Exploring Sleep Quality and Driving Behaviors in Ramadan among Fasting Adults

INTRODUCTION

Every year, Muslims in many countries observe fasting during the entire month of Ramadan. In this religious ritual, Muslims abstain from food, water, and beverages during the daytime, starting just before sunrise until sunset. To be able to fast, people tend to change their daily routine. For example, mealtimes will be shifted from regular breakfast, lunch, and dinner times to eat the first meal just after sunset, that is, Iftar, the second meal late at night, and the third in the early morning before sunrise. In addition, the work hours are usually adjusted and shortened. Schools, universities, and governmental and private sectors start the workday around 9–10 a.m. in Ramadan instead of 6–8 a.m. in other months. Work hours are shorter in Ramadan and range from 3 to 6 h instead of the normal 8 h/day. In some companies, employees have the choice to completely transition to evening work shifts after Iftar. These changes in mealtimes and work times could have some effects on many aspects of Muslims’ lives during the month of Ramadan, including sleep and driving behaviors.

Due to changing mealtimes and work times in Ramadan, the sleep pattern also changes. People tend to delay their bedtime and wake-up time^[1] to accommodate Ramadan mealtimes and work hours. In addition, those who sleep early tend to wake up in the early hours before sunrise to have some food and water; this meal is called Suhur.^[2] Furthermore, a systematic review and meta-analysis by Faris et al.^[3] concluded that the sleep duration was reduced and daytime sleepiness increased during the month of Ramadan. These changes in sleep patterns may reduce the overall sleep quality during Ramadan.

As mentioned before, the work hours change in Ramadan. In addition, it is observed that people rush to reach their destinations before Iftar time. For example, some people often drive to buy groceries to use in Iftar meal preparation. As such, the traffic times and rush hour periods are different in the month of Ramadan compared to other months,^[4,5] with peak hours around Iftar time.^[6] This could place fasting drivers in situations that may provoke feelings of anger, which may be expressed as speeding, tailgating, cutting lanes, and honking the car horn.^[5,7,8] This increases the likelihood of being involved in an accident.

As this social phenomenon is repeated every year, it could affect people’s health and safety. Although previous studies investigated traffic patterns, traffic injury rates, and sleep during and after Ramadan, little is known about driving behaviors while fasting compared to after Iftar. This study aims to explore the change in sleep quality during Ramadan compared to before Ramadan, as well as some of the driving behaviors that may influence fasting drivers to feel angry.

MATERIAL AND METHODS

This study followed a cross-sectional study design. An online questionnaire was used to collect the data and consisted of three main sections. The first section assessed sleep quality using a single question: “How would you rate your sleep quality overall?.” The participants recorded their response in a Likert scale ranging from very poor (0) to excellent (10).^[9] This question was administered twice, once to assess sleep quality before Ramadan and the second to assess sleep quality during Ramadan.

The second section evaluated driving behavior using 10 items. The first five questions were developed to assess the likelihood of experiencing anger when exposed to some specific traffic scenarios before and after Iftar, that is, the meal Muslims have at the time of sunset to break the fast. The five scenarios are: “A slow driver is blocking the fast lane,” “another driver cuts into your lane (cuts you off),” “The driver behind you tailgates you, leaving no safe following distance, in an irritating way,” “being stuck in heavy traffic congestion,” and “someone honks the car horn at you.” The responses were recorded on a 5-point Likert scale ranging from extremely likely to extremely unlikely. The following set of three questions evaluated the likelihood of engaging in some aggressive driving behaviors before and after Iftar. These are as follows: “Speeding aggressively to overtake a slow or reckless driver,” “chasing (tailgating) another driver closely to express anger,” and “repeatedly pressing the car horn to show frustration.” In these questions, the participants recorded their response on a 5-point Likert scale ranging from extremely likely to extremely unlikely. The last two questions focused on driver safety habits (wear a seat belt while driving) and compliance with traffic rules (obey speed limits and traffic rules), with responses recorded on a 5-point Likert scale ranging from never to always. The second section was adopted from the previous studies.^[7,10-12]

The third part of the questionnaire collected demographic data such as age (in years), sex (male/female), weight (in kg), employment status (student, employed, unemployed, and other), and daily working hours (in hours).

A pilot test involving 15 participants was performed to ensure the quality of the questionnaire and rectify errors. The online questionnaire was administered for 3 weeks starting from March 8, 2025. The study used a convenience sampling method. The inclusion criteria were being 18 years or older and voluntarily agreeing to participate in the study. Any participant who was under 18 or did not consent to participate was excluded. The study was conducted in accordance with the Helsinki Declaration and approved by the Biomedical Research Ethics Committee at Umm Al-Qura University [ethical approval number HAPO-02-K-012-2025-04-2651].

The collected data were analyzed using JASP statistical software (JASP Team, 2025; Version 0.19.3) to explore the differences between sleep quality before and during Ramadan, and the difference in driving behaviors before and after Iftar. Descriptive statistics were reported as mean ± standard deviation or as frequency and percentage. Due to the non-normal distribution of data, the paired sample Wilcoxon signed-rank test was used to report the difference, the effect size, and the confidence interval of the effect size, with findings considered significant when P-value is less than α = 0.05.

RESULTS

The number of participants in this study was 522. The average age and weight of the sample are 33.49 ± 13.03 years and 73.97 ± 21.21 kg, respectively, with about 71% of the participants being male. Many of the participants are employees (50.20%) followed by students (29.70%). Tables 1 and 2 summarize the demographics of the sample.

