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Effect of fasting during Ramadan on sleep architecture, daytime sleepiness and sleep pattern

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Abstract

Fasting during Ramadan is distinct from regular voluntary or experimental fasting. This project was conducted to objectively assess the effect of Ramadan fasting on sleep architecture, daytime sleepiness and the circadian cycle of melatonin level. Eight healthy volunteers reported to the Sleep Disorders Center on four occasions for polysomnography and multiple sleep latency tests: 1) an initial visit for adaptation; 2) 2 weeks before Ramadan (BL); and 3,4) during the first and third weeks of Ramadan (R1, R3). Salivary melatonin level was measured using radioimmunoassay. Sleep latency at night was significantly shorter and the amount of rapid eye movement sleep was significantly less, at R3 compared to BL. There was no difference in multiple sleep latency test data between BL and Ramadan. Although melatonin level kept the same circadian pattern at BL, R1 and R3, it had a flatter slope and a significantly lower peak at midnight (00:00) at R1 and R3. This study showed a significant reduction in sleep latency and rapid eye movement sleep during the third week of Ramadan fasting. Otherwise, there was no significant effect of Ramadan on sleep architecture and assessment revealed no increase in daytime sleepiness. Although melatonin level had the same circadian pattern during Ramadan, the level of the hormone dropped significantly from baseline.

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References

  1. Fereidoun A. Research in Islamic fasting and health. Ann. Saudi. Med. 2002; 22: 186–91.

    Google Scholar 

  2. Bahammam A. Sleep pattern, daytime sleepiness and eating habits during the month of Ramadan. Sleep and Hypnosis. 2003; 5: 163–70.

    Google Scholar 

  3. Rocky R, Iraki L, HajKhlifa R, Ghazal NL, Hakkou F. Daytime alertness, mood, psychomotor performance and oral temperature during Ramadan intermittent fasting. Ann. Nutr. Metab. 2000; 44: 101–7.

    Article  Google Scholar 

  4. Rocky R, Chapotot F, Taoudi M, Benaji B, Hakkou F, El Khalifi H, Buguet A. Daytime sleepiness during Ramadan intermittent fasting: polysomnographic and quantitative waking EEG study. J. Sleep Res. 2003; 12: 95–101.

    Article  Google Scholar 

  5. Miles A, Thomas R. Melatonin — a diagnostic marker in laboratory medicine? In: Miles, A, Philbrick, DRS, Thompson, C, eds. Melatonin: Clinical Perspectives. Oxford, Oxford University Press 1988; 253–79.

    Google Scholar 

  6. Johns MW. A new method for measuring daytime sleepiness: the Epworth Sleepiness Scale. Sleep 1991; 14: 540–5.

    CAS  PubMed  Google Scholar 

  7. Wilson WL, Heyward VH. Validation of the near-infrared interactance method for Native Indian, black, Hispanic and white men 19–57 years. Basic Life Sci. 1993; 60: 389–92.

    CAS  PubMed  Google Scholar 

  8. Rechtschaffen A, Kales A, eds. A Manual of Standardized Terminology, Techniques and Scoring System for Sleep Stages of Human Subjects. NIH Publication #204 Washington: DC. US. Government Printing Office, 1968.

    Google Scholar 

  9. American Sleep Disorders Association Atlas Task Force. EEG arousals: scoring rules and examples. Sleep 1992; 15: 174–84.

    Google Scholar 

  10. Thorpy MJ, Westbrook P, Ferber R, Fredrickson P, Mahowald M, Perez-Guerra F, Reite M, Smith P. The clinical use of the multiple sleep latency test. An American Sleep Disorders Association report. Sleep 1992; 15: 268–76.

    CAS  PubMed  Google Scholar 

  11. Cajochen C, Dijk DJ. Electroencephalographic activity during wakefulness, rapid eye movement and non-rapid eye movement sleep in humans: comparison of their circadian and homeostatic modulation. Sleep Biol. Rhythm 2003; 1: 85–95.

    Article  Google Scholar 

  12. Nowak R, McMillen C, Redman J, Short RV. The correlation between serum and salivary melatonin concentrations and urinary 6-hydroxymelatonin sulphate excretion rates: two non-invasive techniques for monitoring human circadian rhythmicity. J. Clin. Endocrinol. 1987; 27: 445–52.

    Article  CAS  Google Scholar 

  13. Laakso ML, Porkka-Heiskanen T, Alila A, Stenberg D, Johansson G. Correlation between salivary and serum melatonin: dependence on serum melatonin levels. J. Pineal Res. 1990; 9: 39–50.

    Article  CAS  PubMed  Google Scholar 

  14. Frost G, Pirani S. Meal frequency and nutritional intake during Ramadan: a pilot study. Hum. Nutr. Appl. Nutr. 1987; 41: 47–50.

    CAS  PubMed  Google Scholar 

  15. Rocky R, Chapotot F, Hakkou F, Taoudi M, Buguet A. Sleep during Ramadan intermittent fasting. J. Sleep Res. 2001; 10: 319–27.

    Article  Google Scholar 

  16. Michalsen A, Schlegel F, Rodenbeck A, Ludtke R, Huether G, Teschelr H, Dobos GJ. Effects of short-term modified fasting on sleep patterns and daytime vigilance in non-obese subjects: results of a pilot study. Ann. Nutr. Metab. 2003; 47: 194–200.

    Article  CAS  PubMed  Google Scholar 

  17. Al-Hadramy MS, Hawaii TH, Abdelwahab SM. Altered cortisol levels in relation to Ramadan. Eur. J. Clin. Nutr. 1988; 42: 359–62.

