 1.86, whereas standard deviation as 0.899. Figure: When I play I lose track of time

16%

Agree Neutral

21% 63%

Disagree

Table 25: Distribution of Respondents on the basis of survey Questions No.18: When I play I lose track of time


63 21 16 100

63.0 21.0 16.0 100.0

Valid Percent 63.0 21.0 16.0 100.0


Mean

1.53

S.D

.758

63% of the respondents selected Agree, while 21% of the respondents selected Neutral. The total mean calculated for question 18 was calculated as 1.53, whereas standard deviation as 0.758.

66

Figure: When I play I can’t tell that I am getting tired

Agree

34%

40%

Neutral Disagree

26%

Table 26: Distribution of Respondents on the basis of survey Questions No.19: When I play I can’t tell that I am getting tired



Mean

2.06

S.D

.862

40% of the respondents selected Disagree, while 34% of the respondents selected Agree. The total mean calculated for question 19 was calculated as 2.06, whereas standard deviation as 0.862. Figure: I play longer than I meant to

16% Agree

33%

51%

Neutral

Disagree

Table 27: Distribution of Respondents on the basis of survey Questions No.20: I play longer than I meant to

67



S.D

.744

51% of the respondents selected Agree, while 33% respondents selected Neutral. The total mean calculated for question 21 was calculated as 1.65, whereas standard deviation as 0.744.

Figure: I feel like I can’t stop playing

20% Agree Neutral

51%

Disagree

29%

Table 28: Distribution of Respondents on the basis of survey Questions No.21: I feel like I can’t stop playing


20 29 51 100

20.0 29.0 51.0 100.0

Valid Percent 20.0 29.0 51.0 100.0


Mean

2.31

S.D

.787

51% of the respondents selected Disagree, while 29% respondents selected Neutral. The total mean calculated for question 21 was calculated as2.31, whereas standard deviation as 0.787.

68

Figure: I tend to stay up late due to online games

33%

45%


22%

Table 29: Distribution of Respondents on the basis of survey Questions No.22: I tend to stay up late due to online games


Frequency Percent 33 33.0 22 45 100

Valid Cumulative Percent Percent 33.0 33.0

22.0 45.0 100.0

22.0 45.0 100.0

Mean

55.0 100.0

2.12

S.D

.879

45% of the respondents selected disagree, while 33% respondents selected Agree. The total mean calculated for question 21 was calculated as 2.12, whereas standard deviation as 0.879. Figure: I skip sleep just to finish my game

33%

38%

Agree

Neutral Disagree 29%

69

Table 30: Distribution of Respondents on the basis of survey Questions No.23: I skip sleep just to finish my game



S.D

.845

38% of the respondents selected Disagree, while 33% respondents selected Agree. The total mean calculated for question 21 was calculated as 2.05, whereas standard deviation as 0.845. Figure: I had recent health problems associated with a lack of sleep

14% Agree 13% 73%

Neutral Disagree

Table 31: Distribution of Respondents on the basis of survey Questions No.24: I had recent health problems associated with a lack of sleep



S.D

.726

70

73% of the respondents selected Disagree, while 14% respondents selected Agree. The total mean calculated for question 21 was calculated as 2.59, whereas standard deviation as 0.726.

Figure: Video games have negatively affected my sleep habits

30%

37%


33%

Table 32: Distribution of Respondents on the basis of survey Questions No.25: Video games have negatively affected my sleep habits



Mean

2.07

S.D

.820

37% of the respondents selected Disagree, while 33% respondents selected neutral. The total mean calculated for question 21 was calculated as 2.07, whereas standard deviation as 0.82.

71

Figure: My sleep quality overall is rated good

27%

29%


44%

Table 33: Distribution of Respondents on the basis of survey Questions No.26: My sleep quality overall is rated good


100

100.0

Valid Cumulative Percent Percent 27.0 27.0 44.0 71.0 29.0 100.0

Mean

2.02

S.D

.752

100.0

44% of the respondents selected Neutral, while 29% respondents selected Disagree. The total mean calculated for question 21 was calculated as 2.02, whereas standard deviation as 0.752.

Key findings indicated: ▪

General lethargy upon rising up.

▪

Many gamers are unable to get out of their bed due to having insufficient sleep.

▪

Many gamers stimulate their brain with videogames just an hour prior to bedtime.

▪

Many gamers are engaged in nocturnal gaming technology usage before bedtime.

▪

Many gamers cannot fall asleep when they intend to do so.

▪

An inability to fall asleep due to an awake and stimulated brain.

▪

Many gamers can sustain their sleep through midnight.

▪

Not many have disrupted sleep that causes them to stay awake at nights.

72

▪

Majority of the gamers do not take any medication to help them sleep better at nights and feel they do not need to drug themselves to that end.

▪

Mixed reaction shows that gamers are inconsistent with fixing a set routine to sleep everyday across the world and majority fail to stick to a proper, fixed schedule indicating a general lack of self-discipline.

▪

Many gamers are not getting enough sleep.

▪

Not many are satisfied with their current sleep routine.

▪

Not many feel completely refreshed with the few hours they manage to sleep during nighttime.

▪

Many believe that their current sleep routine is causing them to not function properly during the day.

▪

Majority do not feel refreshed during the day.

▪

Majority do not intermittently sleep during daytime.

▪

Majority of gamers feel like they are sacrificing sleep to continue their gaming. This result is interesting as it was later observed that many contradicted this claim while they were reluctant to admit their gaming caused sleep loss.

▪

Majority of the gamers are not aware how time passes and cannot tell when it is bedtime while they are immersed in their gaming.

▪

Not many gamers can tell if they are fatigued and need to rest but some are able to distinguish that and discern when to put a halt to their problematic activity.

▪

Gamers are engaged in gaming and unintentionally lose hours playing an immersive game.

▪

Gamers don’t feel like they are addicted to gaming and are able to inhibit their prolonged gaming habits when they want to.

▪

Most gamers do not prefer playing online games that keep them wide awake at night time.

▪

Gamers are inclined to not admitting their problematic video gaming which sacrifices sleep due to higher game engagement.

