Sleep is a necessity of modern days as its it is becoming increasingly rare in modern society. It is influenced by many factors, including demography, socio economic norms, genetic predispositions, and medical conditions [1]. The structure of sleep pattern per se is shaped by the demands of daily life, including study and work schedules, along with many other associated factors like stress both physical and academic , living conditions and most so with the usage of digital devices.[1]. Symptoms of sleep disturbance, such as excessive daytime sleepiness (EDS), poor sleep quality, and sleep deprivation, are common among medical students (2) and often exacerbated by their academic schedules. Since impairment in sleep quality directly affects academic performance (4) and also emotional aspects,(6) we emphasize the importance of measuring sleep quality in medical students. Digital devices, the modern day necessity are one of the major factors that cause sleep deprivation. With the advent of digital education, use of internet is more often a necessity as screens have replaced paper both as a medium of education and communication. Medical students have a tendency to sacrifice sleep to mange academic workload. This study was aimed to chalk out problem areas, identify the severity of digital media overuse and device methods to explore changes in sleep quality.

A total of 350 students from 2020, 2021 and 2022 admission batches were asked to take a predesigned, pretested, semi structured self-administered questionnaire including information on socio demographic profiles and lifestyle questions, between the months of March 2025 to April 2025. The data collected was assessed and tabulated. All participants gave written informed consent. Anonymity regarding the data were maintained. The Pittsburgh Sleep Quality Index (PSQI) scale was applied. Its seven components-subjective sleep quality; sleep latency; sleep duration; habitual sleep efficiency; sleep disturbances; use of sleeping medication; and daytime dysfunction-were analyzed separately. The range of this instrument is from 0 to 21 points, and scores ≥ 5 signify poor sleep quality, indicating possible sleep disturbance. The sum of the seven component scores produces a global score. All participants were also asked to take the Internet Addiction Test which is a questionnaire with 20 items with a rating system between 1 to 5 . The maximum score being 100 points , the higher the score the higher the addiction. Statistical analysis was performed using SPSS version 23.0.

Observation The 19 items in PQSI were grouped into 7 components, including 1.sleep duration 2. Sleep disturbance 3. Sleep latency 4.daytime dysfunction due to sleepiness 5. Sleep efficiency overall sleep quality 7. Sleep medication use.( 1,10) The Internet Addiction Test (IAT) was developed by Young (1998). The IAT measures self-reported compulsive use of the Internet and assesses symptoms of Internet addiction in a variety of settings and measures the presence and severity of internet addiction among the population.(7) Demographic characteristics of the medical students included in this study (n = 350) In the current study, it was found that there were a total of 350 students who participated in the study. The majority (67%) of the students were in the age group of 21–25 years the average age of the study population being 22.81 ± 1.32 years. The study group contained 49.71% female subjects as well. Data are represented as the frequency (%) for categorical data and mean ± standard deviation and as percentage of total. 1. Sleep duration 2. Sleep disturbance 3. Sleep latency 4.daytime dysfunction due to sleepiness 5. Sleep efficiency overall sleep quality 7. sleep medication use. When the data were compared between male and female gender no significant difference were found in the different parameters we used for study. The average time spent on social media per day was 2–6 hours among 67%of the students, and only 5% of students were indulged over more than 6 hours a day on social media. . Regarding the purpose of screen use, 44.1% of the subjects spend most of their screen time on social media for recreation. Additionally, 46.7% of the participants interact with screens as soon as they wake up, highlighting the prevalence of early-day screen use also 66.22% reported pre bed time usage of mobile phones. It was noted that 77% of students complied to have a sleep of around 6–8 hours a day, and 23% of students were found to have lack of sleep with an average period of less than 5 hours a day. Around 27% students complained of day time sleepiness and difficulty in concentration especially in morning classes. Sleep efficiency was found to be average with most students ( 58%) ensured that they got sound sleep on most days but the efficiency was found to be low in pre examination days . Furthermore, 2% of students gave history of use of medicines to get sleep. It was noted that 46%of students had poor sleep quality. There is a very strong association between poor sleep quality and usage of digital devices especially prior to sleep ( p <0.01) . 36.9% of students with 4-6 hours of screen time experienced poor sleep quality, and this number jumped to 66.7% for those with 6-8 hours of screen time. On applying IAT, it was found that 6% of students had severe internet addiction, 18.23% had moderate internet addiction, and 75.77% had mild internet addiction ( IAT score less than 40). On regression analysis of internet addiction with sleep quality, it was found that the total score of internet addiction with poor quality of sleep was statistically significant, suggesting a higher degree of internet addiction have poor sleep quality. Scores of IAT were assessed in relation to sleep quality, showing that with an increased average total score of internet addiction (39.93 ± 10.36), there was an increasing occurrence of poor sleep quality (P < 0.05). Similarly, it was noted that lack of control was more with poor quality of sleep and increased internet addiction. More than half (58.8%) of the subjects experience physical effects, such as eye strain, from prolonged screen time. Furthermore, 54% believe that screen time has an impact on their day to day activities and 66% are of the opinion that their daily activities are centered around social media influences. Finally, a significant majority (80%) of the participants feel that it is important to set goals to reduce their screen time.

The findings of the study are significant because they show a very strong association between poor sleep quality and internet addiction .A similar study done by Mohammad beigi A et al ( 11) showed that with increasing severity of internet addiction, there was an increase in total PSQI score, which was statistically significant. It was observed that with increasing severity of internet addiction, there was decreasing sleep quality, and changes in sleep latency were noted; in addition, there was a significant reduction in sleep with increasing degree of internet addiction, leading to increased usage of sleep medication and daytime dysfunction. Another study by Siroha M et al also reported that internet usage among young adults has become an alarming public health concern. Practicing caution in its use can help mitigate its negative impacts on both physical and psychological health. Healthy living requires maintaining a balance through participation in sports, education, culture, and other engaging activities.( 1) In a study conducted in the past by Mohapatra, D et al in Odisha Medical College, 60% of participants indicated poor sleep quality was due to prolonged bedtime smartphone usage. (3) There were few studies that indicated male gender to be one of the risk factors in smart phone addiction but our study had no such findings. (4) In a crosss sectional study by Jon D. Elhai et al excessive smart phone use is associated with depression and anxiety. This also was supported by our findings where study participants also reported increased anxiety as one of the symptoms of excessive smart phone usage. Korkeila J et all suggested that the IAT seems to tap some of the key domains of addiction, as in the single factor solution the items with the highest loadings imply neglect of other important activities and failure to control one's use of the Internet. Likewise, in the two-factor solution, “salient use” and “loss of control”, explained most of the variance in the total IAT. The use of IAT in our study is therefore significant. (9)

The current study states that while a majority of students are aware of the adverse effects of prolonged screen use on the physical, mental and emotional health, let alone affecting the quality of sleep there is a discrepancy between knowledge and practice. This gap between awareness and behavior highlights the need for more emphasis on adopting protective practices. Internet is a double edged sword and must be used carefully. Its use should be restricted at least inside classrooms, practical halls and skill labs to encourage thinking and avoid distraction. Also many life style modifications might be put to practice like yoga and meditation to improve the quality of sleep among the medical students. Promoting a balanced approach to internet usage and emphasizing the importance of healthy sleep habits is crucial for maintaining both physical and mental health. The teachers should identify the problem areas and encourage the use of paper and pen in taking down class notes or writing an assignment. Its high time we learn to address this issue before the addiction to internet ruins the mental and emotional faculties of the future doctors of the society.

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