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ORIGINAL ARTICLE

Internet addiction and daytime sleepiness among professionals in India:

A web‑based survey
Lokesh Kumar Singh, K. Hari Hara Suchandra, Amrit Pattajoshi1, Spoorthy Sai Mamidipalli, Huma Kamal2,
Sharda Singh, Bhoomika Sachacher3, Varun Mehta4
Department of Psychiatry, All India Institute of Medical Sciences, 2Department of Psychiatry, Pt. J.N.M Medical College,
Raipur, Chhattisgarh, 1Department of Psychiatry, Hi Tech Medical College and Hospital, Bhubaneshwar, Odisha,
3
Department of Psychiatry, Amity University, 4Department of Psychiatry, Central Institute of Psychiatry, Ranchi, Jharkhand, India

ABSTRACT

Background: The likelihood of the relation between Internet overuse and comorbid psychiatric conditions is on the
rise. However, sleep disturbances are common psychiatric symptoms associated with internet overuse. Our objective
was to examine the association of Internet overuse with excessive daytime sleepiness, sleep problems in professionals
from India.
Materials and Methods: This was a web‑based cross‑sectional study through a predesigned questionnaire which
included various professional groups. The information included in the questionnaire was sociodemographic details,
Young’s internet addiction test (IAT) and Epworth sleepiness scale (ESS).
Results: About 1.0% of total sample population had severe internet addiction whereas 13% were in the range of
moderate internet addiction and the mean score on IAT was found to be 32 (standard deviation [SD] = 16.42). The mean
duration of total night time sleep (5.61 ± 1.17) is significantly lower in participants with moderate and severe internet
addiction (6.98 ± 1.12) compared to those with no and mild internet addiction. The mean scores of ESS were significantly
higher in individuals with moderate and severe addiction (M = 10.64, SD = 4.79). We found that sleepiness while in 5
of the situations such as driving a car ( χ2 = 27.67; P < 0.001), sitting and reading ( χ2 = 13.6; P = 0.004), traveling in a
car ( χ2 = 15.09; P = 0.002), afternoon rest time ( χ2 = 15.75; P = 0.001), and postlunch quiet time ( χ2 = 24.09; P < 0.001),
predicted membership to moderate‑to‑severe internet addiction, even after controlling for the confounding effects of
age and gender.
Conclusions: This study shows an association between Internet overuse, excessive daytime sleepiness, and other sleep
problems. Clinicians should be proactive and conscious in scrutinizing the patients for internet addiction and its consequences.

Key words: Addiction, internet, sleep

INTRODUCTION

Internet is no longer just used for educational and research

Address for correspondence: Dr. Spoorthy Sai Mamidipalli, purposes unlike in the past. Over the years because of
Department of Psychiatry, All India Institute of Medical Sciences,
Raipur, Chhattisgarh, India.
E‑mail: saispoorthy.m@gmail.com This is an open access journal, and articles are distributed under the terms of
the Creative Commons Attribution‑NonCommercial‑ShareAlike 4.0 License,
which allows others to remix, tweak, and build upon the work non‑commercially,
Access this article online as long as appropriate credit is given and the new creations are licensed under
the identical terms.
Quick Response Code
Website: For reprints contact: reprints@medknow.com
www.indianjpsychiatry.org

How to cite this article: Singh LK, Suchandra KH, Pattajoshi A,

DOI:
Mamidipalli SS, Kamal H, Singh S, et al. Internet addiction and
daytime sleepiness among professionals in India: A web-based
10.4103/psychiatry.IndianJPsychiatry_412_18
survey. Indian J Psychiatry 2019;61:265-9.