▪

Many have not had insomnia or other sleep related problems that they associate with their current video gaming behavior.

▪

Gamers cannot decide whether it is the video gaming that is effecting their sleep routine or other moderating factors are involved. There is inherent bias because statistic suggests they are not sleeping as well as they should or want to.

▪

Great ambivalence leaning to general disagreement that gamers are having quality sleep overall.

73

Hypothesis testing Correlations ST Pearson Correlation

TST 1

Sig. (2-tailed) ST

.140

Sum of Squares and Crossproducts

153.790

-14.470

1.553

-.146

100

100

-.149

1

Covariance N Pearson Correlation Sig. (2-tailed) TST

-.149

.140

Sum of Squares and Crossproducts

-14.470

61.710

-.146

.623

100

100

Covariance N

Correlations

I lose hours of sleep to

Pearson Correlation

gaming

Sig. (2-tailed)

I lose hours of

Video games have negatively

sleep to gaming

affected my sleep habits

1

.000

N Video games have

Pearson Correlation

.507**

100

100

.507**

1

negatively affected my sleep Sig. (2-tailed)

.000

habits

100

N

100

**. Correlation is significant at the 0.01 level (2-tailed).

Table 34: Pearson Correlation between questions “I lose hours of sleep to gaming” and “Video games have negatively affected my sleep habits”

74

Figure 57: Scatter plot graph of Pearson Correlation

Group Statistics Gender ST

TST

N

Mean

Std. Deviation

Std. Error Mean

Male

50

2.9800

1.30133

.18404

Female

50

2.8000

1.19523

.16903

Male

50

3.0600

.84298

.11922

Female

50

3.4000

.69985

.09897

Table 35: Inferential statistics- Independent t-testing group statistics

75 Independent Samples Test Levene's Test for Equality of Variances

t-test for Equality of Means 95% Confidence Interval of the

F ST

Sig.

t

.740

.720

df

Sig. (2-

Mean

Std. Error

tailed)

Difference

Difference

Difference Lower

Upper

Equal variances

.110

98

.473

.18000

.24988

-.31588

.67588

.720 97.300

.473

.18000

.24988

-.31593

.67593

98

.031

-.34000

.15495

-.64748

-.03252

-2.194 94.792

.031

-.34000

.15495

-.64761

-.03239

assumed Equal variances not assumed TST

Equal variances

.023

.879

-2.194

assumed Equal variances not assumed

Table 36: Inferential statistics- Independent t-testing results

76

Chapter V: Discussion The purpose of the survey was to ask gamers questions about their sleep habits in order to device an understanding of sleep deprivation on gamers. Video gamers have avidly defended their gaming habits by staying neutral or claiming that video game has not caused their sleep deprivation or sleep related health problems while remaining neutral about their sleep quality. They deny that they do not skip their sleep just to continue gaming while their game engagement index is doubtlessly high. However, statistics have proven that they are dissatisfied with their current sleep patterns and many have admitted that they do lose hours of sleep due to gaming and staying up late online caused them to not get enough hours of sleep they need. They also experience day time drowsiness, deeming it difficult to get out of their beds early. They do not necessarily suffer insomnia but just an erratic sleep pattern. Some gamers lose sleep to deal with anxiety, bad dreams, hotness and using bathroom during nighttime hours. Single person, RPG, FPS and action games are the preferred choice of genre by the majority indicating that these are the ones most responsible for stimulating an active, adult brain during night time hours. Older gamers reported sleeping more than younger adults due to biological differences of requiring more hours of sleep as they aged and gaming likely did not impact them much but in fact helped them stay more awake. Those with responsibilities such as parenting or employment are compelled to sacrifice their gameplay just to get their sufficient night hours of sleep. “Other (specify)” responses indicated that there is general anxiety and also significant reduction in attention span so they can not finish games or sustain longer reading. But it is unclear whether it is actually prolonged gaming which causes that due to unavailability of measuring techniques. As depicted in table 34, the correlation is positive and significant (0.507), thus it can be concluded that when the amount of screentime increases, the Total sleep Time slightly increases. There is a moderate, linear relationship and statistically significant correlation between the two variables. Therefore, null hypothesis is rejected and alternative hypothesis has been accepted. There is significant effect on sleep pattern.

77

The fact that high usage gamers are losing sleep because of video games shows that these adults are not managing their time appropriately enough to ensure that they get enough sleep. This could also be because video game players lose track of time when they are playing, as supported by research by Woods, Griffiths, & Parke. Overall, these relationships demonstrate validity for the items in measuring their intended domain, including the inverse relationships between sleep health and engagement item which asks about sleep suffering due to gaming. However, it is not possible to tell whether it is the gaming itself that causes the sleep loss or there are other confounding variables involved in sleep deprivation itself that are indirectly related to the population samples' introverted personalities or merely maladaptive coping with a hectic life routine and/or comorbid health concerns.

78

Chapter VI: Conclusion and Recommendations It has been proven that prolonged gaming does affect sleep pattern significantly regardless of whether gamers prefer to admit it or not. There is a direct relation with extended gaming hours and lack of sleep. The survey results shows that gamers are participating in poor sleep habits even though they are aware of the damaging effects sleep deprivation has on their health. Conclusively, gamers are having a better sense of responsibility about their gaming habits as they evolve into younger adults due to job preoccupations and are far less invested in it than before. Despite acknowledgment of learning some useful life skills from gaming, they admit it is time consuming and could interfere with circadian rhythm.

6.1- Benefits 1- Tool has multiple items so a richer data can be easily acquired. Data triangulation was easier to identify as if one item lacked to grasp enough information, another item was able to resort it. 2- It has been used on an international level so it was easier to find trends and recover data globally. One could find which country has a set trend of gaming hours considered acceptable. 3- Different types of gamers’ data had been gathered. It was possible to decipher that not just white people play hours of video games but adults of all races equally engage in this hobby for prolonged intervals of time detrimental enough to sacrifice sufficient hours of sleep. 4- Qualitative data as well as quantitative data was acquired through the survey providing a richer data open for interpretation using inferential analysis. 5- Video game companies can take note of this serious issue and address it in their conventions after considering this research study. 6- Teachers can benefit from this study by counseling kids, teenagers, adolescence and even adults regarding sleep related issues developing later on in life. 7- Gamers will be able to know the disadvantages of sleepless nights and gaming. They will also be able to manage time properly for a better health routine. 8- Adults will know how to control their addiction by following the “do” and “don’t” from this research study.

