INTRODUCTION:

Prevalence estimates of insomnia among university students in the west are well documented, but robust population-based epidemiological data on insomnia in UAE populations are very scarce¹. Sleep difficulties are a common complaint among the general populations of western countries, with rates of self-reported insomnia ranging between 10% and 48%^2-4. Up to one-third of adults in the United Kingdom ⁵ and more than 60 million Americans⁶ are estimated to have some type of sleep problem. A Taiwanese study of community-dwelling elderly Chinese people aged 65 years or above revealed a low prevalence of 6% insomnia^7. A study of Chinese people aged 70 years or above, reported sleep disturbances and insomnia of 75% and 38.2% respectively⁸. Another study of middle-aged Chinese women reported that about 26% of the sample were poor sleepers⁹. Using structured questions, an earlier population-based study reported the overall prevalence of insomnia among Chinese people at 11.9%, with females being at higher risk for insomnia than males¹⁰. Insomnia is a major burden on society, in addition to deleterious effects on physical functioning¹¹, patients with sleep problems report greater use of general medical services¹².

In the United States, the direct costs of insomnia were estimated at $13.9 billion¹³. Chronic insomnia has also been associated with greater work absenteeism¹² and work-related accidents or injuries^3,14,15. There is a high level of psychiatric comorbidity with insomnia, compounding interference with daily activities. Insomnia is particularly symptomatic of depression and anxiety. Between 50 and 90% of subjects diagnosed with depression complain of poor sleep quality^16,17. While insomnia has been considered widely as a major factor affecting the course of depression, there are data suggesting that it is similarly a risk factor for the development of depression^18-22. Studies on sleep disorders related to diseases has revealed that adult Americans who experience night-time heartburn are more likely to have symptoms of sleep problems/disorders such as insomnia, sleep apnea, daytime sleepiness and restless legs syndrome than those who don’t have night-time heartburn. Several recent studies show links between shortened sleep duration, defined as less than six hours of sleep, and increased risk of heart disease. Interestingly, long sleepers with an average of nine or more hours, also showed a 38% increased risk of developing or dying from coronary heart disease and a 65% increased risk of stroke²³. A study also revealed that shorter sleep predicted worsening hypertension as for most people, blood pressure falls at night so it could be that with shorter sleep it's just not enough for that dip to take place. Good-quality sleep decreases the work of the heart, as blood pressure and heart rate go down at night. Lack of sleep can increase insulin resistance, a risk factor for the development of type II diabetes and heart disease²⁴. A study has revealed that among cancer patients with insomniaa warm foot bath was observed to be very effective on inducing sleep onset²⁵.

This paper reports the prevalence of insomnia among the UAE university students, through comparing components of everyday behavioral activities with their sleep patterns and overall sleep quality.

METHODS:

Sampling and procedures:

The study was conducted on 380 students of both genders with average aged of 24 years, from three different universities in the UAE. The response rate was 380 out of 400(95%). The questionnaire comprises 21 questions that cover sociodemographic data including gender, age, employment status, ethnicity, marital status, religion, weight status, associated diseases, medications taken on daily basis, smoking habit, drinking specific beverages, exercising habits, type of music and food preferred, sleeping experiences, room lightening condition, napping habits, activities done at night and before bed and finally rating sleep quality as generated by following the standard Pittsburgh Sleep Quality Index (PSQI).

Statistical analyses:

Statistical analyses were performed on collected data, using the Statistical Package for the Social Sciences (SPSS) software version 20.0, to determine sample characteristics. All questions were coded and then they were imported to the SPSS for analysis. All variables categories were coded with numbers. For example, question with the answer (yes) was coded as (1); and (no) as (0). The items were checked for accuracy by examining unusual coding values by independent person. Descriptive analysis was used to analyze the socio-demographic and PSQI data. The descriptive statistics included mean, median, frequency and standard deviation. The correlation analysis was performed using Pearson and Spearman correlation tests. Results were presented as numbers with percentages for categorical variables. P≤0.05 was considered as significant while P≥0.05 as not significant.

RESULT:

The sample sociodemographic profile is presented in Table 1. Of the 380 respondents, the average age was 24years. 76.3% of respondents were in the youngest age group (17–21) years. 51.3% of the sample were females and 48.7% males. 82.1% were Arabs and 95.5% were Muslims. Most students (93.2%) were singles and those with a part time job were 8.4%.

Table 1. Socio-demographic data of all respondents

Socio-demographic term

Frequency

Percentage

Age:

(17-21) years

(22-31) years

Gender:

Female

Male

Employment status:

Unemployed

(with part time job)

Ethnicity:

Arab

Asian

African

European

Others

Religion:

Muslim

Christian

Hindu

Others

Marital Status:

Single

Engaged

Married

Divorced

290

195

185

348

312

363

354

76.3%

23.7%

51.3%

48.7%

91.6%

8.4%

82.1%

10.5%

5.5%

0.3%

1.6%

95.5%

2.4%

0.8%

1.3%

93.2%

3.9%

2.4%

0.3%

The resultant prevalence of insomnia among the students was assessed by three criteria. These are time to fall asleep (Table 2), quality of sleep (Table 3) and respondents with and without problem sleeping (Table 4).

