Journal of Clinical and Diagnostic Research. 2019 Jan, Vol-13(1): LC14-LC20 14 14 DOI: 10.7860/JCDR/2019/38403.12493 Original Article Public Health Section Socio-demographic and Lifestyle Determinants of Insomnia among Adult Patients Attending Primary Healthcare Centres, Jeddah: A Cross-sectional Study INTRODUCTION Sleep hygiene is influenced by environmental conditions and lifestyle practices that influence sleep [1]. The importance of sleep hygiene was formally recognised in 1990 when “inadequate sleep hygiene” was added as a diagnostic category to the international classification of sleep disorders [2]. Insomnia is a common sleep disorder that is associated with fatigue irritability, impaired daytime functioning, and disturbed mood, in severe cases even suicide [3,4]. The prevalence of insomnia among the general population is approximately 9-15% [5]. Several risk factors can influence insomnia such as age, gender, and work-shifts [6]. Common lifestyle practices known to affect sleep include: taking caffeine, drinking alcohol, smoking nicotine cigarettes, exercising (amount and timing), napping, bedtime routine, and consistency of getting-up- and bedtimes [7,8]. Conceptually, insomnia occurs when a combination of predisposing, precipitating, and perpetuating factors reach a threshold. Precipitating factors are those initiating the onset of insomnia include dramatic events such as grief, divorce or exams, while perpetuating factors play a role in sustaining of insomnia [9]. Caffeine, a commonly ingested psychoactive substance present in coffee, tea, cocoa, soft drinks, and many medications, stimulates the central nervous system and delays sleep onset by increasing alertness and vigilance in direct proportion to the amount consumed [10]. Although alcohol does expedite sleep onset, it is not recommended as a sedative since it disturbs sleep cycles. Intake of alcohol decreases the time to onset of sleep [11]. Smoking cigarettes containing nicotine has been associated with disturbed sleep, but the changes are inconsistent and a cause-and-effect relationship has not been established [12]. Changes in sleep due to smoking cigarettes are often complicated by simultaneous use of caffeine and alcohol. A combination of alcohol and caffeine and/or nicotine may disturb sleep more than any substance taken individually [12]. Regular exercise is recommended for improving sleep but the mechanisms remain uncertain [13,14]. Because exercise is arousing, the essential recommendation is to practice regularly but to avoid exercise three hours before sleep to prevent delayed sleep onset. In Saudi Arabia, a study conducted in Riyadh region found about 62% have or may have sleeping disorders [15]. PHC is the first line of contact with Saudi health system, however, 40% of Primary Health Care (PHC) physicians thought that sleep disorders are not common [9]. Insomnia disorders constitute a significant burden for PHC physicians and need attention for prevention and early detection. In Saudi Arabia, Jeddah is the second most important urban and densely populated urban area following Riyadh region. As the population in Riyadh was previously studied [15], this study aimed to find out the effect of different socio-demographic or lifestyle factors on insomnia prevalence and severity in Jeddah region. As PHC is the first line of contact with health system in Saudi Arabia, patients attending PHC’s centres are expected to be more representative of general population in Jeddah region. MATERIALS AND METHODS This cross-sectional study was conducted in the period June- October 2016 in the Government PHC centres of Jeddah province. The study was conducted by the Directorate of Health Affairs in Jeddah (Approval No. A00383). Inclusion criteria comprised adults ABEER LAFI ALMOHAMMADI 1 , MAJED ALGHAMDI 2 , EMAD LAFI ALMOHAMMADI 3 Keywords: Health centres, Risk factors, Sleep disturbances ABSTRACT Introduction: Insomnia is the most prevalent sleep disorder. Its prevalence differs worldwide, from 5% to 40% depending on the criteria used to define insomnia, techniques, and method of collecting data. In Saudi Arabia, approximately 40% of adults with insomnia also have comorbid medical or psychiatric disorders. There are many factors which are associated with insomnia. Aim: To assess the association between socio-demographic and lifestyle factors with the occurrence of insomnia. Materials and Methods: This was a cross-sectional study conducted in 10 PHC centres of Jeddah. A total of 376 adult participants were interviewed by using a questionnaire which included questions about sociodemographic and lifestyle-related questions. Pittsburgh Sleep Quality Index and the Insomnia Severity Index was used to assess insomnia. Data were analysed and descriptive statistics (i.e., frequency, percentages, mean and standard deviation) were calculated. The chi-square test was applied to test significance of differences between groups. The p-values <0.05 were considered as statistically significant. Results: More than half of participants (51.1%) had poor sleep quality. The highest prevalence of poor sleep quality was observed among those who performed physical exercise four times or more weekly (67.3%). The poor quality of sleep was higher among those who drink coffee (p=0.001). Regarding risk factors for grades of insomnia, higher prevalence of severe insomnia was observed among younger participants (p=0.001), Saudi citizens (p=0.032), obese participants (p=0.045), university educated participants (p<0.001), and those who practised exercise four times or more weekly (p=0.001). Conclusion: Lifestyle factors had a significant effect on sleeping quality especially among young adults, obese people, and highly educated participants.