Sleep Hygiene During Ramadan (SHIR)

June 10, 2026 updated by: Kais Elabed, The Higher Institute of Sport and Physical Education of Sfax

Effects of a Culturally Adapted Sleep Hygiene Intervention on Sleep, Vigilance, and Physical Performance During Ramadan in Male Sports Science Students: A Randomized Controlled Trial

Ramadan fasting often disrupts sleep patterns, which can affect alertness and physical performance in student-athletes. This study tested whether a brief sleep education program designed for Ramadan could help improve sleep quality and maintain performance.

Sixty-four male sport-science students who planned to fast during Ramadan were randomly assigned to one of two groups. The first group received a 45-minute educational session about sleep hygiene specifically adapted to Ramadan practices (timing of sleep around evening and pre-dawn meals, managing light exposure, limiting caffeine and screen time before bed). They also received weekly text message reminders and completed short weekly checklists about their sleep habits. The second group continued their usual routines without any intervention.

Participants wore activity monitors on their wrist to track sleep throughout the study. They also completed computerized tests of attention and reaction time, as well as physical performance tests (jumping, handgrip strength, agility) before Ramadan and during the final week of fasting.

The researchers found that students who received the sleep education maintained better sleep duration and quality during Ramadan compared to those who did not receive the program. They also showed better attention, faster reaction times, and better preservation of physical performance. This suggests that simple, culturally-adapted sleep education can help student-athletes maintain their health and performance during Ramadan.

Study Overview

Status

Completed

Conditions

Intervention / Treatment

Detailed Description

This pilot randomized controlled trial investigated the effects of a culturally adapted sleep hygiene education program on objectively measured sleep, psychomotor vigilance, and physical performance during Ramadan in male sport-science students.

STUDY DESIGN AND PARTICIPANTS:

Sixty-four male sport-science students (aged 18-30 years) from the Higher Institute of Sport and Physical Education of Sfax, Tunisia, who intended to observe Ramadan fasting, were randomly allocated to either an intervention group (n=32) or a control group (n=32). Randomization was performed using computer-generated block randomization with allocation concealment via sealed envelopes.

INTERVENTION:

Participants in the intervention group received a single 45-minute educational session during the week preceding Ramadan. The session addressed sleep hygiene strategies specifically adapted to Ramadan constraints, including: (1) maintaining consistent sleep schedules compatible with suhoor (pre-dawn meal) and iftar (evening meal) timing, (2) managing evening light exposure and screen use, (3) regulating caffeine intake, (4) optimizing the sleep environment, and (5) planning sleep consolidation strategies. Participants received written educational materials and weekly text message reminders (Monday and Thursday) throughout Ramadan. Adherence was monitored using weekly self-report checklists returned each Saturday. The control group received no intervention and maintained their usual daily habits.

OUTCOME MEASURES:

Primary outcomes were sleep parameters assessed continuously using wrist actigraphy (ActiGraph wGT3X-BT) from baseline (approximately 2 weeks before Ramadan) through week 4 of Ramadan. Derived parameters included total sleep time, sleep efficiency, and wake after sleep onset (WASO). A minimum of 5 valid nights was required for analysis.

Secondary outcomes assessed at baseline and Ramadan week 4 included:

  • Psychomotor vigilance: 10-minute Psychomotor Vigilance Test (PVT) measuring mean reaction time and number of lapses (reaction times >500 ms)
  • Neuromuscular performance: countermovement jump (CMJ), squat jump (SJ), handgrip strength, and agility (change-of-direction test)

COVARIATES:

Baseline values of all outcome variables were included as covariates. Additional covariates assessed at baseline included chronotype (reduced Morningness-Eveningness Questionnaire), daily caffeine intake (cups/day), and evening screen exposure (minutes in the last hour before bedtime).

STATISTICAL ANALYSIS:

Changes in sleep parameters were analyzed using linear mixed-effects models with group, time, and group × time interaction as fixed effects, and participant as a random effect. Baseline values were included as covariates. For cognitive and physical performance outcomes at week 4, analysis of covariance (ANCOVA) was used with group as the fixed factor and baseline values as covariates. Effect sizes were reported as partial eta squared (η²p) for ANCOVA models and Hedges' g for adjusted between-group comparisons. Statistical significance was set at p < 0.05.

STUDY PERIOD:

Data collection occurred from February 10, 2025 (baseline) to March 31, 2025 (end of Ramadan 1446 AH, corresponding to March 1-30, 2025 in Tunisia).

ETHICAL CONSIDERATIONS:

The study was conducted in accordance with the Declaration of Helsinki. Written informed consent was obtained from all participants. The protocol was reviewed by the Institutional Scientific Committee of ISSEPS Sfax and determined to be exempt from formal external ethics committee review under Tunisian regulations governing minimal-risk behavioral research.

This trial was registered retrospectively at ClinicalTrials.gov.

