Sleep got worse during Ramadan and mood mostly didn't — in a cohort of 30 Saudi women

A prospective repeated-measures cohort of thirty young Saudi women, assessed before, during and after Ramadan, found sleep duration significantly shorter and global sleep quality significantly worse during the fasting month — with both recovering afterwards [s1].

What did not move was mood. Depression and anxiety scores stayed stable across all three phases [s1].

The design

The study was conducted in the Department of Physical Therapy at Jazan University in Saudi Arabia, recruiting healthy women aged 18 to 30 through convenience sampling, with exclusions for chronic illness, pregnancy, lactation, psychological disorders, or recent hospitalisation [s1]. Self-reported data were collected online at three time points: before Ramadan, during Ramadan, and after Ramadan [s1].

Instruments were the International Physical Activity Questionnaire–Short Form for activity, the Pittsburgh Sleep Quality Index for sleep, and the Depression, Anxiety and Stress Scale-21 for emotional state [s1].

The repeated-measures structure is the design's main strength: each participant serves as her own comparison, which removes between-person confounding that a cross-sectional Ramadan study cannot address.

What changed

Sleep was significantly disrupted during Ramadan, with shorter duration (p < 0.001) and poorer global sleep quality (p = 0.002), followed by marked improvement afterwards, with all pairwise comparisons at p ≤ 0.001 [s1].

That is the least surprising result in the paper, and also the most robust. Ramadan restructures the day: the pre-dawn meal fragments the night, the evening meal shifts eating late, and social and religious activity extends into hours that would otherwise be sleep. The recovery afterwards indicates the disruption is tied to the schedule rather than to a lasting change.

Physical activity moved in the opposite direction, increasing significantly from pre-Ramadan to Ramadan (p = 0.039) and again from pre-Ramadan to post-Ramadan (p = 0.009) [s1].

Stress peaked during Ramadan and declined significantly afterwards (p = 0.010) [s1]. Depression and anxiety remained stable across all phases, with no significant differences (p > 0.05) [s1].

The finding that survives the small sample

The regression results are where the paper is most interesting. Poorer sleep quality significantly predicted higher depression, anxiety and stress before and during Ramadan (all p ≤ 0.002) — but not afterwards [s1]. Physical activity and BMI were not associated with mental health outcomes at any point [s1].

Two things follow. First, the sleep–mood relationship held in the periods when sleep was under strain and dropped out once sleep normalised, which is at least consistent with the relationship being driven by sleep debt rather than by a stable trait.

Second, the increase in physical activity — a variable that in most populations is reliably associated with better mood — showed no link to emotional wellbeing here [s1]. The authors' own summary is that sleep and stress emerged as the key factors across the Ramadan cycle, while activity did not [s1].

The limits, which are substantial

Thirty participants. All young, all healthy, all women, all recruited by convenience sampling from a single university department in a single Saudi city, all screened to exclude anyone with a psychological disorder [s1].

The exclusion criteria matter for interpreting the flat depression and anxiety results. A sample deliberately screened to remove people with psychological disorders is a sample with little room to move on those scales — a floor effect. The finding that depression and anxiety did not change during Ramadan in healthy young women says nothing about what happens to people who already have an anxiety or mood disorder, which is arguably the more clinically consequential question.

All measures were self-reported and collected online. The Pittsburgh Sleep Quality Index is a validated questionnaire, not an objective measure; it does not distinguish sleep architecture changes from perception changes, and there was no actigraphy or polysomnography.

With thirty participants and multiple comparisons across three time points and several instruments, individual p-values close to 0.05 — the physical activity result at 0.039, the stress decline at 0.010 — warrant more caution than the sleep results at p < 0.001.

This is descriptive research about a population's experience of an annual observance, not advice. Decisions about fasting, particularly for anyone with a health condition, sit with individuals and their clinicians.

What it adds

Ramadan fasting has been studied extensively for metabolic effects and rather less for the interaction between sleep and mental health, and studies specifically in young women in the Gulf are scarcer still. A within-person design across three phases, even at this sample size, is a more informative structure than the cross-sectional comparisons that dominate the literature.

What to watch next

Whether a larger cohort with objective sleep measurement reproduces the sleep–mood association and its disappearance after Ramadan. The pattern is the paper's most novel claim and the one that most needs replication at a sample size where it could survive.

Sources

1. Mental Health, Sleep, and Physical Activity Among Young Saudi Women During Ramadan: A Comparative Cohort Study — Nature and Science of Sleep, 11 June 2026 (primary)