Table 2. Time to fall asleep

Time to fall asleep	Males		Females
Time to fall asleep	Frequency	%	Frequency	%
Right away	18	9.7%	11	5.6%
Within a few minutes	81	43.8%	73	37.4%
30 min-1 hour	64	34.6%	79	40.5%
> 1 hour	22	11.9%	32	16.4%

Table 3. Quality of sleep

Quality of sleep	Males		Females
Quality of sleep	Frequency	%	Frequency	%
Very good	29	15.7%	27	13.8%
Fairly good	57	30.8%	53	27.2%
Neutral	58	31.4%	73	37.4%
Fairly bad	36	19.5%	38	19.5%
Very bad	5	2.6%	4	2.1%

Table 4. Respondents with and without problem sleeping

Respondents	Males		Females
Respondents	Frequency	%	Frequency	%
With problem sleeping	59	31.9%	85	43.6%
Without problem sleeping	126	68.1%	110	56.4%

With respect to time to fall asleep, 51.8% of respondents needs ≥30 minutes to fall asleep, 29.2% of them were females and 22.6% males (Table 2). Concerning quality of sleep, both gender scored almost identical figures of 19.5% and 2% for fairly and bad quality of sleep respectively (Table 3). With respect to problem sleeping, 37.9% of respondents were having problem sleeping, 22.4% of them females and 15.5% males (Table 4). The two criteria of the prevalence of insomnia, namely time to fall asleep (Table 2) and respondents with and without problem sleeping (Table 4) were both higher in females compared to males.

Table 5 presents the health and lifestyle characteristics of the respondents.

Table 5. Health and lifestyle characteristics of the respondents

Term

Frequency

Percentage

Weight:

Underweight

Normal

Overweight

Obese

Diseases:

Allergic Rhinitis Asthma

Sinusitis Nose Polyps

Hypertension Hyperthyroidism

Cardiac Diseases Hypothyroidism

Diabetes

Cancer COPD

Others

Smoking: Take medications daily:

Drinks:

Tea

Coffee

Soft Drinks Home Squeezed Juice Packaged Juice Energy Drinks

Alcohol

Other Herbal Drinks

Exercise:

Never Once Daily Once a\ Week

Several Time a week Every now and then

Music:

Pop

Classical

Rock

Jazz

Opera

Rap

Other

Type of Food:

Spicy

Fatty Sweet and Sour

Sweets and Confectionary

Others

235

239

187

155

103

120

130

174

167

101

8.4%

61.8%

26.1%

3.4%

5.5%

4.5%

1.6%

1.3%

1.1%

0.8%

0.5%

0.3%

3.2%

16.8%

15.5%

62.9%

49.2%

40.8%

27.1%

31.6%

19.2%

3.9%

2.4%

17.4%

10.5%

14.7%

23.2%

34.2%

45.8%

43.9%

25.3%

14.2%

5.8%

4.7%

18.2%

26.6%

19.5%

13.4%

13.9%

A high percentage of respondents (61.8%) had normal body weight which is reflected in the low level of health problems ranging from 5.5% for allergic rhinitis to 0.3% COPD (Table.5). The majority comprised non-smokers (83.2%) and non-alcoholic consumers (96.1%). Stimulants like tea (62.9%) and coffee (49.9%) were the most popular consumed drinks. About 82.6% exercised in one way or another, while 17.4% had never engaged in exercise (Table.5). Pop music (45.8%) was more popular than rap (4.7%). With respect to food, spicy and fatty food seemed to be preferred over other types of food (Table.5).

The percentage of respondents having sleep disorders is shown in Fig 1. 23.4% and 22.6% of the respondents were having nightmares and falling experience respectively, while 10.8% of them experienced sleep-talk.

Fig 1. The percentage of students having sleep disorders

The results identified some significant relations between some sleep disorders and behavior or diseases. Nightmares had a significant relation with listening to rap music (p<0.031), playing with cell phone or tablet before sleeping (p<0.023), drinking tea and coffee (p <0.004), energy drinks (p<0.034), take a medicine to promote sleeping (p<0.017), as well as allergic rhinitis (p <0.009). Whereas falling experience had a significant relation with listening to pop music (p<0.018), playing with cell phone or tablet before sleeping (p<0.009) and diseases like hypothyroidism (p<0.009) and diabetes (p <0.009). On the other hand, spinning room experience had a significant relation with cardiac diseases (p <0.019), take a medicine to promote sleeping (p<0.003), hyperthyroidism (p<0.009) and listening to rap music (p <0.015). The results also identified that sleep-walk had a significant relation with listening to rock music (p <0.050), and rap music before bed (p<0.035). Whereas sleep-talk had a significant relation with asthma (p <0.048), and hypertension (p<0.034).