79

6.2- Limitations The limitations of this study have influenced the data quality thereby altering the accuracy of the results. A limited proportion of population sample had been focused on due to time restraints and technological limitations. 1- As the tool was completely quantitative, therefore qualitative results could not be extensively accessed to get a comprehensive understanding of sleep deprivation. Making the tool semi-open ended led to people writing irrelevant responses such as their dog or spouse or neighbors caused them to lose sleep. This has led to frivolous responses that were avoided by making the tool less open-ended. Perhaps another researcher would be mindful of picking their sample of the more serious population who do not make light of their disrupted sleeping habits. 2- As it was international and worldwide to access, we could not focus on trends of just one country or a specific area/region. The number of participants was not equally distributed for each category of data. 3- We could not decipher the sleep pattern of non-gamers because they were simply not interested in filling the form meant to study about video gamers. Perhaps more options for non-gamers could be included so they participated and gave their suggestions on why they think sleep is detrimental to their sleep and overall health. 4- The tool is quite lengthy so the data analysis got even harder. Perhaps it needs to be more refined to include only specific and absolutely relevant questions. The quantitative approach could perhaps have broader options. 5- Tool was difficult to administer because a few left incomplete responses for the researcher to fill up later. 6- The research study was not able to generalize gaming habits of kids, teenagers and adolescents as it focused only on adults. 7- Parents will have no benefit from this research study. Though some parents who have kids in adult age range can take advantage of this research. Yet nevertheless, it has a limited area and scope when it comes to age range. 8- Surveys requiring gamers to self-report have a high probability of having biased response which potentially interferes with the accuracy of the survey responses. 9- Questions seem suggestive of sleep problems and there was inherent bias by gamers to defend their gaming habit by not attributing it to poor sleep. Losing two hours of sleep may be common for one person to pursue a leisure activity,

80

whereas for others who keep to a more regular sleeping routine, this may be an indicator of a striking shift in behavioural priorities. Therefore, these intensities are likely relative to each person’s context and history, which will be difficult to capture in quantitative measures with any degree of brevity. 10- The most jarring issue is that every question in the survey assumes that gamers lose sleep ONLY due to gaming. The last two questions employed data triangulation to check whether gaming in the past has negatively affected their sleep pattern and whether they still lose hours of sleep due to gaming. This led to skewed statistics. As gamers do not have a consistent play schedule and playtime varies, chances are sleep loss is caused by other factors on different occasions. 11- Survey can be improved and data inconsistency can be vastly mitigated by putting way more 'other: write' options. 12- More respondents would mean better representation of population sample.

6.3- Implications The greatest advantage of this research is that it is the first of its kind. It will serve as the base in this area of study and guide future researchers in similar related topic. They can find better respondents for their own survey and plan a better routine or healthy lifestyle related to sleep hygiene which will help others improve their sleep behavior by rectifying their current pattern. It can bring a great change by helping them improve their sleep quality significantly after reflecting on these findings that late technology usage and especially video game usage for prolonged interval drastically affects their sleep when done so close before bedtime. If their schedule is inconsistent, perhaps maintaining a sleep diary to rectify their internal body clock and also disciplining themselves to play less than an hour or two before bedtime and rather fix a schedule they would follow during the daytime instead would prove beneficial.

6.4- Recommendations Gamers prefer nocturnal habits when their brains are actively functioning or anxious due to overthinking. They need distraction from their mundane life activities as a form of escapism. A more relaxing game could serve as a pacifier to improve their sleep instead of a stimulating and/or violent game. Educational video games that are interactive could be designed RPG-esque to be more engaging and conducive to night time sleep with relaxing elements to lull the players into desiring to sleep using binaural soundtrack.

81

Practicing relaxing techniques and getting more exercise can give a better sense of self as they would be less reluctant to partake in video gaming if they felt no emotional attachment to a means of reprieve from their current reality. This could ultimately also fix their late rising from bed the next day and help them sleep sooner, thereby rectifying their internal biological clock and thus improving their overall sleep pattern. A brief, psycho-educational “sleep hygiene” intervention could be administered to help gamers improve problematic behavior; they should be given education on IGD and sleep hygiene to include shutting off the computer 30 minutes to an hour before sleep. As there were a few limitations preventing this research from providing optimal results, a suggestion for future researchers is to conduct the surveys in various formats. The surveys for this study were mainly conducted by using social media to send out the links but future researchers should consider using a paper formatted survey as online survey distribution remove the possibility of the 1:1 interaction that is more possible with distributing the paper format. This may result in more accurate data responses. Survey facilitators should conduct this study in various groups outside of social media and look towards approaching randomized groups to distribute this survey to multiple gaming network like internet gaming cafes inhabited by professional MLG pro gamers and this way, more hardcore gamer adults can theoretically take it and more variance in data would enhance the overall data quality.

