BACKGROUND: The increase in the number of Internet users has increased Internet dependence worldwide. In adolescents, this dependence may interfere with sleep, which is important for the development of psychophysiological capabilities. However, few large-scale surveys have described the relationship between Internet addiction (IA) and sleep disturbance using standardized questionnaires. We conducted a survey in one prefecture in Japan to determine the relationship between sleep disturbance and IA in adolescents based on the categories of the Young Diagnostic Questionnaire (YDQ). METHODS: In 2016, high school students (N = 10,405, age range: 15-16 years) in all 54 daytime high schools in the selected prefecture were surveyed using a self-administered questionnaire. Participants with scores > 5.5 points on the Japanese version of the Pittsburgh Sleep Quality Index were defined as having a sleep disturbance. IA was evaluated using the YDQ: Participants with five to eight YDQ items present were classified as having IA; those with three or four items present were classified as "at risk of IA"; and those with two or less YDQ items were classified as "non-IA". Multiple logistic regression analysis was performed with sleep disturbance as the dependent variable, IA as the explanatory variable, and adjustments for eight other variables. RESULTS: High YDQ scores were associated with a high prevalence of sleep disturbance in boys and girls. These findings persisted after controlling for other factors in the multiple regression model. CONCLUSIONS: Among Japanese adolescents, there was a significant independent relationship between IA and sleep disturbance.