A bidirectional model of sleep and technology use: A theoretical review of How much, for whom, and which mechanisms.

The link between technology and sleep is more complex than originally thought. In this updated theoretical review, we propose a new model informed by the growing body of evidence in the area over the past 10 years. The main theoretical change is the addition of bi-directional links between the use of technology and sleep problems. We begin by reviewing the evidence to date for the originally proposed mechanisms of bright light, arousal, nighttime sleep disruptions, and sleep displacement. Then, in support of the new direction of effect (sleep problems preceding technology use), we propose two new mechanisms: technology before sleep might be used as a time filler and/or as an emotional regulation strategy to facilitate the sleep-onset process. Finally, we present potential moderators of the association between technology and sleep, in recognition of protective and vulnerability factors that may mitigate or exacerbate the effects of technology on sleep and vice versa. The goal of this theoretical review is to update the field, guide future public health messages, and to prompt new research into how much technology and sleep affect each other, for whom it may be problematic, and which mechanisms may explain their association.

Sleepless on the road: Are mothers of infants with insomnia at risk for impaired driving?

Infant sleep problems have been associated with a myriad of adverse child and parent outcomes, yet whether these problems may pose a risk for parents on the road has received little research attention. This study sought to test whether mothers of infants with insomnia are at an elevated risk for vehicular crashes, by comparing their objectively measured driving performance with that of mothers of well-sleeping infants and with that of women without children. Fifty-four women from these three groups completed a simulated driving task. Outcome measures included standard deviation of lateral position, number of lane crossings, standard deviation of speed, average speed and maximum speed. Women additionally reported on their driving behaviour using the Driving Behaviour Questionnaire, and on sleep, sleepiness and insomnia symptoms using 7-day sleep diaries and questionnaires. Mothers of infants with insomnia demonstrated greater lane deviation (Wald = 9.53, p = 0.009), higher maximum speed (Wald = 6.10, p = 0.04) and poorer self-rated driving behaviour (Wald = 7.44, p = 0.02) compared with control groups. Analyses also indicated that driving performance in mothers of infants with insomnia tended to be poorer relative to control groups with the progression of time on task. While further research is needed to assess the scope of these effects, our findings suggest that parents, healthcare providers and policymakers should be aware of the potential consequences of infant sleep problems on road safety, and collaborate to establish strategies to mitigate these risks.

Development of evening sleep homeostatic pressure in early adolescent boys.

The physiological processes governing sleep regulation show maturational changes during adolescent development. To date, data are available to specify when delays in circadian timing occur; however, no longitudinal data exist to characterize the maturation of the accumulation of sleep pressure across the evening. The aim of this longitudinal study was to test whether this change in evening sleep propensity can be identified during early adolescence. Twenty pre-pubescent boys' (Mage = 10.3, SD = 0.4 years) evening sleep homeostats were assessed using a series of sleep latency tests every hour (7:30 p.m. to 3:30 a.m.) at 6-month intervals across four waves. While results revealed shorter sleep onset latencies with increasing wakefulness (p < .001), this effect was not moderated by study wave (p = .79). Evening sleep propensity thus appears to remain stable in boys during early adolescence. Future studies should expand upon these findings by using larger samples of girls as well as boys across an extended age range during the teenage years.

Technology use as a sleep-onset aid: are adolescents using apps to distract themselves from negative thoughts?

Study Objectives: The aim of this study was to; (1) explore whether adolescents use technology as distraction from negative thoughts before sleep, (2) assess whether adolescents who perceive having a sleep problem use technology as distraction more compared to adolescents without sleep complaints, and (3) collect qualitative information about which devices and apps adolescents use as a distraction. Methods: This study used a mixed-methods cross-sectional design, where 684 adolescents (M = 15.1, SD = 1.2, 46% female) answered both quantitative and qualitative questions about their sleep (perceived sleep problem, sleep onset time (SOT), and sleep onset latency [SOL]) and technology use as distraction from negative thoughts. Results: The majority of adolescents answered "yes" or "sometimes" using technology as a distraction from negative thoughts (23.6% and 38.4%). Adolescents who answered "yes" to using technology as distraction were more likely to report having a sleep problem, longer SOL, and later SOT, compared to adolescents who answered "no". The most popular device to distract was the phone, because of its availability, and the most common apps used for distraction included YouTube, Snapchat, and music apps. Conclusions: This study shows that many adolescents use technology to distract themselves from negative thoughts, which may help them manage the sleep-onset process. Thus, distraction may be one mechanism explaining how sleep affects technology use, rather than vice versa.