The average sleep quality rating before Ramadan was 6.84 ± 2.16, and during Ramadan, it was 4.95 ± 2.36 [Table 3]. The difference between sleep quality before and during Ramadan was statistically significant (z = 13.24, P < 0.05) with a large effect size, as shown in Table 4.

For driving behaviors, the findings show a trend toward a higher likelihood of feelings of anger before Iftar than after. Many subjects are more likely to feel angry when a slow driver blocks the fast lane before Iftar time, compared to after Iftar time. Similarly, a higher percentage of the participants indicated more likelihood to feel angry when another driver cuts into their lane, when being tailgated, when being stuck in heavy traffic congestion, and when another driver honks the horn at them before Iftar time, compared to after Iftar time [Table 5]. The findings also show higher trends of engaging in aggressive driving before Iftar time. Higher percentages of the participants reported a higher likelihood of engaging in aggressive behaviors such as speeding aggressively to overtake slow drivers, tailgating, and pressing the car horn to show frustration before Iftar time than after Iftar time [Table 5]. These differences were found to be statistically significant with a small to moderate effect size, as shown in Table 6.

The findings of commitment to safety and rules [Table 7] indicate that drivers behave almost similarly before and after Iftar time. Differences in frequencies of wearing seat belts were found not significant, while obeying speed limits and traffic rules were statistically significantly different between before Iftar time and after Iftar time with a small effect size [Table 8].

DISCUSSION

This cross-sectional study recruited 522 participants and aimed to find the effect of fasting in Ramadan on sleep and driving behavior. The findings indicate that sleep quality in Ramadan is less than that reported before Ramadan. In addition, our findings indicate that drivers are more likely to feel angry and to engage in aggressive driving behavior when driving while fasting compared to when driving after having some food. These findings reflect the changes in sleep and driving habits that take place during the month of Ramadan.

For sleep quality, our findings showed reduced sleep quality during the month of Ramadan compared to the time before Ramadan. The previous studies varied in their findings. The reduced sleep quality can be attributed to changes in daily routine, increased night prayers, late night meal, and reduction in the proportion of REM sleep.^[13-15] A possible explanation of the finding is the shorter duration of sleep.^[16] Although the study by Boukhris et al.^[17] reported that sleep duration was reduced during Ramadan by almost 2 h, the fermentation study reported that sleep quality did not change. However, the study by Boukhris et al.^[17] recruited participants who were young and engaged in moderate physical activity, which suggests that physical activity provides some protection against poor sleep quality.^[18] Another study by Alzhrani et al.^[2] reported that sleep duration did not change during Ramadan and contradicted other studies.^[16] Alzhrani et al.^[2] reported that their participants changed their daily routine, including sleep time, mealtimes, and dietary intake, but the duration of sleep remained unchanged.^[2] These changes may have an impact on sleep quality.^[19] Given that most of our participants are middle-aged working adults, we speculate that the reduced sleep quality could be explained by changes in daily routine, such as changes in work hours, mealtimes, dietary intake, and sleep quantity. Poor sleep quality could adversely affect cognitive function and fatigue for both workers and students, resulting in poorer performance.^[20]

The second part of the study found a significant tendency toward feeling angry and engaging in aggressive driving behavior while fasting compared to after Iftar. These findings agree with previous studies. A study reported that the level of anger increased slightly during fasting, as well as the level of tension.^[21] In another study by Latif et al., participants reported feeling angry and irritable while fasting.^[22] In addition, the feeling of hunger due to fasting, which is probably greater at the time of sunset, is associated with feelings of anger and irritability.^[23] These feelings could induce aggressive driving behaviors such as speeding to overtake slow drivers, chasing other drivers, cutting into lanes, or pressing the horn to express anger. Consequently, fasting individuals could be at greater risk of being involved in an accident. A systematic review reported that the rate of road traffic injuries during the month of Ramadan is twice as high compared to other months.^[6] In addition, about one-fifth of the recorded injuries in Saudi Arabia were at sunset , that is, Iftar time.^[6]

The limitations of this study should be considered when interpreting the findings. Although the study recruited 522 participants, it used a cross-sectional study design and convenience sampling method; a more powerful study design should be used in the future, such as following the participants for a longer duration to further investigate the relationship between fasting during Ramadan and sleep quality. Second, we did not assess or include any questions about nicotine intake through smoking or other means, which is known to have an association with sleep disturbance;^[24] and anger.^[25] In addition, future studies could explore the relationship between various demographics, sleep, and engagement in aggressive driving behaviors. Nevertheless, the study provided some insight into a social phenomenon in the community observed during the month of Ramadan.

The findings of this study can inform future research, especially that aiming to promote health and safety during the month of Ramadan in Muslim communities. Special health awareness campaigns and programs can be developed before Ramadan to raise awareness of sleep quality, to reduce road traffic accidents at sunset, and to educate people on positive coping mechanisms. In addition, health awareness campaigns should also address the other effects associated with intermittent faith-based fasting such as reduced physical activities, cognitive performance, depression, tension and fatigue.^[20,21]

CONCLUSION

This cross-sectional study investigated sleep quality and driving behaviors during the month of Ramadan. The study found that there is a reduction in sleep quality among the sample during the month of Ramadan. Furthermore, the participants are more likely to adopt aggressive driving behaviors while fasting compared to after having Iftar. The findings of this research provide valuable information that should be used in public health campaigns by researchers and professionals who aim to improve sleep quality and reduce road traffic accidents in Ramadan.