DISCUSSION:

The resultant estimate of insomnia as assessed by three criteria that comprise, time to fall asleep, quality of sleep and respondents with and without problem sleeping, indicated that insomnia was highly prevalent among university students in the United Arab Emirates. Similar studies^26-28 have revealed comparable prevalence estimates of insomnia, where analysis of sleep perception revealed that 67.2% of students suffered from poor sleep²⁶. Similar studies done in Taiwan, USA and Iran, showed that most college students suffer from sleep disturbances. However, factors chosen did not show any significance to establish a connection leading to the poor sleep quality^27-29. Our results also revealed significant gender difference, with respect to time to fall asleep and problem sleeping. These results had been supported by a number of studies^30-33, where women reported more sleep disturbances than men. The present results identified some significant relations between some sleep disorders and behavior or diseases. These results indicated that nightmares had significant relations with listening to rap music, playing with cell phone or tablet before sleeping, drinking tea, coffee, energy drinks, take a medicine to promote sleeping, as well as allergic rhinitis. Although several studies showed that listening to music, especially classic and soft music improves sleep quality in students and elders^34-36, but the present results revealed significant relations between listening to rap, pop and rock music and nightmares, spinning room and falling experiences as well as sleep-walk. Comparable findings showed that listening to heavy metal music lead to greater levels of anxiety, when respondents are exposed to stress³⁶. In addition, a study had shown that listening to any music before sleeping might lead to poor quality of sleeping³⁷. The relationship between sleeping disorders and playing with cell phones or tablets before sleeping, generally agreed with a study, which had shown that technology greatly influences sleep duration and daytime functioning³⁷. We also observed that drinking stimulants like tea, coffee and energy drinks had significant relation with nightmares. These observations agreed with a number of studies ^39-41. Contrary to our findings, a number of studies have shown that consuming stimulants did not seem to have an influence on sleep quality²⁵. Although nightmares may be attributed to the side effects of certain drugs like amphetamines, antidepressants, and stimulants like cocaine and caffeine, blood pressure medications and levodopa^42-44, but comparable to our findings, certain studies have revealed that even medicines taken to promote sleeping may trigger nightmares and sleep walk ^45,46. Although, no study revealed a direct relationship between nightmares and allergic rhinitis, but certain findings revealed the coexistence of a relation between nightmares and certain drugs like montelukast used to inhibit bronchoconstriction associated with allergic rhinitis⁴⁷.

Although hypothyroidism had been associated with sleep apnea and sleep disorders⁴⁷, but no study had explicitly stated a direct relationship between falling experience and hypothyroidism. A number of studies revealed that having diabetes increases the risk of sleep disorders, such as sleep apnea and restless leg syndrome and that both high and low blood glucose levels can disrupt sleep ⁴⁸, but none of them had studied the relationship between falling experience and diabetes. The observed relationship between spinning room experience and cardiac diseases, may be attributed to sleep apnea that is associated with high blood pressure, arrhythmia, stroke and heart failure⁴⁹. Several studies showed links between shortened sleep duration and increased risk of heart disease^23,50,51. It was observed that hyperthyroidism may lead to insomnia, anxiety, or disrupted sleep patterns^{52, 53}. A study had reported that some patients started to sleep walk at the time when their hyperthyroidism was diagnosed⁵⁴, but no study had revealed any sort of relationship between spinning room experience and hyperthyroidism. Our results identified significant relationships between certain diseases, such as asthma, hypertension and sinusitis and sleep-talk. Number of studies revealed that asthma might increase the risk for sleep apnea^55-58. Sleep talking often occurs concurrently with other sleep disorders such sleep apnea. Although sleep apnea was observed to increase the risk of hypertension⁵⁹, but no study had been conducted to observe the relationship between hypertension and sleep walk.

LIMITATION:

Our study was limited by its cross-sectional design, which did not allow determination of the time course, and hence we could not infer the causes between insomnia and associated factors. Although, the study findings shed light on the unidirectional relations of insomnia to sociodemographic and psychosocial variables, but the extent to which these variables interact with insomnia in influencing quality of life outcomes is unclear. In addition, our sample size was not high enough to reflect the full extent of prevalence of insomnia among student’s population in the UAE.

CONCLUSION:

The present results suggested that insomnia is highly prevalent among university students of both genders in UAE and is somewhat more prominent in females. They also indicated significant relations between some sleep disorders and behavior or diseases.

CONFLICT OF INTEREST:

The authors report no conflict of interest. The authors alone are responsible for the contents of this article.

ACKNOWLEDGMENTS:

We are really grateful and thankful to all students, who have participated in this study.

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Received on 25.10.2021 Modified on 03.01.2022

Research J. Pharm. and Tech. 2022; 15(8):3401-3406.

DOI: 10.52711/0974-360X.2022.00569