Insomnia in Infancy, Childhood, and Adolescence.

Insomnia is the most prevalent sleep disorder in youth, tends to persist over time, and is associated with a myriad of adverse outcomes. This paper synthesizes the current evidence regarding the phenomenology, prevalence, assessment, consequences, cause, and treatment of pediatric insomnia, highlighting areas that warrant further research and addressing the unique characteristics of this disorder in infants, children, and adolescents.

Can cry tolerance be increased in mothers of infants with sleep problems, and why does it matter? A quasi-experimental study.

STUDY OBJECTIVES: Infant sleep problems are one of the most common complaints of new parents. Research to date has demonstrated a relationship between low parental cry tolerance and infant sleep problems. The aim of this study was to explore whether three emotion regulation strategies could increase parental cry tolerance. METHODS: This study utilised a quasi-experimental design. We recruited 83 females (Mage= 32, SD= 5.26) comprising 3 groups: mothers of good sleeping infants aged 6-24 months, mothers of poor sleeping infants aged 6-24 months, and good sleeping women aged 23-40 years without children. Participants were instructed to listen to crying audio segments and indicate when they felt the child needed to be tended to (measured in seconds). This crying audio was paired with one of three emotion-regulation strategies (i.e., music, gaming, reappraisal). Each participant completed all 4 cry conditions which were counterbalanced to control for order effects. RESULTS: We found that all three strategies yielded significantly longer reaction times (indicating higher cry tolerance) compared to the control condition (p <.001). We also found that mothers of poor sleepers and good sleeping women benefitted from all three emotion regulation strategies compared to control (p <.001 and p= <.05, respectively). The cry tolerance of mothers of good sleepers, on the other hand, did not differ between the control condition and any of the strategies (all ps >.05). CONCLUSIONS: This demonstrates that cry tolerance can be increased using emotion regulation strategies, such as distraction via music or gaming, and reappraisal. This has clinical implications for families implementing behavioural sleep interventions.

Validation of the Parental Understanding and Misperceptions about BAby's Sleep Questionnaire using auto-videosomnography.

BACKGROUND: Previous studies have suggested that parental cognitions about child's sleep may be an important factor underlying pediatric sleep problems. The current study aimed to (a) develop an assessment tool measuring parental understanding and misperceptions about baby's sleep (PUMBA-Q); (b) validate the questionnaire using self-report and objective sleep measures. METHODS: There were 1,420 English-speaking caregivers (68.0% mothers, 46.8% of children being females, mean age 12.3 months), who has completed online self-reported questionnaires. The PUMBA-Q, which was developed for this study, Dysfunctional Beliefs and Attitudes about Sleep (DBAS) and Maternal Cognitions about Infant Sleep Questionnaire (MCISQ) were included to evaluate participant's thoughts on their own or child's sleep. Insomnia Severity Index (ISI) was collected to access participant's subjective insomnia severity. Brief Infant Sleep Questionnaire-Revised (BISQ-R) was used to assess parental-reported child sleep. Auto-videosomnography was used to record child's sleep. RESULTS: Exploratory factor analysis indicated the best fit with a 4-factor model using 23 items (RMSEA = .039). The four subscales were labeled: (a) Misperceptions about parental intervention; (b) Misperceptions about feeding; (c) Misperceptions about child's sleep; and (d) General anxiety of parents. Internal consistency was adequate (Cronbach's alpha = .86). PUMBA-Q scores were significantly associated with MCISQ (r = .64, p < .01), DBAS (r = .36, p < .01), ISI (r = .29, p < .01), BISQ-R (r = .-49, p < .01), objective child's total sleep time (r = -.24, p < .01) and objective number of parental nighttime visits (r = .26, p < .01). CONCLUSIONS: The results demonstrated that PUMBA-Q 23 is a valid assessment tool for parental cognitions of child sleep. The link between parental cognitions and child sleep highlights the importance of managing parental cognitions about child sleep when treating pediatric sleep problems.

Let's Talk about Sleep Baby: Sexual Activity Postpartum and Its Links with Room Sharing, Parent Sleep, and Objectively Measured Infant Sleep and Parent Nighttime Crib Visits.