82

Bibliography and references Van den Bulck, J. (2004). Media use and dreaming: The relationship among television viewing, computer game play, and nightmares or pleasant dreams. Dreaming, 14 (1), 43-49. Van den Bulck, J. (2004). Television viewing, computer game playing, and Internet use and self-reported time to bed and time out of bed in secondary-school children. Sleep, 27(1), 101-104. Cheung, L. M., & Wong, W. S. (2011). The effects of insomnia and internet addiction on depression in Hong Kong Chinese adolescents: an exploratory cross-sectional analysis. Journal of sleep Research Society, 20, 311-317. Cole, H., & Griffiths, M., (2007). Social interactions in massively multiplayer online roleplayinggames. CyberPsychology and Behavior. 10, 575-583. Choi, K., Son, H., Park, M., Han, J., Kim, K., Lee, B., &Gwak, H. (2009). Internet overuse and excessive daytime sleepiness in adolescents. Psychiatry and Clinical Neurosciences, 62, 455-462. Bushman, C. A. (2001). Effects of violent video games on aggressive behaviour, aggressive cognition, aggressive affect, physiological arousal, and prosocial behavior: A Meta- Analytic Review of the Scientific Literature. Psychological Science, Vol. 12, No. 5, pp. 353-359. Daniel L. King, M. G. et. al., (2012). The impact of prolonged violent video-gaming on adolescent sleep: an experimental study. Journal of Sleep Research, 137-143. Retrieved from: http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2869.2012.01060.x/full Dewald, J. F. (2010). The influence of sleep quality, sleep duration and sleepiness on school performance in children and adolescents: a meta-analytic review. Sleep Med. Rev., 14: 179–189. Edward Weaver, Gradisar. M. et. al., (2010). The Effect of Presleep Video-Game Playing on Adolescent Sleep. Journal of clinical sleep medicine: JCSM: official publication of the American Academy of Sleep, 7. Retrieved from: http://europepmc.org/articles/PMC2854707 Gackenbach, J. K. (2010). Computer Games: Learning Objectives, Cognitive Performance and Effects on Development Chapter 5: Dreams and video game play. In F. Columbus (Ed.). Hauppauge: NY: Nova Science. Horn, R. V. (1999). Violence and Video Games. The Phi Delta Kappan, Vol. 81, No. 2, pp. 173-174. Jordan Weaver, P. K. (2013). The impact of video games on student GPA, study habits, and time management skills: what's the big deal? Issues in Information Systems, 122‐128. Retrieved from: http://iacis.org/iis/2013/184_iis_2013_122-128.pdf M Tai, D. M. (2017). The relationship between video game use, game genre, and lucid/control dreaming. Sleep, Volume 40, 271. OfirTurel, A. R. et. al., (2016). Health Outcomes of Information System Use Lifestyles among Adolescents: Videogame Addiction, Sleep Curtailment and Cardio-Metabolic Deficiencies. PLoSONE11(5). Retrieved from: http://journals.plos.org/plosone/article?id=10.1371%2Fjournal.pone.0154764

83 Public, S. f. (2009). The Science of Slumber. Science News, Vol. 176, No. 9, 16-24. Retrieved from: https://www.sciencenews.org/sites/default/files/sn_sleep_whyofsleep_lo.pdf Darien, IL. (2016, June 13). Video game playing negatively influences adequate sleep and bedtimes: Over 67 percent of gamers reported missed sleep due to playing. Retrieved from American Academy of Sleep Medicine: https://aasm.org/video-game-playing-negatively-influences-adequate-sleep-andbedtimes/ Dworak M, Schierl T, Bruns T, Struder, HK. (2007) Impact of singular excessive computer game and television exposure on sleep patterns and memory performance of school-aged children. Pediatrics; 120: 978-985 Ponce, R. (2015, December 18). The impact of prolonged violent video-gaming on adolescent. Retrieved from: https://prezi.com/boyvi9w2ahgr/the-impact-of-prolonged-violent-video-gaming-onadolescent/ Anderson, C. A., Shibuya, A., Ihori, N., Swing, E. L., Bushman, B. J., Sakamoto, A., et al. (2010). Violent video game effects on aggression, empathy, and prosocial behavior in eastern and western countries: A meta-analytic review. Psychological Bulletin, 136(2), 151 (American Psychological Association). Retrieved from: http://psycnet.apa.org/doiLanding?doi=10.1037%2Fa0018251 Gentile, D. (2009). Pathological video game use among youth 8 to 18: a national study. Psychological Science, 20, 594-602. Kyle, S. (2012, December 2). Sleepio blog. Retrieved from Sleepio Research Bulletin: https://www.sleepio.com/blog/2012/12/02/video-games-and-sleep-loss/ Ivarsson M, Anderson M, Akerstedt T, Lindblad F. (2009) Playing a violent television game affects heart rate variability. ActaPaed 2009; 98:166-72. Retrieved from: https://www.ncbi.nlm.nih.gov/pubmed/19006532 Palaus, M. (2017, June 22). Neural Basis of Video Gaming: A Systematic Review. Frontiers in Human Neuroscience. Retrieved from: https://medicalxpress.com/news/2017-06-video-games-brain.html Regoniel, P. A. (2015, January 5). Conceptual Framework: A step by step guide on how to make one. Retrieved from: http://simplyeducate.me/2015/01/05/conceptual-framework-guide/ Brandon Peters, M. (2017, September 27). Sleep Latency and Its Impact on Your Sleep. Retrieved from: https://www.verywell.com/sleep-latency-3014920 Oxford. (n.d.). English Oxford Living Dictionaries. Retrieved from: https://en.oxforddictionaries.com/definition/video_game UnityPoint Health. (n.d.). Retrieved from: http://www.addictionrecov.org/Addictions/?AID=45 Convenience Sampling. (n.d.). Retrieved from: https://explorable.com/convenience-sampling Bulck, L. E. ( 2014). Sleep quality is negatively related to video gaming volume in adults. Journal of Sleep Research. European Sleep Research Society, 8.