Study Type

Interventional

Enrollment (Actual)

64

Phase

  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

  • Tunisia
    • Sfax Governorate
      • Sfax, Sfax Governorate, Tunisia, 3000
        • Higher Institute of Sport and Physical Education of Sfax (ISSEP Sfax)

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

  • Adult

Accepts Healthy Volunteers

Yes

Description

Inclusion Criteria:

  • Male sports science students aged 18 to 30 years
  • Intend to fast for the full duration of Ramadan
  • No history of diagnosed sleep disorders or medical conditions affecting sleep or cognition
  • Free from musculoskeletal injuries that could limit physical performance tests

Exclusion Criteria:

  • Chronic sleep disorders (e.g., insomnia, obstructive sleep apnea)
  • Use of medications known to affect sleep or alertness
  • Failure to complete the Ramadan fasting period
  • Non-compliance with actigraphy monitoring procedures

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Other
  • Allocation: Randomized
  • Interventional Model: Parallel Assignment
  • Masking: Double

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Experimental: Experimental Group (Sleep Hygiene Education)
Participants receive a single 45-minute culturally adapted sleep hygiene education session prior to Ramadan, followed by written materials, weekly adherence checklists, and bi-weekly SMS reminders throughout Ramadan.
Behavioral: Culturally Adapted Sleep Hygiene Education Program
A structured educational session addressing sleep scheduling relative to suhoor/iftar, evening light and screen exposure management, caffeine intake regulation, and sleep environment optimization. Delivered as a single 45-minute session before Ramadan, supplemented with written guidelines, weekly self-report checklists, and bi-weekly SMS reminders.
No Intervention: Control Group
Participants receive no sleep hygiene education or reminders and are instructed to maintain their usual daily routines and sleep habits throughout the Ramadan period.

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Total Sleep Time
Time Frame: Baseline and Ramadan week 4
Total sleep time in minutes per night, assessed continuously using wrist actigraphy (ActiGraph wGT3X-BT) from baseline (approximately 2 weeks before Ramadan) through week 4 of Ramadan. A minimum of 5 valid nights required for analysis at each time point.
Baseline and Ramadan week 4
Sleep Efficiency
Time Frame: Baseline and Ramadan week 4
Sleep efficiency percentage (ratio of total sleep time to time in bed × 100), assessed continuously using wrist actigraphy (ActiGraph wGT3X-BT) from baseline through week 4 of Ramadan. A minimum of 5 valid nights required for analysis at each time point.
Baseline and Ramadan week 4
Wake After Sleep Onset (WASO)
Time Frame: Baseline and Ramadan week 4
Wake after sleep onset in minutes per night, assessed continuously using wrist actigraphy (ActiGraph wGT3X-BT) from baseline through week 4 of Ramadan. A minimum of 5 valid nights required for analysis at each time point.
Baseline and Ramadan week 4

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Psychomotor Vigilance - Lapses
Time Frame: Baseline and Ramadan week 4
Number of lapses (reaction times ≥500 milliseconds) on the 10-minute Psychomotor Vigilance Test (PVT), assessed at baseline and Ramadan week 4.
Baseline and Ramadan week 4
Countermovement Jump Height
Time Frame: Baseline and Ramadan week 4
Lower-limb explosive power assessed by countermovement jump (CMJ) height in centimeters. Best performance of 3 maximal trials retained for analysis.
Baseline and Ramadan week 4
Squat Jump Height
Time Frame: Baseline and Ramadan week 4
Lower-limb explosive power assessed by squat jump (SJ) height in centimeters. Best performance of 3 maximal trials retained for analysis.
Baseline and Ramadan week 4
Handgrip Strength
Time Frame: Baseline and Ramadan week 4
Maximal handgrip strength in kilograms measured using a handgrip dynamometer. Best performance of 3 maximal contractions with dominant hand retained for analysis.
Baseline and Ramadan week 4
Agility Performance
Time Frame: Baseline and Ramadan week 4
Change-of-direction agility test performance time in seconds. Best performance of 2 trials retained for analysis.
Baseline and Ramadan week 4
Psychomotor Vigilance - Mean Reaction Time
Time Frame: Baseline and Ramadan week 4
Mean reaction time in milliseconds on the 10-minute Psychomotor Vigilance Test (PVT), assessed at baseline and Ramadan week 4 under standardized conditions.
Baseline and Ramadan week 4

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

The Higher Institute of Sport and Physical Education of Sfax

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

February 10, 2025

Primary Completion (Actual)

March 30, 2025

Study Completion (Actual)

March 31, 2025

Study Registration Dates

First Submitted

June 5, 2026

First Submitted That Met QC Criteria

June 5, 2026

First Posted (Actual)

June 10, 2026

Study Record Updates

Last Update Posted (Actual)

June 12, 2026

Last Update Submitted That Met QC Criteria

June 10, 2026

Last Verified

June 1, 2026

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • ISSEPS_SleepRamadan_2025

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

YES

IPD Plan Description

De-identified participant data will be made available. This includes demographic and anthropometric data, objective sleep outcomes derived from actigraphy (total sleep time, sleep efficiency, wake after sleep onset), psychomotor vigilance test (PVT) results (mean reaction time, lapses), and physical performance test results (countermovement jump, squat jump, handgrip strength, and agility).

IPD Sharing Time Frame

Data will be available within 3 months following the publication of the results in a peer-reviewed journal and will remain available for 5 years.

IPD Sharing Access Criteria

Data can be requested by researchers with a specific, scientifically sound research proposal. Requests should be submitted via email to the corresponding author (kais.elabed@gmail.com). A data use agreement may be required prior to sharing.

IPD Sharing Supporting Information Type

  • STUDY_PROTOCOL
  • SAP
  • ICF

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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