The postpartum period may pose a considerable challenge for both parent sleep and sexual activity. This study assessed the links between partnered sexual frequency and satisfaction postpartum and parent sleep, infant sleep, parent nighttime caregiving, and parent-infant room sharing. Participants were 897 parents of infants aged 1-18-months (M = 8.8 ± 4.3, 49% girls). Parents completed an online survey about their sexual frequency and satisfaction, sleep, relationship satisfaction, depression, and demographic characteristics. Infant sleep and parent nighttime crib visits were measured objectively using auto-videosomnography during 2-weeks, with 8,460 nights assessed. Results indicated that the frequency of partnered sexual activity was 3.8 ± 4.2 times per month. Frequency of sexual activity increased with infant age, yet increases beyond the first 6 months postpartum were non-significant. Adjusted GEE modeling revealed that more parent nighttime crib visits were significantly associated with lower sexual frequency, regardless of infant age. Other parent and infant sleep-related factors were not significantly linked with sexual frequency in adjusted models. Moreover, sexual satisfaction was not associated with parent nighttime caregiving, parent or infant sleep, or parent-infant sleeping arrangements in adjusted models, suggesting that it may not be susceptible to the effects of disrupted sleep in the postpartum period. These findings suggest that it is not infant or parent sleep disruption per se, but rather parent nighttime engagement with the infant that is associated with parent sexual activity frequency. Longitudinal investigations are warranted to examine the directional pathways of these links.

Implementation of Behavioral Interventions for Infant Sleep Problems in Real-World Settings.

OBJECTIVES: To compare the real-world frequency, timing, duration, difficulty, and helpfulness of 3 infant Behavioral Sleep Intervention (BSI) approaches: Unmodified Extinction, Modified Extinction, and Parental Presence and to examine the effectiveness and safety of these approaches by comparing infant sleep, parent sleep, daytime sleepiness, depression, and parent-infant bonding between parents who had and had not implemented these interventions. STUDY DESIGN: Participants were 2090 parents (75% mothers, 79% White/Caucasian) of US infants (49% girls) aged 3-18 months (M = 9.1, SD = 4.1). Parents completed online questionnaires regarding their infant's sleep, their own sleep, daytime sleepiness, depression levels, and parent-infant bonding. Infant sleep was assessed via objective-albeit exploratory-autovideosomnography data obtained from the 14 days prior to survey completion. RESULTS: Sixty-four percent of parents reported implementing BSIs. The average age at intervention was 5.3 months (SD = 2.6). Unmodified and Modified Extinction were rated as significantly more difficult to implement compared with Parental Presence but also as more helpful, shorter, and quicker to show improvements. Infant nighttime sleep was longer and more consolidated in the Unmodified and Modified Extinction groups compared with the Parental Presence and non-BSI groups. No differences were found between BSI groups in parent sleep, sleepiness, depression, or parent-infant bonding. CONCLUSIONS: Implementation of BSIs outside clinical settings is pervasive and occurs earlier than generally recommended. Unmodified and Modified Extinction were associated with longer and more consolidated infant sleep. Despite concerns regarding the potential harm of BSIs, implementation of these approaches was not linked with negative outcomes, providing additional evidence for their safety and effectiveness.

What's "app"-ning to adolescent sleep? Links between device, app use, and sleep outcomes.

This study investigated the associations between adolescent evening use of technology devices and apps, night time sleep, and daytime sleepiness. Participants were 711 adolescents aged 12-18 years old (46% Female, Mage = 15.1, SD = 1.2). Time spent using technology devices and apps in the hour before bed, and in bed before sleep onset, was self-reported. Participants additionally completed a questionnaire about their sleep on school nights and next day sleepiness. In the hour before bed, 30 min of phone use was associated with a 9-min delay in bedtimes. Thirty minutes spent using laptops, gaming consoles, and watching YouTube was associated with later lights out times of 9 min, ∼16 min and ∼11 min respectively, while watching TV was associated with a 9 min earlier lights out times. Using gaming consoles and watching YouTube were associated with greater odds of receiving insufficient sleep (≤7 h TST). In bed before sleep onset, 30 min spent using laptops, phones, iPad/tablets, and watching YouTube were linked with later lights out times of ∼7 min for phones and laptops, 9 min for iPad/tablets, and ∼13 min for YouTube. Watching Netflix was associated with greater daytime sleepiness. YouTube at this time point was associated with increased odds of sleeping ≤7 h on school nights. Adolescents are engaging with a wide range of technology devices and apps in the evenings. However, certain devices and apps (e.g., phones, laptops, gaming and YouTube) might lead to more negative sleep outcomes for adolescents on school nights compared to others.