84 Dehmler, K. (2009). Adolescent technology usage during sleep-time: does it influence their quality of sleep, attention difficulties and academic performance? Rochester Institute of Technology, 78. Retrieved from: http://onlinelibrary.wiley.com/doi/10.1111/jsr.12255/pdf Bushman, C. A. (2001). Effects of violent video games on aggressive behaviour, aggressive cognition, aggressive affect, physiological arousal, and prosocial behavior: A Meta- Analytic Review of the Scientific Literature. Psychological Science, Vol. 12, No. 5, pp. 353-359. Gerbner, G. &. (1976, Mar 20). Living with television: The violence profile. Journal of Communication, 172-199. Griffiths, M. ( 2002). The educational benefits of videogames. SHEU Education and Health, Vol. 20 No.3. Hamid Allahverdipour, M. B. (2010). Correlates of video games playing among adolescents in an Islamic country. BMC Public Health, 7. Horn, R. V. ( 1999). Violence and Video Games. The Phi Delta Kappan, Vol. 81, No. 2, pp. 173-174. Jeanne H Brockmyer, K. C. (2009). The development of the Game Engagement Questionnaire: A measure of engagement in video game-playing. Journal of Experimental Social Psychology, 12. Michael M. Kasumovic, K. B. (2015). Why do people play violent video games? Demographic, statusrelated, and mating related correlates in men and women. Elsevier , 8. Patrick M. Markey, C. N. (2010). Vulnerability to Violent Video Games: A Review and Integration of Personality Research. Review of General Psychology © American Psychological Association, Vol. 14, No. 2, 82–91. Przybylski, A. (2014, April 7). Aggressive Behavior Linked to Players’ Experiences, Video gamers’ aggression linked to frustration, not violent content. Retrieved on September 18, 2017 from http://www.rochester.edu/newscenter/frustration-in-mastering-video-games-linked-to-aggression/ Teacher, T. S. (2007). Science and the Brain, Vol. 74, No. 1. National Science Teachers Association, p.12, 14. Ferguson, C. J., & Kilburn, J. (2010). Much ado about nothing: The misestimation and over interpretation of violent video game effects in eastern and western nations: Comment on Anderson et al. American Psychological Association. Adachi, P. J. C., Hodson, G., Willoughby, T., &Zanette, S. (2015). Brothers and sisters in arms: Intergroup cooperation in a violent shooter game can reduce intergroup bias. Psychology of Violence. Gentile, D. A., Choo, H., Liau, A., Sim, T., Li, D., Fung, D., et al. (2011). Pathological video game use among youths: A two-year longitudinal study. Pediatrics, 127(2), e319–e329. Jane McGonigal (2011). Reality Is Broken: Why Games Make Us Better and How They Can Change the World. Penguin Books

85 Chory, R.M. &Goodboy, A.K. (2011): Is Basic Personality Related to Violent and Non-Violent Video Game Play and Preferences? , Cyber psychology, Behaviour and Social Networking Journal, Vol 14, no.4 Ivarsson, M., Anderson, M., Åkerstedt, T., &Lindblad, F. (2013). The effect of violent andnonviolent video games on heart rate variability, sleep, and emotions in adolescentswith different violent gaming habits. PsychosomaticMedicine, 75(4), 390–396 (LWW). Tolchinsky, A. (2013). The Development of a Self-Report Questionnaire to Measure Problematic Video Game Play and its Relationship to Other Psychological Phenomena. Eastern Michigan University DigitalCommons@EMU, 97. Eickhoff E, Y. K. (2015). Excessive Video Game Use, Sleep Deprivation, and Poor Work Performance Among U.S. Marines Treated in a Military Mental Health Clinic: A Case Series. Association of Military Surgeons of the U.S. Jasper Wolfe, K. K. (2014). Single night video-game use leads to sleep loss and attention deficits in older adolescents. Journal of Adolescence, Volume 37, Issue 7, 1003-1009. SakariLemola, et al. (2014). Adolescents’ Electronic Media Use at Night, Sleep Disturbance, and Depressive Symptoms in the Smartphone Age. Journal of Youth and Adolescence. Gradisar, M., Wolfson, A. R., Harvey, A. G., Hale, L., Russell Rosenberg, F., & Czeisler., C. A. (2013). The Sleep and Technology Use of Americans: Findings from the National Sleep Foundation's 2011 Sleep in America Poll. Journal of Clinical Sleep Medicine, 1291-1299. Alexandru G, M. S. (2006). Epidemiological aspects of self-reported sleep onset latency in Japanese junior high school children. Journal of Sleep Research. Markus Dworak, T. S. (2007). Impact of Singular Excessive Computer Game and Television Exposure on Sleep Patterns and Memory Performance of School-aged Children. American Academy of Pediatrics, VOLUME 120 / ISSUE 5. James B. Weaver III, D. M. (2009). Health-Risk Correlates of Video-Game Playing Among Adults. American Journal of Preventive Medicine. Lavender, R. M. (2015). Electronic Media Use and Sleep Quality. Undergraduate Journal of Psychology, 6. Lisa J.Smith, M. D. (2017). Intrinsic and extrinsic predictors of video-gaming behaviour and adolescent bedtimes: the relationship between flow states, self-perceived risk-taking, device accessibility, parental regulation of media and bedtime. Sleep Medicine, 64-70. Kevin Guest, M. S. (2009). ADOLESCENT SLEEP. Smith, L. (2017, August 25). Individual and social influences on videogaming and sleep in adolescents.(Doctoral dissertation). Retrieved from https://flex.flinders.edu.au/file/e65bba0d-63814dcb-9915-84afa96500ee/1/SMITHLJthesis_openaccess.pdf Loton, D. J. (March, 2014). Video Game Addiction and Engagement in Adult Gamers: Differentiation Based on Relationships with Health and Functioning. Melbourne, Australia. (Doctoral dissertation). Retrieved from http://vuir.vu.edu.au/25835/1/Daniel%20John%20Loton.pdf