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Singh, et al.: Internet addiction and day time sleep
accessibility and affordability, the number of users has
increased day‑by‑day. With 2 billion global users, in India,
there were a predicted total of 354 million internet users
in 2015.[1] Adolescents and young adults are especially at
increased risk for internet addiction and its consequences
compared to the elderly.[2]
Internet addiction has been defined as “excessive or
poorly controlled preoccupations, urges or behaviors
regarding computer use and internet access that lead to
impairment or distress.”[3] Although there are controversies
over use of the term “addition,”[4] and many prefer to use
terms ‑ “problematic internet use,”[5] “excessive internet
use,”[6] etc., all of these terms convey similar implications.
Overall, this condition is defined as the inability of
individuals to control the internet use, resulting in marked
distress and/or functional impairment in daily life.[7‑9]
Since the time Goldberg[10] introduced the term “internet
addiction,” there is growing interest in this field. Multitude
of studies conducted till date studied the prevalence,
risk factors and consequences of internet addiction.[11,12]
However, the gray zone still persists as it has not been given
place in the existing classificatory systems such as DSM‑5.
The only behavioral addiction considered in the DSM‑5 is
the internet gaming disorder under conditions requiring
further study.[13]
With the increase in time spent in the internet use various
studies showed relation between growing internet use and
comorbid psychiatric issues such as loneliness, depression,
harm avoidance, anxiety symptoms, impulsivity, and
attention‑deficit–hyperactivity disorder.[14‑16] Furthermore,
individuals with excessive internet usage have less time to
sleep and feel tired more often than not. Excessive daytime
sleepiness (EDS) is associated with impaired workplace
performance, injuries, and risk of drowsy driving.[17] Studies
addressing this issue of internet overuse and EDS have
been rarely carried out in India. A few studies available till
date tell us about the prevalence of internet overuse in
professional groups[18,19] where workplace functioning is of
utmost importance.
MATERIALS AND METHODS
This was a web‑based survey conducted between January
and February 2018 (2 months) through predesigned online
questionnaire (www.surveymonkey.com). The questionnaire
was circulated by using E‑mails, WhatsApp, Facebook,
other messenger applications by the investigators of four
medical colleges to their contacts, who included various
professional groups such as teachers, engineers, nurses,
and students. The study commenced after taking approval
from Ethics Committee. The target population included
was between 18 and 65 years of age, of either gender. The
respondents could fill the survey only once through their
266
respective devices that way maintaining authenticity of the
sample. The information included in the questionnaire was
sociodemographic details, Young’s internet addiction test
(IAT)[20] and the Epworth sleepiness scale (ESS).[21] For the IAT,
we used 5 point Likert scale (1 = rarely, 2 = occasionally,
3 = frequently, 4 = often, and 5 = always); total scores
ranging from 20 to 100.  Final responses were analyzed
using the appropriate statistical method.
The purpose of the present study was to examine the
association of Internet overuse with EDS in professionals
from India.
RESULTS
Out of the 2015 responses received, 233 were excluded
due to incomplete responses. Hence, the overall sample
included was 1782 [Figure 1]. Out of this sample, the groups
we included were doctors, students (nursing and MBBS),
and other professionals.
Sociodemographic data
In the final sample of 1782 completers of the online survey,
58.4% (n = 1040) were male, 41.6% (n = 742) were female.
The mean age group was found to be 27.7 years. About
27.4% were doctors (Post MBBS, PGs), 38.3% were students,
and 34.3% included other professionals. The proportion
of individuals who stayed at home (n = 876%–49.2%) and
away from home (n = 906%–50.8%) was almost similar in
the current sample. Most commonly used gadget was
mobile phone (n = 1611, 90.4%) followed by desktop/laptop
(n = 171, 9.6%).
Scores of internet addiction and it is relation to sleep
The mean score on Young’s IAT is 32 (standard
deviation = 16.42), indicating that the most of the population
was within the average user range. About 1.0% of the total
sample population had significant problems with internet
usage, whereas 13% were in the range of frequent/occasional
Figure 1: Flow diagram illustrating inclusion of samples in the
study
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Singh, et al.: Internet addiction and day time sleep

problems, 62.9% of the sample were average internet users. It was also found that the participants with moderate‑severe
About 23% of the sample scored even <20 suggestive of internet addiction had significantly high chance of dozing in
having no problem with their internet use. all the eight situations listed out on ESS [Table 2].