Sleep and physical activity - the dynamics of bi-directional influences over a fortnight.

STUDY OBJECTIVES: The day-to-next day predictions between physical activity (PA) and sleep are not well known, although they are crucial for advancing public health by delivering valid sleep and physical activity recommendations. We used Big Data to examine cross-lagged time-series of sleep and PA over 14 days and nights. METHODS: Bi-directional cross-lagged autoregressive pathways over 153,154 days and nights from 12,638 Polar watch users aged 18-60 years (M = 40.1 SD = 10.1; 44.5% female) were analyzed with cross-lagged panel data modeling (RI-CPL). We tested the effects of moderate-to-vigorous physical activity (MVPA) vs. high intensity PA (vigorous, VPA) on sleep duration and quality, and vice versa. RESULTS: Within-subject results showed that more minutes spent in VPA the previous day was associated with shorter sleep duration the next night, whereas no effect was observed for MVPA. Longer sleep duration the previous night was associated with less MVPA but more VPA the next day. Neither MVPA nor VPA were associated with subsequent night's sleep quality, but better quality of sleep predicted more MVPA and VPA the next day. CONCLUSIONS: Sleep duration and PA are bi-directionally linked, but only for vigorous physical activity. More time spent in VPA shortens sleep the next night, yet longer sleep duration increases VPA the next day. The results imply that a 24-h framing for the interrelations of sleep and physical activity is not sufficient - the dynamics can even extend beyond, and are activated specifically for the links between sleep duration and vigorous activity. The results challenge the view that sleep quality can be improved by increasing the amount of PA. Yet, better sleep quality can result in more PA the next day.

Sleep's role in the development and resolution of adolescent depression.

Two adolescent mental health fields - sleep and depression - have advanced largely in parallel until about four years ago. Although sleep problems have been thought to be a symptom of adolescent depression, emerging evidence suggests that sleep difficulties arise before depression does. In this Review, we describe how the combination of adolescent sleep biology and psychology uniquely predispose adolescents to develop depression. We describe multiple pathways and contributors, including a delayed circadian rhythm, restricted sleep duration and greater opportunity for repetitive negative thinking while waiting for sleep. We match each contributor with evidence-based sleep interventions, including bright light therapy, exogenous melatonin and cognitive-behaviour therapy techniques. Such treatments improve sleep and alleviate depression symptoms, highlighting the utility of sleep treatment for comorbid disorders experienced by adolescents.

Wi-Fi off, devices out: do parent-set technology rules play a role in adolescent sleep?

There is limited evidence surrounding the relationship between parent-set technology rules and adolescent sleep. This study had two aims: 1) to investigate the relationship between presence of and compliance to parent-set technology rules and adolescent sleep outcomes and daytime sleepiness; 2) to investigate if compliance, non-compliance, or the absence of rules could moderate the relationship between Fear of Missing Out (FoMO) and Bedtime Procrastination (BtP) on sleep outcomes and daytime sleepiness. A total of 711 adolescents aged 12-18 years old (46% Female, M age  = 15.1, SD = 1.2) were recruited through secondary schools in South Australia. Participants completed a survey containing self-report measures about their sleep, daytime sleepiness, FoMO, BtP, the presence/absence of technology rules in their house, and their compliance to these rules. The study design was cross sectional. Results indicated that the presence of a parent-set technology rule was associated with earlier bedtimes regardless of compliance. Earlier lights out times and increased sleep duration were observed in adolescents who always complied to their rules compared to those who did not comply or did not have parent-set technology rules. BtP and FoMO were associated with later bedtimes, later lights out times, longer sleep onset latency, shorter sleep duration, and more daytime sleepiness. However, parent-set rules did not moderate the links between BtP/FoMO and adolescent sleep. Whilst longitudinal investigations are warranted to examine the directionality of these relationships, the present study suggests that parent-set technology rules may play an important role in protecting adolescent sleep.

Evaluation of a Brief Sleep Intervention Designed to Improve the Sleep, Mood, and Cognitive Performance of Esports Athletes.

