Studies have shown that people who are fasting sleep for around an hour and a half less than usual. Picture for illustrative purposes only. Image Credit: Shutterstock

Abu Dhabi: Ramadan is a month of worship and togetherness, yet its nightly prayers and predawn meals can send the worshipper’s sleep habits into a tailspin.

Studies have shown that people who are fasting sleep for around an hour and a half less than usual. The quality of sleep can also suffer as it is spread out into smaller chunks over a 24-hour period. Doctors have therefore advised residents to set up a workable sleep schedule during the month, and to ensure they get at least four hours of uninterrupted sleep at night.

Importance of sleep

Dr Sobia Farooq

“Sleep is a vital part of keeping healthy that allows the body to recharge and recover. A lack of sleep can affect a person’s mood as well as their physical health, including weight gain to an increased risk of heart disease or even diabetes,” said Dr Sobia Farooq, pulmonologist at Cleveland Clinic Abu Dhabi. On average, an adult needs between seven-and-a-half to eight hours of sleep every night, whereas children aged six to 12 hours need between nine and 12 hours of sleep daily.

Dr Muhammed Anas Ayoob

Dr Muhammed Anas Ayoob, pulmonary disease specialist at NMC Specialist Hospital, said many worshippers face acute lack of sleep during the night, which contributes to drowsiness, sleepiness and mood swings during the day. “Studies have shown a sudden and significant delay in bedtime and wake-up time in participants observing Ramadan when compared to other months. In addition, the percentage of subjects who wake up after 12 noon is significantly higher in the third week of Ramadan, and daytime sleepiness is significantly higher. Finally, the percentage of students who said they fell asleep accidentally in class increased significantly from 15 per cent before Ramadan to 36 per cent in Ramadan,” Dr Ayoob.

Such sleep loss can contribute to acute symptoms like mood swings, joint pain, and drowsiness. “Drowsiness can interfere with cognitive function, harm memory, cause personality changes, and even depression. Drowsy driving has been shown to be more dangerous than driving under the influence of alcohol,” Dr Farooq warned.

Risks of sleep deprivation

Doctors warned that accumulated sleep loss and sleep deprivation has many more harmful repercussions, including increased risk of obesity, diabetes and heart disease. And in the UAE, prioritising sleep is especially important, given the high prevalence of sleep disorders like insomnia and obstructive sleep apnoea.

Sleep apnoea

Dr Sawsan Humaida

According to Dr Sawsan Humaida, internal medicine specialist at Bareen International Hospital, sleep apnoea is aggravated by daytime drowsiness, which increases during Ramadan. Unlike in many other countries however, the UAE has special provisions in place to ensure the health and well-being of worshippers. Chief among them is the reduction in working and school hours mandated by the government. “It is advised that each individual has sufficient sleep according to their physical needs. While sleep hours during the night may decrease as Muslims observe the prayers, worshippers can make up the reduced hours during the day to avoid a detrimental impact on health, and this is where the reduced working hours in the UAE are especially beneficial,” Dr Humaida said.

As long as worshippers make up lost sleep later in the day or during the subsequent day, they can prevent the harmful effects of sleep deprivation.

Set a routine

“Planning for the sleep disruptions people can experience during Ramadan can be very helpful to help introduce a new routine, especially as routine is an important part of healthy sleep. Find a solution that works for you and try to stick to it,” Dr Farooq advised.

Dr Ayoob said people should aim for at least one long block of fours of sleep at night, ideally before waking up for Suhoor, and then get a few more hours after the dawn prayer before waking up for the day.

Take power naps

Dr Farooq also recommended taking naps whenever possible. “Naps can be a fantastic way to catch up on a bit of sleep and help people feel more energised. However, it is important that people regulate their naps properly to get the benefit. I recommend people limit their naps to 20 minutes by setting an alarm, as sleeping for longer than this can be counterproductive and lead to feeling more tired and groggy than before,” she said.

As always, diet and physical activity play a vital role in ensuring sleep quality.

Eat right

“People should avoid heavy meals rich in saturated fat and carbohydrates in the period before sleep. This will assist in better digestion before and during sleep. Moderate to high physical activity is also very effective in ensuring sleep quality,” Dr Humaida said.

Eating right is critical to maintain a healthy sleep cycle during Ramadan. Picture for illustrative purposes only. Image Credit: Supplied

Unfortunately, many people opt for heavy, calorie-laden and sugar-rich diet during Ramadan. “These food types will significantly disrupt the quality of your sleep, as your body will be working to digest them when it needs to be resting. Similarly, very spicy food can cause heartburn, which leads to disruptive sleep,” Dr Ayoob said.

Fasting children

Parents should also ensure that children and young adults get the required amount of sleep. “It can be hard to get teens to sleep, particularly during the festive atmosphere we enjoy during Ramadan. One great but difficult tip is to try and limit screen time before bed as blue light can interfere with healthy sleep,” Dr Farooq recommended.

Sleep apnoea

Patients with sleep apnoea should take special care to get enough, good-quality sleep as well. The disease is common worldwide because of the obesity epidemic. “In 2016, the obesity prevalence in the UAE amounted to 29.9 per cent in the adult population. In addition, a study of 1,214 consecutive patients presenting to a primary health care clinic in Dubai, found that 20.9 per cent were at high risk for the condition,” Dr Farooq said.

“In Ramadan if we are not careful, further weight gain can be an issue. Additionally, patients with sleep apnoea, tend to ignore their treatment due to interrupted sleep. The same tips and suggestions would apply to them for good sleep as to other patients. I also recommend patients use their CPAP every time they sleep. Getting four hours of CPAP usage helps improve the quality of sleep and can be refreshing,” she added.