To test our primary objective, we divided the overall sample
based on IAT scores into two categories ‑ none and mild
(includes those with IAT scores <20 and 20–49), moderate
and severe (includes those with IAT scores 50–79 and 80–100).
Sleep disturbances and internet addiction severity
In this study, the total sleep duration of the participants
ranged between 4 and 10 h, whereas the mean sleep duration
was found to be 6.7 h. About 66.2% reported some form of
sleep disturbances. Among this lack of freshness after sleep
was seen in majority (24.6%) followed by difficulty initiating
sleep (17.9%), difficulty maintaining sleep (12.7%), and early
morning awakening (11%), respectively.
As shown in Table 1, we can understand that the mean
duration of total nighttime sleep is significantly lower in
participants with moderate and severe internet addiction
compared to those with no and mild internet addiction.
Furthermore, we found out that participants with nighttime
sleep disturbances had significantly higher severity of
internet addiction. When different types of sleep problems
were compared between both severity groups, lack of
freshness of sleep was significantly higher in the moderate
and severe addicts group compared to no and mild addicts.
All other types of sleep problems such as getting up earlier
than intended, intermittent awakenings, difficulty falling
asleep were found to be at a similar rate across different
levels of severity of internet addiction.
Findings from Epworth sleepiness scale
The mean scores of Epworth sleepiness scores were
significantly higher in individuals with moderate and severe
addiction. These findings suggest that the higher the
internet addiction the more it cause interference in daytime
alertness [Table 2].
RESULTS OF LOGISTIC REGRESSION
A logistic regression analysis was conducted with levels
of internet addiction (no or mild level of addiction as one
group; moderate or severe level of addiction as other group)
as dependent variables, ESS categories as independent
variables with age and gender as covariates. We found that
sleepiness while in 5 of the situations such as driving a car
(2 = 27.67; P < 0.001), sitting and reading (2 = 13.6;
P  = 0.004), travelling in a car (2 = 15.09; = 0.002),
afternoon rest time (2 = 15.75; P = 0.001), and postlunch
quiet time (2 = 24.09; P < 0.001), predicted membership
to moderate to severe internet addiction, even after
controlling for the confounding effects of age and gender.
This model produced an overall Cox and Snell pseudo
R2 = 0.139 (2 = 266.01; P < 0.001).
DISCUSSION
The current study determined the prevalence of internet
addiction and patterns of EDS among professionals in
India. This study has also provided an estimate of the sleep
problems among the respondents.
The relation between sleep and excessive internet usage
forms a vicious cycle. Several hypotheses put forward predict
that excessive exposure to the light emitting diodes screens
particularly before bedtime, disrupts the biological clock
and the circadian rhythm, thus leading to a phase delay and
a slowing of melatonin secretion.[22] According to existing
literature, the consequences of this phase shift leads to leads to
sleep disturbances with later bedtimes, shorter sleep duration,
diurnal hypersomnolence, and headaches.[23,24] However, the
vice‑versa is also true, individuals who are predisposed to
sleep disturbances or have existing sleep disturbances are
likely to use internet as a measure to distract.[25]

Table 1: Sleep disturbances and relation to internet addiction

Variables Yes/no Mean±SD/n; n (%) t‑test/χ2 (P)
No‑mild severe Moderate‑severe
Duration of sleep at night (h) ‑ 6.98±1.12 5.61±1.17 17.74 (<0.001)
Sleep disturbances Yes 974 (63.6) 205 (82) 32.58 (<0.001)
No 558 (36.4) 45 (18)
Most common sleep problem
Falling asleep Yes 277 (18.1) 42 (16.8) 0.24 (0.624)
No 1255 (81.9) 208 (83.2)
Intermittent awakenings Yes 195 (12.7) 31 (12.4) 0.02 (0.885)
No 1337 (87.2) 219 (87.6)
Getting up earlier than intended Yes 163 (10.6) 33 (13.2) 1.44 (0.230)
No 1369 (89.4) 217 (86.8)
Lack of freshness after sleep Yes 339 (22.1) 100 (40) 35.39 (<0.001)
No 1193 (77.9) 150 (60)
SD – Standard deviation

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Singh, et al.: Internet addiction and day time sleep