This study evaluated a brief sleep intervention designed to improve the sleep, mood, and cognitive performance of professional electronic sports (esports) athletes from three major esports regions (i.e., Asia, North America, and Oceania). Fifty-six esports athletes from South Korea (N = 34), the United States (N = 7), and Australia (N = 15) completed the study. Participants completed an initial 2-week pre-intervention phase to establish a baseline, followed by a 2-week intervention phase that involved a group sleep education class, 1:1 session with a trained clinical psychologist, and daily biofeedback. A wrist activity monitor and daily sleep diary were used to monitor sleep during both phases, while at pre- and post-intervention, participants completed a battery of sleep and mood questionnaires and underwent cognitive performance testing. Sleep knowledge increased from pre- to post-intervention (d = 0.83 [95% CI −1.21, −0.43], p =< 0.001), while there were modest improvements in sleep diary estimates (i.e., sleep onset latency (Mdiff = −2.9 min, p = 0.02), sleep onset time (Mdiff = −12 min, p = 0.03), and sleep efficiency (Mdiff = 1.1%, p = 0.004)) and wrist activity monitor estimates (i.e., sleep onset time (Mdiff = −18 min, p = 0.01)). Insomnia severity scores decreased significantly (d = 0.47 [95% CI 0.08, 0.84], p = 0.001), while sleepiness scores increased but not meaningfully (d = 0.23 [95% CI −0.61, 0.14], p = 0.025). However, there was no significant change in mood (i.e., depression and anxiety) or cognitive performance scores (i.e., mean reaction time or lapses). Sleep interventions for esports athletes require further investigation. Future research should examine whether a stepped-care model, whereby increasing therapeutic input is provided as needed, can optimize sleep, mood, and cognitive performance outcomes.

The "Dream Changer": a randomized controlled trial evaluating the efficacy of a parent-based intervention for childhood nightmares.

STUDY OBJECTIVES: Recurrent nightmares in childhood may have a range of detrimental effects for both the child and parents. This randomized controlled trial evaluated the efficacy of a novel parent-based intervention for childhood nightmares, using a new device called the "Dream Changer." METHODS: A total of 56 children aged 3-10 years (M = 7.1 ± 2.1 years; 51.8% boys), and one of their parents were randomized to either the intervention or waitlist control group. The intervention group received a "Dream Changer"-a light-emitting remote-control-like device that the child was encouraged to take to bed and use upon experiencing a nightmare. Parents completed online surveys at baseline, 1-week, and 2-weeks following the intervention. Parents in the intervention group additionally completed a 3-month follow-up survey. Outcome variables included children's nightmare frequency, sleep-wake patterns, and sleep anxiety, as well as parents' daytime sleepiness. RESULTS: Significant group-by-time interaction effects were found for nightmare frequency (p = 0.001) and sleep anxiety (p = 0.006). Parents of children who received the "Dream Changer" reported fewer nightmares (Mdifference = 1.7, p < 0.001, d = 1.06) and decreased anxiety (Mdifference = 0.9, p = 0.001, d =0.41) at post-intervention, whereas such benefits were not found in the waitlist control group. Three-month follow-up assessments demonstrated that gains were maintained over-time. Interaction effects were not significant for children's sleep metrics or for parents' daytime sleepiness. CONCLUSIONS: The present study provides preliminary evidence for the efficacy of a brief, highly accessible intervention for reducing children's nightmares and nighttime anxiety. Future research may wish to test these effects using larger samples and longer follow-up assessments. CLINICAL TRIAL REGISTRATION: The trial has been registered at the Australian New Zealand Clinical Trials Registry (https://www.anzctr.org.au/; Identifier:ACTRN12620000633987).

Sleeping through COVID-19: a longitudinal comparison of 2019 and 2020 infant auto-videosomnography metrics.