Recommendations for daytime napping

Anytime we fall asleep, we begin to move through a series of sleep stages.

Dr Ayoob said researchers found that five-minute naps are too short to move deep enough through sleep stages to produce a notable benefit. On the other hand, sleeping for 30 minutes or longer gives the body enough time to enter deep (slow-wave) sleep, but napping for too long or waking up from slow-wave sleep can leave you feeling groggy for up to an hour, in a phenomenon known as sleep inertia.

Tips for healthy sleep
* Right environment: Make sure that your bedroom is comfortable, cool, quiet, and dark. Blackout curtains and earplugs can help prevent light and noise from affecting your sleep.
* Scents: There is evidence that scents can affect your sleep. Lavender has been shown to decrease heart rate and blood pressure, making you feel more relaxed and ready for sleep. Try using a scented candle, essential oil or potpourri to give your bedroom a relaxing fragrance that will help you sleep (provided there is no sensitivity towards fragrances and breathing difficulties)
* Exclusive bedroom use: Avoid using your bedroom for activities other than sleeping. Watching television, eating, working, or using your computer in the bedroom can be distracting and keep you awake.
* Relaxing activity: If you can’t fall asleep in 20 minutes, try leaving your bedroom and finding a relaxing activity until you feel tired.
* Power naps only: Try to avoid taking naps which are longer than 20-30 minutes in the daytime unless you’re extremely tired. A 20-minute power nap in the afternoon can revive flagging energy and focus levels. Set an alarm as oversleeping can make you feel groggy and even sleepier than before your nap.
* Regular exercise: This contributes to a good night’s sleep. It helps tire out the body and relax the mind. However, exercising too soon before bed can have the opposite effect. It’s best to exercise earlier in the day, and not within 4 hours of your bedtime.
* Right diet: Avoid eating heavy, fatty or sugary foods at Iftar — your sleep can be disrupted as your bodywork overtime to digest your meal. Focus on healthy foods at Suhoor that will provide slow release energy throughout the day such as wholegrains and protein. Avoid anything too sugary such as jam as it can interfere with sleep in the short term and can make you feel more tired later on.
* Avoid caffeine: Try to avoid caffeine as much as possible, particularly in the hours before you plan to sleep.
* Sleep routine: Try planning an adjusted sleep routine for Ramadan so that you’re sleeping and waking at around the same time every day. This will help your body get into a rhythm for more restful sleep.
* Device use: As much as possible, avoid using electronic devices such as your mobile phone, laptop and TV close to bedtime as studies suggest that the blue light from screens can interfere with quality sleep.
* Sleep apnoea tip: Use your CPAP machine every time you sleep. Getting four hours of CPAP usage helps improve the quality of sleep and can be refreshing.

“Given these considerations, the best nap length in most situations is one that is long enough to be refreshing but not so long that sleep inertia occurs. Naps lasting 10 to 20 minutes are considered the ideal length. They are sometimes referred to as “power naps” because they provide recovery benefits without leaving the napper feeling sleepy afterward,” the doctor explained.

Healthy sleep habits help lower risk of heart failure
Anytime we fall asleep, we begin to move through a series of sleep stages. Image Credit: Shutterstock

Naps also play a special role for drivers and shift workers. Driving while drowsy is dangerous for you, your passengers, and others on the road. So if you start to feel sleepy while driving, drinking caffeine and pulling over safely for a 20-minute nap can help. However, this is not a long-term solution, as naps and caffeine are known to increase alertness for only a short period of time. On the other hand, planned napping improves alertness and reaction time in shift workers.

Finally, Dr Ayoob said naps should be taken earlier in the day. “Napping late in the day can affect your ability to fall asleep at bedtime. Try napping around the halfway point between the time you wake up and the time you plan to go to bed, and opt for a sleep-friendly environment,” he advised.

Sleep deprivation in UAE

Sleep deprivation is a common phenomenon in UAE. “The importance of night time sleep is underappreciated as nightlife is more active given the hot climate. But sleep deprivation is a rising epidemic, and a sleep survey conducted among 4,672 respondents in the UAE in 2018 found that 90 per cent of people are not getting the perfect rest,” Dr Farooq said.

In the survey, the majority of participants — 46.42 per cent — reported sleeping only for seven hours a night, while 32.42 per cent averaged only six hours and 1.76 per cent are only able to sleep for four hours per night.

Device overuse

“Poor sleep is strongly correlated with smart-device overuse, which has increased considerably across the Middle East. In fact, 47.5 per cent of people surveyed in three cities in the UAE reported being heavy users of smart-devices. In addition, 74.5 per cent used their smart-device at bedtime and 81 per cent were reported to be poor sleepers,” the doctor added.

Sleep disorders

Sleep deprivation can also be brought about in ways other than smart device overuse. The most commonly known ones are sleep disorders like insomnia, as well as obesity-related conditions like obstructive sleep apnoea.

“One study conducted at a primary health care centre in Dubai showed the sleep apnoea incidence in males is 22 per cent and 19 per cent in females. Another study in Sharjah reported 34 per cent of the study population reported to be snorers, and 43 per cent of snorers were at high risk of sleep apnoea,” Dr Ayoob said.

Other contributors

A person with sleep apnoea can also contribute to a partner’s sleep deprivation because of the snoring associated with the condition.

Other factors that lead to sleep deprivation include stress, poor sleep hygiene, an inconducive sleep environment, certain medications, shift work, and certain medical conditions like acid reflux and depression, and pregnancy.