The Impact of Ramadan Fasting on Sleep and Treatment Compliance in Psychiatric Patients: A Survey Study.

  • Marwa Ben Mbarek Fattouma Bourguiba Hospital of Monastir
  • Badii Amamou Fattouma Bourguiba Hospital of Monastir
  • Amjed Ben Haouala Fattouma Bourguiba Hospital of Monastir
  • Ahmed Mhalla Fattouma Bourguiba Hospital of Monastir
  • Leila Gassab Fattouma Bourguiba Hospital of Monastir
  • Ferid Zaafrane Fattouma Bourguiba Hospital of Monastir
Keywords: Fasting, Ramadan, Sleep duration, Chrono-biological rhythms, Psychiatry


Background: During Ramadan, fasting is a duty for all healthy adult Muslims. During this month, there is a major and abrupt break in chrono-biological rhythms, sleep duration and timing, and the activity/rest cycle.

Aims: This study aims to explore the impact of the month of Ramadan, with its various biological, behavioral, and social repercussions, on mental health in Tunisian psychiatric patients who may or may not be fasting.

Objective: To determine the impact of the month of Ramadan on sleep and treatment compliance in psychiatric patients.

Methods: This was a survey study of all patients under follow-up at the Monastir psychiatric outpatient department for mental disorders, with two measurements during and after the month of Ramadan in 2019 (i.e., from May 05 to June 04, 2019, the number of hours of fasting in Tunisia was between 15h 43 min and 16 h 36 min). The data was analyzed in 2020.

Results: After studying 107 survey responses twice, during and after Ramadan, this study shows that sleep quality was significantly impaired during Ramadan for both fasters and non-fasters. There was also a significant difference between Ramadan and post-Ramadan in terms of treatment compliance; hence, adherence to treatment in the study population depended on the Ramadan effect and not the Fasting effect.

Conclusion: This study showed that sleep quality assessed by the ISI insomnia scale was significantly impaired during the month of Ramadan for both fasting and non-fasting subjects. Also, adherence to treatment in the study population depended on the Ramadan effect and not the fasting effect.


Centre national de ressources textuelles et lexicales [National Center for Textual and Lexical Resources]. (n.d.). Retrieved fromûne.

Tabib GEM, Métaboliques M, Mohammed CHU, Marrakech VI. Thérapie par le jeûne et métabolisme métabolisme: procédures métaboliques: constats [Fasting therapy and metabolism: metabolic procedures: findings], 2018, 1, 82-85.

Masmoudi J, Trabelsi S, Elleuch E, Jaoua A. Les troubles des conduites alimentaires

Pendant et en dehors du Ramadan [Eating disorders during and outside Ramadan]. J Ther Comport Cogn, 2008, 18, 26-31.

Marc Y, Le C. Le jeûne dans la santé et pendant la maladie [Fasting in health and illness], 2018, 14, 1128-1132.

Eddahby S, Kadr, N, Moussaou, D. Ramadan and bipolar disorder: Example of circadian rhythm disturbance and its impact on patients with bipolar disorders. Encephale, 2013, 39, 306-312.

Çelen A. Influence of Holy Month Ramadan on Alcohol Consumption in Turkey. J Relig Health, 2015, 54, 2122-2133.

Mourad S. La durée du jeûne en Tunisie parmi la plus longue dans le monde arabe [Fasting time in Tunisia among the longest in the Arab world]. Tunisie numérique, 2019.ûne-en-tunisie-parmi-la-plus-longue-dans-le-monde-arabe/

Gueguen J, Dufaure I, Barry C, Falissard B. Evaluation de l’efficacité de la pratique du jeûne comme pratique à visée préventive ou thérapeutique [Evaluating the effectiveness of fasting as a preventive or therapeutic practice], 2014, 1-114.

Chaperot C, Altobelli A. Psychiatry and atmosphere. Evol Psychiatr, 2014, 79, 541-555.

Gagnon C. Christine Gagnon. Validation De L’Index De Sévérité De L’Insomnie Dans Les Cliniques De médecine générale [Validation Of The Insomnia Severity Index in General Practice Clinics], 2012.

Misdrahi D, Verdoux H, Llorca PM, Baylé FJ, Observance thérapeutique et schizophrénie : intérêt de la validation de la traduction française du Medication Adherence Rating Scale (MARS) [Medication adherence and schizophrenia: the value of validating the French translation of the Medication Adherence Rating Scale (MARS)], 2004, 409-410.

Bencharif M, Dahili K, Benseghir L., Benabbas Y. Effet du jeûne du Ramadan sur l’alimentation et l’activité physique : comparaison selon l’âge et le genre [Effect of Ramadan fasting on diet and physical activity: comparison by age and gender]. Nutr Clin Metab, 2017, 31, 140-150.