86 Tazawa, Y., & Okada, K. (2001). Physical signs associated with excessive television-game playing and sleep deprivation. Pediatrics International, 43(6), 647-650. Long video game sessions can give you insomnia. (2012, October 19). Retrieved from thehealthsite: http://www.thehealthsite.com/news/long-video-game-sessions-can-give-you-insomnia/ Christian Vollmer, C. R. (2014). Computer Game Addiction in Adolescents and Its Relationship to Chronotype and Personality. SAGE pub, 5. Shigekazu Higuchi, Y. M. (2005). Effects of playing a computer game using a bright display on presleep physiological variables, sleep latency, slow wave sleep and REM sleep. Journal of Sleep Research.Retreived from: http://onlinelibrary.wiley.com/doi/10.1111/j.13652869.2005.00463.x/full Weaver JB 3rd, M. D. (October 2009). Health-Risk Correlates of Video-Game Playing Among Adults. American Journal of Preventive Medicine (AJPM), Volume 37, Issue 4. Claburn, T. (2009 , Aug. 18). Video Game Playing Linked To Health Risks. Retrieved from InformationWeek: http://www.informationweek.com/story/showArticle.jhtml?articleID=219400496 Cemelli, C. M., Burris, J., & Woolf, K. (2016). Video Games Impact Lifestyle Behaviors in Adults. Clinical Nutrition, Volume 31 - Issue 2 - p 96–110. Milton Kramer, M. L. (2015). Dream Research: Contributions to Clinical Practice. New York: Routledge. Otenyo, J. K. (2017). Sleeping Habits and Sleep Deprivation Among College Students. The University of Arizona. Lujiaozi Wang, S. Z. (2011). Online Game Addiction Among University Students. (Dissertation). Retrieved from: https://www.diva-portal.org/smash/get/diva2:602320/FULLTEXT01.pdf Erin Eickhoff, K. Y. (2015). Excessive Video Game Use, Sleep Deprivation, and Poor Work Performance Among U.S. Marines Treated in a Military Mental Health Clinic: A Case Series. MILITARY MEDICINE, 180, 7:e839. Prot, S., Anderson, C. A., Gentile, D. A., Brown, S. C., & Swing, E. L. (2014). The positive and negative effects of video game play. In A. Jordan & D. Romer (Eds.). Media and the Well-Being of Children and Adolescents (109-128). New York: Oxford University Press. Berland, A. J. (2013). Does recreational computer use affect high school achievement? Educational Technology Research and Development. Lauren Hale, S. G. (2015). Screen Time and Sleep among School-Aged Children and Adolescents: A Systematic Literature Review. Sleep Med Rev. Moshkovich, O. (2013). SLEEP DURATION IN ADOLESCENT GIRLS: CORRELATES AND ASSOCIATION WITH OBESITY RISK. Mari Hysing, S. P. (2014). Sleep and use of electronic devices in adolescence: results from a large population-based study. BMJ Open. Felipe Beijamini, S. I. (2014). After Being Challenged by a Video Game Problem, Sleep Increases the Chance to Solve It. PLoS ONE. Loria, K. (2017, Dec. 26). 'Gaming disorder' may get classified as a mental health condition — here's what that means. Retrieved from http://www.businessinsider.com/who-considers-adding-gamingdisorder-to-icd-11-2017-12

87 Weaver, E., Gradisar, M., Dohnt, H., Lovato, N., & Douglas, P. (2010). The effect of presleep video-game playing on adolescent sleep. Journal of clinical sleep medicine: JCSM: official publication of the American Academy of Sleep Medicine, 6(2), 184. Kuss, D. J., Griffiths, M. D., & Pontes, H. M. (2017). DSM-5 diagnosis of Internet Gaming Disorder: Some ways forward in overcoming issues and concerns in the gaming studies field: Response to the commentaries. Journal of Behavioral Addictions, 6(2), 133–141. http://doi.org/10.1556/2006.6.2017.032 Loria, K. (2016, January 22). Virtual reality is about to completely transform psychological therapy. Retrieved from Tech Insider: http://www.businessinsider.com/how-virtual-reality-is-used-for-ptsdand-anxiety-therapy-2016-1 Adam EK, Snell EK, Pendry P. Sleep timing and quantity in ecological and family context: A nationally representative time-diary study. Journal of Family Psychology. 2007;21(1):4-19. doi: 10.1037/0893-3200.21.1.4. PubMed PMID: 2007-03149-002.

88

Appendix A: Questionnaire for participants of the survey

Islamic Online University

PROLONGED VIDEO GAMING ON SLEEP PATTERN QUESTIONNAIRE (PVGSQ) SECTION A: CONSENT FORM Dear participant, You are invited to participate in a research survey regarding “video gaming and sleep pattern “for my thesis which is a part of my bachelor’s degree in Psychology from the Islamic Online University. The intention behind this study is to probe the impact of prolonged video gaming on sleep pattern in adults through this study. You were chosen as a suitable participant for this as you are an active gamer. If you are willing to take part in the research, please complete the enclosed survey. It will take about 15-20 minutes to complete it. The survey does not attract any monetary or any other benefit but your responses will enrich the findings of the research study as well as provide remedial solutions to sleep related problems. Any possible inconvenience to you will be solely from the time duration of the survey. CONFIDENTIALITY AND ANONMITY Any information collected in connection to the research study and that relates to you will be kept with utmost confidential. The information will only be used for research purpose and not for personal use or disclosed in any manner. All identifying information obtained by participating in this research study will be kept strictly confidential unless State or Federal law mandates disclosure. The results of this study may be used in reports, papers, presentations, and publications; however, any identifying information will be omitted or disguised to ensure confidentiality and anonymity. In order to maintain anonymity and confidentiality you will be asked to create a unique code. This code will be used to identify the data in case you wish to withdraw from the study. Password protected accounts will store your data which will only be accessible to the researcher. All the data will then be destroyed in 2 weeks followed by the study completion. All the responses will only be used for the current study. PARTICIPATION Your participation to this research survey is entirely voluntary and you may choose to leave anytime without accountability to the researcher. If you wish to complete the survey then your responses will be highly appreciated. However, if you wish to withdraw after completing the survey, there is a maximum time of 2 weeks. In that case, you may email the researcher with your unique code. In case of withdrawal, there will be no penalty on your part. Please feel free to email the researcher, if you have any additional questions regarding the study: Nida Usman, Islamic Online University, Email: [email protected] Tel: 00966541891542.

