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Fear of being out of mobile phone contact -- known as (no mobile phone phobia) -- was extremely common among college students and was tied to poor sleep health, a preliminary study suggested.

Nine out of 10 university students had moderate or severe nomophobia, which was linked to greater daytime sleepiness, avolition, and poorer sleep hygiene, said Jennifer Peszka, PhD, of Hendrix College in Conway, Arkansas, at the virtual SLEEP 2020, a joint meeting of the American Academy of Sleep Medicine (AASM) and the Sleep Research Society.

Severity of nomophobia was correlated with severity of maladaptive sleep hygiene behaviors, Peszka reported.

Previously, active phone use at bedtime was linked with disrupted sleep and a good recommendation to improve sleep was to limit phone use before and during bedtime, she noted.

"However, for those with the characteristic of nomophobia -- the fear of not having one's mobile phone -- this recommendation could exacerbate anxiety at and around bedtime, and disrupt rather than improve sleep," Peszka said in an online presentation.

"In 2012, 77% of 18-to-24-year-olds were classified as nomophobic," she added. "We found that 89.4% of college-age students fit these criteria. Because our study suggests a connection between nomophobia and poor sleep, it's interesting to consider if nomophobia severity is increasing, and the implications of that increase."

In the study, Peszka and colleagues recruited 327 university students with a mean age of 19.7 from introductory psychology courses and campus newsletters. Participants provided demographic information, completed the (NMP-Q), the (ESS), the , the , and answered questions about features associated with sleep hygiene.

In total, 82.7% of students were classified as having moderate nomophobia, 6.7% had severe nomophobia, 10.3% had mild nomophobia, and only one participant (0.3%) reported no nomophobia at all.

Greater severity of nomophobia was related to greater daytime sleepiness on the ESS (r=0.150, P<0.05). It was linked to features associated with poor sleep on other scales (daytime sleepiness r=0.097, P<0.05; avolition r=0.100, P<0.05).

Nomophobia severity also was tied to more maladaptive sleep hygiene behaviors including active technology use during sleep time (r=0.249, P<0.05), long daytime naps, inconsistent wake and bed times, using bed for non-sleep purposes, uncomfortable bed, and bedtime cognitive rumination (r=0.097 to 0.182).

"Because nomophobia is one subset of anxiety, it was not surprising that individuals with greater nomophobia were also more likely to engage in anxiety-related cognitive rumination, like thinking, planning, or worrying while in bed," Peszka said.

"This important study needs to be replicated, and in the meantime, ways to figure out how to best address nomophobia are important to help address adverse health outcomes," noted AASM president Kannan Ramar, MD, of the Mayo Clinic in Rochester, Minnesota.

"The recommendation to curtail bedtime phone use, which is meant to improve sleep and seems rather straightforward, might need adjustment or consideration for these individuals," Peszka suggested.

"Rather than recommending exiling the phone from the bedroom for those with nomophobia, interventions may instead focus on curtailing active phone use in and around sleep time through the use of timers, caller dates, and reminder applications," she said.

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