Yavangi M, Amirzargar MA, Amirzargar N, Dadashpour M. Does Ramadan fasting have any effects on menstrual cycles? Iran J Reprod Med, 2013, 11, 145-150.

Kadri N, Mouchtaq N, Hakkou F, Moussaoui D. Relapses in bipolar patients: Changes in social rhythm? Int J Neuropsychopharmacol, 2000, 3, 45-49.

Herrag M, Lahmiti S, Yazidi AA. Ramadan: a different side of the emergencies? Afr Health Sci, 2010, 10, 215-216.

Bouguerra R, Jabrane J, Hamzaoui J, Maâtki C, Slama CB. Les effets métaboliques du jeûne du mois de ramadan chez des diabétiques de type 2 [Metabolic effects of Ramadan fasting in type 2 diabetics]. East Mediterr Health J, 2003, 9, 1099-1108.

Bahammam AS, Almushailhi K, Pandi-Perumal SR, Sharif MM. Intermittent fasting during Ramadan: Does it affect sleep? J Sleep Res, 2014, 23, 35-43.

Roky, R, Chapotot, F, Hakkou, F, Benchekroun, MT, Buguet, A. Sleep during Ramadan intermittent fasting. J Sleep Res, 2001, 10, 319-327.

Trabelsi K, Bragazzi N , Zlitni S, Khacharem A, et al. Observing Ramadan and sleep-wake patterns in athletes: A systematic review, meta-analysis, and meta-regression. Br J Sports Med, 2019, 1-8. doi: 10.1136/bjsports-2018-099898

Berrichi H, Zatout S, Bessot N, Davenne D. Le jeûne du mois de Ramadan en été : quel impact sur le rythme veille-sommeil, la somnolence diurne, la fatigue et les troubles de l’humeur ? [Summer Ramadan fasting: what impact on sleep-wake rhythm, daytime sleepiness, fatigue, and mood disorders?]. Médecine du Sommeil, 2018, 15, 46-47.

Margolis SA, Reed RL. Effect of religious practices of Ramadan on sleep and perceived sleepiness of medical students. Teach Learn Med, 2004, Spring;16 (2):145-9. doi:10.1207/s15328015tlm1602_5

Almeneessier AS, Bahammam AS. How does diurnal intermittent fasting impact sleep, daytime sleepiness, and markers of the biological clock? Current insights. Nat Sci Sleep, 2018, 10, 439-452.

Oudghiri DM, Motaib I, Elamari S, et al. Ramadan and Hypothyroidism: Impact of Ramadan Fasting on Thyroid Status. Med Clin Res Open Access. 2022; 3(1):1-5.

Les C, Souffran, P, Bipolaire T. Le vecu du mois du ramadan chez les patients souffrant de trouble bipolaire [The experience of the month of Ramadan in patients with bipolar disorder]. 2019.

Bouznad N., El Mghari G, El Ansari, N. Observance thérapeutique des diabétiques hypertendus durant le mois du Ramadan dans la région de Marrakech [Therapeutic compliance of hypertensive diabetics

during the month of Ramadan in the Marrakech region]. Diabetes Metab, 2014, P340, 40, A108.

Chelbi S, Abdesslam H, Bendag N, et al. Diabétiques type 2 : observance thérapeutique et Ramadan [Type 2 diabetics: compliance and Ramadan]. Ann Endocrinol (Paris), 2018, 79, 484.

Masood B. Re: Impact of Ramadan on the treatment of psychosis. Ir J Psychol Med, 2007, 24, 162. doi: 10.1017/S079096670001065X

Zeeneldin AA, Gaber AA, Taha FM. Does fasting during Ramadan trigger non-adherence to oral hormonal therapy in breast cancer patients? J Egypt Natl Canc Inst, 2012, 24, 133-137. doi : 10.1016/j.jnci.2012.06.003

Chehovich C, Demler TL., Leppien E. Impact of Ramadan fasting on medical and psychiatric health. Int Clin Psychopharmacol, 2019, 34, 317-322. doi : 10.1097/YIC.0000000000000275

Lessan N, Saadane I, Alkaf B, Hambly C, et al. The effects of Ramadan fasting on activity and energy expenditure. Am J Clin Nutr, 2018, 107, 54-61. doi: 10.1093/ajcn/nqx016.

How to Cite
Ben Mbarek, M., Amamou, B., Ben Haouala, A., Mhalla, A., Gassab, L., & Zaafrane, F. (2024). The Impact of Ramadan Fasting on Sleep and Treatment Compliance in Psychiatric Patients: A Survey Study. Journal of Internal Medicine: Science & Art, 5, 1 - 9.