89 Thank you for your time. Sincerely, Nida Usman Project Supervisor: Dr. G.HusseinRassool, Department of Psychology, Islamic Online University

INSTRUCTIONS FOR PARTICIPANTS I am researching the effects of video game play on the symptoms of insomnia. In order to participate in this research study, you must be a video game player of age 18+. You will not be receiving a clinical diagnosis of a mental health disorder by participating in this study. Symptoms include fatigue, insomnia, restlessness, body aches, bad dreams, disturbed sleep pattern or difficulty falling asleep and/or staying awake. To participate in this study and help further research on video games, you will complete a brief subjective measure instrument- a survey questionnaire. This survey may take approx. 20 minutes to complete. Please make sure you take this survey in a distraction-free environment and with good internet connection. First, you will be asked some demographic data. Then you will be asked to fill in the questionnaire about your sleep and gaming habits. Please make sure to continue to the debriefing information before you have completed the mentioned tasks. Once you have read the debriefing information and wish to submit your results, please click “Submit” before closing the browser window. Thank you for your time. Your participation is greatly appreciated! DEBRIEFING FORM I, Nida Usman, ([email protected]), Student of IOU- Qatar, will be carrying out the above mentioned research project under the guidance of the faculty supervisor of IOU. You are hereby requested to give your voluntary consent to participate in this study titled Impact of Prolonged Video Gaming on Sleep Pattern among Adults which is being carried out as part of the academic requirements of Post Graduate course in Psychology. Any information collected from you during the process would be kept confidential and will be used strictly for research purposes only. You are free to withdraw from the study at any point of time without any prejudice. * Required Measure Capacity to Consent to Participation in the Study The next set of questions are about you consenting to participant in the study and confirming you are informed of what this involves (please see earlier information for details of what the study involves). Please read the following statements carefully and tick each box below to confirm your participation and ensure that you agree with each statement:

I understand that my participation is 100% voluntary and I have the right to withdraw after completing it without providing any reason. * Yes

90

I understand that there is deadline of 2 weeks if I wish to withdraw after completing the survey * Yes I confirm that I am 18 or above 18 years of age. * Yes I confirm that I am not on any medications and have not suffered any kind of brain injury. * Yes I understand that the unique identifying code will be required to maintain data confidentiality and anonymity. * Yes I have read and understood the nature of the research project as outlined in the participant information sheet above * Yes I agree and give consent to take part in the study. * Yes

Unique participant Code: Please create a unique ID code by entering the last three letters of your surname and last two digits of your mobile number. For example, if the surname is Williams and the last two digits of my mobile number are 63, the code will be: AMS63 *

Section B: Measure of Demographic Characteristics- Demographic Information Sheet This next set of questions relate to demographic features. We need to ask these questions as links have been found between these factors and sleep and gaming habits. All information which is collected from you during the course of the research will be kept strictly confidential. Your name and information will not be used in the write up of the study, so no one will be able to link the information to you personally. The information asked for below is required for consent purposes only. Your information will not be used in the write up of the study, so no one will be able to link the information to you personally.

BACKGROUND INFORMATION: DEMOGRAPHIC DATA Please, fill in the following information before starting to respond to the questionnaires 1. Gender * Male Female Other:

2. Age * 18-25 years 25-40 years 40-60 years 60 years and above

91 3.

Location: City and Country of residence *

4. Place of Living * Urban Semi-Urban Rural

5. Education Level and Qualification * High School Diploma/ Associate Undergraduate degree Post Graduate Vocational/Technical training Professional qualification Master's Degree (MA/ MSc) Doctoral Degree (PhD) Other:

6. Marital Status * Married Unmarried Divorced Separated Living with another Civil Partnership Current partner lives elsewhere

7. Occupation * Student Working/Employed Non-Working/Unemployed Self-Employed Retired 8. Ethnicity * White/Caucasian Asian Black Arab Mixed African Caribbean Chinese Other:

Section C: Measure of Prolonged Video Gaming Gamer Experience Survey: BASIC QUESTIONS Dear Participant, please provide accurate information for the following that I require for my study.

9. Yes No

Have you ever purchased a video game? *

92 10. Approximately how many videogames do you own? * None 10 20 30 Above 30

11.

If you play videogames, at what age did you first begin playing? *

12. I consider myself: * A non-video game player A novice video game player (Newbie/ Retro) An occasional video game player (Casual/Social) A frequent video game player (Core/ Specialist) An expert video game player (Hardcore/ Adept/ Professional)

13. How often do you play video games? * Never 1 or 2 times per month 1 time per week Several times per week Every day (gamer for life)

14. Number of years playing online games * 2-4 5-7 More than 7 More than 7 and still playing

15. Compared to five years ago * I play videogames more frequently now. I play videogames less frequently now. There has been little change in the frequency of my video game playing. 16. Which platform do you prefer for gaming? * Consoles PC/ laptop Portable/Handheld gaming system (e.g. Nintendo DS, PSP, etc.) Others: (Please list any videogame systems in your household) Other:

17. How much time do you spend playing video games each day? * Less than 2 hours 2-3 hours 4-5 hours 5-6 hours More than 6 hours

18.

During an average week, how many hours will you spend playing videogames? (Please answer using a whole

number, e.g. 101 and avoid putting down a range e.g. 100 -200) Play approx * Less than 8 hours a week 8-12 hours a week 13-17 hours a week 18-22 hours a week More than 22 hours a week

93

19. How often do you play video games after 10:00 pm? * Never 1 or 2 times per week 20. 1 time per month Several times per week Every day

21. Yes No

Do you have a video game system or console in your bedroom? *

SPECIFIC GAME EXPERIENCE 22.

I prefer playing games that are of genres such as: *can choose multiple options *

Action platform (e.g., Grand Theft Auto) Adventure (text- based, choose your own path visual novels) Horror (e.g., Resident Evil, Evil Within, Silent Hill, Amnesia) First person shooter FPS(DOOM, Quake, Halo, Half- Life, Medal of Honor, Counter-Strike, Overwatch) MMORPG (e.g., Guild Wars, World of Warcraft) Fighting Combat (e.g., Tekken, Mortal Kombat, Dead or Alive, Street Fighter, Soul Calibur) Real- Time Strategy (e.g., Starcraft, Warcraft, Command and Conquer, Age of Empires, Civilization, SimCity,Rise of Nations, Dota2) Puzzle (e.g., Portal, Talos Principle, Tetris) Platformer (e.g., Mario, Sonic) Role-playing RPG (e.g., Final Fantasy, Witcher, Dark Souls, Mass Effect, Dragon Age) Sports(e.g., NBA Live, Madden NFL, FIFA Soccer, SSX, Tony¬Hawk) Simulators(e.g., flight simulator or racing simulator games, The Sims) Stealth (eg., Hitman, Metal Gear, Deus Ex, Splinter Cell) Casual, free games (Solitaire, Free Cell, Minesweeper,Bejeweled, Candy Crush, Farmville) Music (Dance Dance Revolution, Just Dance, Pump it Up) Single player Multiplayer Competitive PVP Multiplayer Cooperative PVE Educational No preference Other:

Section D: Measure of Sleep Problems The following questions relate to your usual sleep habits during the past month only. Your answers should indicate the most accurate reply for the majority of days and nights in the past month. All questions refer to the previous two weeks or this month.