BACKGROUND: With the outbreak of the COVID-19 pandemic, pediatric experts called attention to the potential adverse effects of living restrictions (e.g., lockdown) on child well-being, but at the same time- acknowledged their possible benefits. To date, only few data-driven reports have been published on child sleep during COVID-19, and all have been based on parent- or self-reports. This study used auto-videosomnography to capture the effects of COVID-19 stay-at-home orders imposed in the USA on objectively measured infant sleep. METHODS: Auto-videosomnography metrics of infants assessed nightly between January and May 2020 were compared with metrics of an equivalent infant cohort, assessed in the corresponding 2019 period. A total of 610 infants (50.7% girls) aged 6-18 months (M = 11.8, SD = 3.6) were included, with 71,472 analyzed nights. Multilevel models were applied to assess differences between 2019 and 2020 infant sleep pre- and during-lockdown. RESULTS: Whereas infant cohorts were equivalent in demographic and January-March/April sleep characteristics, during the 2020 lockdown infants had longer nighttime sleep durations (Mdifference = 11.0 min, p = .01), later morning rise times (Mdifference = 9.5 min, p = .008), and later out-of-crib times (Mdifference = 12.3 min, p < .0001), compared to the equivalent 2019 period. In addition, weekday-weekend differences in sleep onset and midpoint times were diminished during 2020 home-confinement compared to the equivalent 2019 period (2019: Mdifference = 5.5 min, p < .0001; Mdifference = 4.5 min, p < .0001; 2020: Mdifference = 2.3 min, p = .01; Mdifference = 3.1 min, p < .0001, respectively). CONCLUSIONS: Notwithstanding the negative implications of COVID-19 living restrictions in other domains, our findings indicate that there might be a silver lining-in promoting longer and more consistent infant sleep. These benefits should be considered in determining policy for the current and future pandemics.

Is It Time We Stop Discouraging Evening Physical Activity? New Real-World Evidence From 150,000 Nights.

Professional and colloquial sleep hygiene guidelines advise against evening physical activity, despite meta-analyses of laboratory studies concluding that evening exercise does not impair sleep. This study is the first to investigate the association between objectively measured evening physical activity and sleep within a real-world big-data sample. A total of 153,154 nights from 12,638 individuals aged 18-60 years (M = 40.1 SD = 10.1; 44.5% female) were analyzed. Nighttime sleep and minutes of physical activity were assessed using Polar wearable devices for 14 consecutive days. Thirty minutes or more of moderate-to-near maximal physical activity during the 3 h before sleep onset were recorded in 12.4% of evenings, and were more frequent on weekdays than weekends (13.3 vs. 10.2% respectively, p < 0.001). Linear mixed modeling revealed that sleep efficiency was not significantly associated with evening physical activity, and that sleep duration was 3.4 min longer on average on nights following evenings in which participants engaged in 30 min or more of moderate-intense physical activity. Effects were found for sleep timing metrics, as evening physical activity was linked with earlier sleep onset and offset times (-13.7 and -9.3 min, respectively). Overall, these effects were greater- but still very small- on weekdays compared to weekends. The present study provides further evidence for the lack of meaningful links between sleep duration or quality and physical activity in the hours preceding sleep. Taken together with recent meta-analytic findings, these findings suggest that changes in public health recommendations are warranted regarding evening physical activity and its relation to sleep.

COVID-19 babies: auto-videosomnography and parent reports of infant sleep, screen time, and parent well-being in 2019 vs 2020.

OBJECTIVE: The COVID-19 pandemic has profoundly impacted families, yet studies on its effects on infants and their parents have thus far been sparse and based mostly on retrospective parent reporting. This study aimed to prospectively evaluate the impact of COVID-19 living conditions on infant and parent sleep, as well as infant screen exposure, parent daytime sleepiness, and parent depression levels, using multi-method assessment. METHODS: Infant and parent data collected in 2020 were compared with a matched cohort collected in 2019. The total sample included 1518 US infants aged 1-18 months (M = 8.5, SD = 4.6; 54% boys). Auto-videosomnography metrics were obtained from the 14-day period prior to survey completion (number of analyzed nights: M = 12.11 SD = 2.66 in the 2019 cohort; and M = 11.91 SD = 2.41 in the 2020 cohort). Parents completed online questionnaires regarding their infant's sleep and screen exposure, as well as their own sleep quality, daytime sleepiness, and depression levels. RESULTS: Compared to 2019, infants in 2020 slept ∼40 min more per night on average, as indicated by auto-videosomnography. Infants additionally had earlier sleep timing, and increased parent-reported sleep-onset latency and nocturnal wakefulness. Infant screen time rose by 18.3 min per day for older infants, but remained stable for younger infants. Parents reported lower daytime sleepiness and higher depression symptomology during 2020, whereas no change was apparent in their sleep quality ratings. CONCLUSIONS: Restricted living conditions during COVID-19 in the USA led to increased infant screen exposure and parental depression, but also to increased infant sleep duration and reduced parent sleepiness. Future research is needed to examine the mechanistic pathways through which COVID-19 impacted on infant and parent well-being.