    CAS  PubMed  Google Scholar 

  18. Sliman NA, Ajlouni KS, Khatib FA. Effect of fasting Ramadan on some blood hormones in healthy Muslim males. Mu’tah J. Res. Studies. 1993; 8: 91–109.

    Google Scholar 

  19. Elati J, Beji C, Danguir J. Increased fat oxidation during Ramadan fasting in healthy women: an adaptive mechanism for body-weight maintenance. Am. J. Clin. Nutr. 1995; 62: 302–7.

    CAS  Google Scholar 

  20. Iraki L, Bogdan A, Hakkou F, Amrani N, Abkari A, Touitou Y. Ramadan diet restrictions modify the circadian time structure in humans. Study on plasma gastrin, insulin, glucose and calcium and on gastric pH. J Clin. Endocrinol Metab. 1997; 82: 1261–73.

    CAS  PubMed  Google Scholar 

  21. Krieger DT, Glick SM. Sleep EEG states and plasma growth hormone concentration in states of endogenous and exogenous hypercortisolemia or ACTH elevation. J. Clin. Endocrinol. Metab. 1974; 39: 986–1000.

    Article  CAS  PubMed  Google Scholar 

  22. Sangiah S, Caldwell DF. Reduction of rapid eye movement (REM) sleep by glucose alone or glucose and insulin in rats. Life Sci. 1988; 42: 1425–9.

    Article  CAS  PubMed  Google Scholar 

  23. Born J, Spath-Schwalbe E, Schwakenhofer H, Kern W, Fehm HL. Influences of corticotropin-releasing hormone, adreno-corticotropin and cortisol on sleep on normal man. J. Clin. Endocrinol Metab. 1989; 68: 904–11.

    Article  CAS  PubMed  Google Scholar 

  24. Pollak C. How should the multiple sleep latency test be analyzed? Sleep 1997; 20: 34–9.

    CAS  PubMed  Google Scholar 

  25. Clodoré M, Benoit O, Foret J, Bouard G. The multiple sleep latency test: individual variability and time of the day effect in normal young adults. Sleep 1990; 13: 385–94.

    PubMed  Google Scholar 

  26. Borbély AA. Sleep in the rat during food deprivation and subsequent reinstitution of food. Brain Res. 1977; 124: 457–71.

    Article  PubMed  Google Scholar 

  27. Danguir J, Nicolaidis S. Dependence of sleep on nutrients’ availability. Physiol. Behav. 1979; 22: 735–40.

    Article  CAS  PubMed  Google Scholar 

  28. Rashotte ME, Pastukhov IF, Poliakov EL, Henderson RP. Vigilance states and body temperature during the circadian cycle in fed and fasted pigeons (Columbia Livia). Am. J. Physiol. 1998; 275: 690–702.

    Google Scholar 

  29. Willie JT, Chemelli RM, Sinton CM, Yanagisawa M. To eat or to sleep? Orexin in the regulation of feeding and wakefulness. Annu. Rev. Neurosci. 2001; 24: 429–58.

    Article  CAS  PubMed  Google Scholar 

  30. Arendt J. Melatonin and the Mammalian Pineal Gland. London: UK. Chapman & Hall, 1995.

    Google Scholar 

  31. Bogdan A, Bouchareb B, Touitou Y. Ramadan fasting alters endocrine and neuroendocrine circadian patterns. Meal-time as a synchronizer in humans? Life Sci. 2001; 68: 1607–15.

    Article  CAS  PubMed  Google Scholar 

  32. Röjdmark S, Wetterberg L. Short-term fasting inhibits the nocturnal melatonin secretion in healthy man. J. Clin. Endocrinol. 1989; 30: 452–7.

    Google Scholar 

  33. Taoudi M, Rocky R, Toufiq J, Benaji B, Hakkou F. Epidemiological study: chronotype and daytime sleepiness before and during Ramadan. Therapie 1999; 54: 567–72.

    Google Scholar 

  34. Morgan L, Arendt J, Owens D, Folkard S, Hampton S, Deacon S, English J, Ribeiro D, Taylor K. Effects of the endogenous clock and sleep time on melatonin, insulin, glucose and lipid metabolism. J. Endocrinol. 1998; 157: 443–51.

    Article  CAS  PubMed  Google Scholar 

  35. Brismar K, Werner S, Wetterberg L. Melatonin and corticosteroid response to metyrapone in patients with pituitary disease. In: Reiter, RJ, ed. The Pineal and its Hormones. New York, NY: Liss 1982, 283–92.

    Google Scholar 

  36. Beck-Friis J, Ljunggren JG, Thoren M, von Rosen D, Kjellman BF, Wetterberg L. Melatonin, cortisol and ACTH in patients with major depressive disorder and healthy humans with special reference to the outcome of the dexamethasone suppression test. Psychoneuroendocrinol 1985; 10: 173–86.

    Article  CAS  Google Scholar 

  37. Chick L, Ho AK, Brown GM. Effects of 24-h serum and pineal melatonin content in male rats. Acta Endocrinol. 1987; 115: 507–13.

    Google Scholar 

  38. Welker HA, Vollrath L. The effects of a number of short-term exogenous stimuli on pineal serotonin-N-acetyltransferase activity in rats. J. Neural Trans. 1984; 59: 68–80.

    Article  Google Scholar 

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Correspondence to Ahmed Bahammam FRCP, FCCP.

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Bahammam, A. Effect of fasting during Ramadan on sleep architecture, daytime sleepiness and sleep pattern. Sleep Biol. Rhythms 2, 135–143 (2004). https://doi.org/10.1111/j.1479-8425.2004.00135.x

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  • DOI: https://doi.org/10.1111/j.1479-8425.2004.00135.x

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