Table 2: Relation between Epworth Sleepiness Scores and internet addiction scores
Variable n; n (%)/mean±SD χ2 (P)
None and mild Moderate and severe
ESS total 6.97 (3.89) (n=1532) 10.64 (4.79) (n=250) 13.34 (<0.001)
While in a vehicle, while stopped for a few minutes in traffic
Would never doze 1215 (79.3) 126 (50.4) 133.35 (<0.001)
Slight chance of dozing 223 (14.6) 61 (24.4)
Moderate chance of dozing 68 (4.4) 36 (14.4)
High chance of dozing 26 (1.7) 27 (10.8)
While sitting and reading
Would never doze 512 (33.4) 41 (16.4) 123.08 (<0.001)
Slight chance of dozing 651 (42.5) 77 (30.8)
Moderate chance of dozing 281 (18.3) 73 (29.2)
High chance of dozing 88 (5.7) 59 (23.6)
While watching TV
Would never doze 717 (46.8) 102 (40.8) 44.16 (<0.001)
Slight chance of dozing 552 (36.0) 69 (27.6)
Moderate chance of dozing 201 (13.1) 46 (18.4)
High chance of dozing 62 (4.0) 33 (13.2)
While sitting inactive in a public place (e.g., a theater or a meeting)
Would never doze 745 (48.6) 84 (33.6) 74.51 (<0.001)
Slight chance of dozing 530 (34.6) 76 (30.4)
Moderate chance of dozing 189 (12.3) 47 (18.8)
High chance of dozing 68 (4.4) 43 (17.2)
While as a passenger in a car for an hour without a break
Would never doze 470 (30.7) 56 (22.4) 26.13 (<0.001)
Slight chance of dozing 532 (34.7) 72 (28.8)
Moderate chance of dozing 331 (21.6) 62 (24.8)
High chance of dozing 199 (13.0) 60 (24.0)
While lying down to rest in the afternoon when circumstances permit
Would never doze 205 (13.4) 24 (9.6) 40.92 (<0.001)
Slight chance of dozing 444 (29.0) 55 (22.0)
Moderate chance of dozing 471 (30.7) 54 (21.6)
High chance of dozing 412 (26.9) 117 (46.8)
While sitting and talking to someone
Would never doze 1217 (79.4) 129 (51.6) 127.08 (<0.001)
Slight chance of dozing 229 (14.9) 63 (25.2)
Moderate chance of dozing 71 (4.6) 39 (15.6)
High chance of dozing 15 (1) 19 (7.6)
While sitting quietly after a lunch without alcohol
Would never doze 488 (31.9) 49 (19.6) 63.94 (<0.001)
Slight chance of dozing 560 (36.6) 70 (28.0)
Moderate chance of dozing 324 (21.1) 63 (25.2)
High chance of dozing 160 (10.4) 68 (27.2)
SD – Standard deviation; ESS – Epworth Sleepiness Scale

The excessive amount of time spent online may directly
reduce the total sleep time leading to a diagnosis of
insomnia. Time spent online, although not assessed
separately, is the basis for 6 (out of 20) items (i.e., 01, 02,
05, 06, 17, and 19) of the IAT, the scale used in our study.
Moreover, validity studies conducting factor analysis also
have found “time” to be a major factor.[26] Studies done till
date to evaluate the relation between social media/internet
usage and sleep have shown that excessive use of screen
leads to sleep‑related consequences such as getting to
bed later in the night, needing more time to fall asleep,
increased number of awakenings in the night, and difficulty
in waking up and feelings of sleepiness in day. In addition,
sleep quality of individuals with higher scores on internet
addiction scale was worse when compared to those with a
lower score. However, these studies were mainly focused
on adolescents and school going children. Moreover, the
sleep‑related variables were assessed using semi‑structured
questionnaires.[17,27‑30]
In our study, we found that the presence of sleep
disturbances and lack of freshness after sleep were
significantly higher among those with higher levels of
internet addiction (moderate‑severe group). Furthermore,
the duration of night sleep was significantly lower in
respondents with higher levels of internet addiction. These
findings are similar to the studies done in India till now.[31]
However, as to our knowledge, this is the first study from
India focusing on internet addiction, sleep disturbances,
and EDS. A few studies done from India assessing internet
addiction and psychiatric comorbidities showed relation
of internet overuse and personality characteristics,[32]

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Singh, et al.: Internet addiction and day time sleep
depression, anxiety, well‑being, and functioning.[19,33,34]
We could not find any study from India that assessed the
relation between daytime sleepiness and internet addiction
using validated scale.
Our study is not without limitations. Predominantly, online
nature of the study might have picked up the sample which
used internet more compared to other population. Although
we tried to include population from all the age groups, the
predominant age group of the final sample was between
25 and 30 years thus limiting the representativeness of
the sample. As it was a cross‑sectional study, no causal
relationships could be ascertained from the same.
CONCLUSIONS AND FUTURE DIRECTIONS
Internet has revolutionized various fields such as education,
marketing, and social communication and so the number
of internet users is increasing exponentially every year.
Developing countries like India are not an exception to this.
India lacks in literature on Internet addiction compared to
western literature thereby showing the lack of awareness
and also the need for more research in this field. The present
study identifies the association between Internet overuse,
EDS, and other sleep problems. As the number of Internet
addicts will continue to grow, clinicians should be proactive
in examining Internet addiction in cases of EDS.
Future studies should focus upon studying daytime sleep
as a mediator between internet addiction and work
performance in professionals.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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