23. How many hours do you sleep at night? * Less than 2 hours 4 hours 6 hours 7-9 hours 10+ hours 24. How many hours of sleep do you THINK you need to function for the next day? * 3-4 5-6 7-8 9-10 more than 10+

94 25. How many hours of actual sleep did you get average per night on a weekend/holiday?* * 2-4 4-6 6-8 8-10 More than 10 hours

26. During the past month, what time have you usually gone to bed at night? * 8 PM 9 PM 10 PM After Mid-Night Past sunrise Other:

27. During the past month, how long (in minutes) has it usually taken you to fall asleep each night? * 5-10 minutes 30-60 Min I am usually awake for more than an hour before sleep Other:

28. During the past month, what time have you usually got up in the morning? * At sunrise 8 AM 12 PM After Mid Day Other:

29. During the past month, on average how many hours of actual sleep did you get per night? * 2 hours 4 hours 6 hours > 6 hours 30. Is your sleep disturbed by any of the following conditions? *can choose multiple options * Pain (e.g., Back pain) Headaches Restless legs (or arms) Night sweats Bad dreams Feeling too hot Feeling too cold Cough Snore loudly Cannot breathe comfortably: My breathing stop for short periods (eg. 10 - 20 secs) during sleep Have to use the bathroom None of the above Other:

31. How often do you exercise for more than 30 minutes in a week? * No exercise Between 1 and 3 times a week Between 3 and 5 times a week More than 5 times a week

95 SECTION THREE: QUESTIONNAIRE Guidelines: Kindly mark the desired answer from the given choices. A = Agree N = Neutral DA = Disagree 32. I am immediately wide awake when I wake up * ( ) Agree ( ) Neutral ( ) Disagree 33. I have trouble getting up in the morning * ( ) Agree ( ) Neutral ( ) Disagree 34. During the hour before bedtime, I do things that make me feel very awake (like playing video games) * ( ) Agree ( ) Neutral ( ) Disagree

35. I use my bed for things other than sleep (such as gaming or using a handheld device) * ( ) Agree ( ) Neutral ( ) Disagree 36. I fall asleep immediately after turning off the light * ( ) Agree ( ) Neutral ( ) Disagree 37. I have trouble falling asleep within 30 minutes * ( ) Agree ( ) Neutral ( ) Disagree 38. I have difficulty staying asleep because I wake up in the middle of the night or early morning * ( ) Agree ( ) Neutral ( ) Disagree 39. I often wake up too early before I intend to and cannot get back to sleep * ( ) Agree ( ) Neutral ( ) Disagree 40. I take substance (prescribed or over the counter medicine) to help me sleep at night * ( ) Agree ( ) Neutral ( ) Disagree 41. My sleeping schedule is consistent * ( ) Agree ( ) Neutral ( ) Disagree 42. I am a person who does not get enough sleep * ( ) Agree ( ) Neutral ( ) Disagree 43. I am DISSATISFIED with my CURRENT sleep pattern * ( ) Agree ( ) Neutral ( ) Disagree 44.

I consider my sleep problem to INTERFERE with my daily functioning (e.g. daytime fatigue, mood, ability to

function at work/daily chores, concentration, memory, mood, etc.) CURRENTLY * ( ) Agree ( ) Neutral ( ) Disagree 45. It is difficult for me to wake up and get out of bed on weekdays * ( ) Agree ( ) Neutral ( ) Disagree 46. I feel sleepy during the day * ( ) Agree ( ) Neutral ( ) Disagree 47. I often need to take naps to get through the day * ( ) Agree ( ) Neutral ( ) Disagree 48. I lose hours of sleep to gaming *My time on games has caused sleep deprivation ( ) Agree ( ) Neutral ( ) Disagree 49.

When I play I lose track of time *

96 ( ) Agree ( ) Neutral

( ) Disagree

50. When I play I can’t tell that I am getting tired * ( ) Agree ( ) Neutral ( ) Disagree 51. When I play I lose track of where I am ( ) Agree ( ) Neutral ( ) Disagree 52. I play longer than I meant to * ( ) Agree ( ) Neutral ( ) Disagree 53. I feel like I can’t stop playing * ( ) Agree ( ) Neutral ( ) Disagree

54. I tend to stay up late due to online games * ( ) Agree ( ) Neutral ( ) Disagree 55. I skip sleep just to finish my game * ( ) Agree ( ) Neutral ( ) Disagree 56. I had recent health problems associated with a lack of sleep * ( ) Agree ( ) Neutral ( ) Disagree 57.

Video games have negatively affected my sleep habits *I often fail to get enough sleep because of playing video

games ( ) Agree ( ) Neutral 58.

( ) Disagree

My sleep quality overall is rated good *

( ) Agree ( ) Neutral

( ) Disagree

Thank you. Your response has been recorded. Thank-you for completing the questionnaire and taking our survey. Your response is very important to us. Once you have completed the above mentioned tasks and wish to submit your results, please make sure to click “Submit” before closing the browser window. Adapted from the Pittsburg Sleep Quality Index (Buysse, Reynolds, Monk, Berman, &Kupfer 1989). Sleep Reduction Screening Questionnaire (van Maanen et al., 2014) Insomnia Severity Index (Morin et al., 2011) Game Engagement Questionnaire (Brockmyer et al., 2009) Any feedback or comments would be welcome and immensely appreciated. Kindly contact me for suggestions on how to improve or if you further wish to contribute to the field positively.