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The effect of intermittent fasting during Ramadan on sleep, sleepiness, cognitive function, and circadian rhythm

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Abstract

Purpose

Studies have shown that experimental fasting can affect cognitive function, sleep, and wakefulness patterns. However, the effects of experimental fasting cannot be generalized to fasting during Ramadan due to its unique characteristics. Therefore, there has been increased interest in studying the effects of fasting during Ramadan on sleep patterns, daytime sleepiness, cognitive function, sleep architecture, and circadian rhythm.

Method

In this review, we critically discuss the current research findings in those areas during the month of Ramadan.

Results

Available data that controlled for sleep/wake schedule, sleep duration, light exposure, and energy expenditure do not support the notion that Ramadan intermittent fasting increases daytime sleepiness and alters cognitive function. Additionally, recent well-designed studies showed no effect of fasting on circadian rhythms. However, in non-constrained environments that do not control for lifestyle changes, studies have demonstrated sudden and significant delays in bedtime and wake time.

Conclusions

Studies that controlled for environmental factors and sleep/wake schedule reported no significant disturbances in sleep architecture. Nevertheless, several studies have consistently reported that the main change in sleep architecture during fasting is a reduction in the proportion of REM sleep.

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References

  1. BaHammam A (2006) Does Ramadan fasting affect sleep? Int J Clin Pract 60(12):1631–1637

    Article  CAS  PubMed  Google Scholar 

  2. BaHammam (2003) Sleep pattern, daytime sleepiness, and eating habits during the month of Ramadan. Sleep Hypnosis 5:165–174

    Google Scholar 

  3. BaHammam (2004) Effect of fasting during Ramadan on sleep architecture, daytime sleepiness and sleep pattern. Sleep Biol Rhythm 2

  4. BaHammam A (2005) Assessment of sleep patterns, daytime sleepiness, and chronotype during Ramadan in fasting and nonfasting individuals. Saudi Med J 26(4):616–622

    PubMed  Google Scholar 

  5. Margolis SA, Reed RL (2004) Effect of religious practices of Ramadan on sleep and perceived sleepiness of medical students. Teaching and Learning in Medicine 16(2):145–149

    Article  PubMed  Google Scholar 

  6. Taoudi Benchekroun M, Roky R, Toufiq J, Benaji B, Hakkou F (1999) Epidemiological study: chronotype and daytime sleepiness before and during Ramadan. Therapie 54(5):567–572

    CAS  PubMed  Google Scholar 

  7. BaHammam AS, Alaseem AM, Alzakri AA, Sharif MM (2013) The effects of Ramadan fasting on sleep patterns and daytime sleepiness: an objective assessment. J Res Med Sci 18(2):127–131

    PubMed  PubMed Central  Google Scholar 

  8. BaHammam AS, Almushailhi K, Pandi-Perumal SR, Sharif MM (2014) Intermittent fasting during Ramadan: does it affect sleep? J Sleep Res 23(1):35–43

    Article  PubMed  Google Scholar 

  9. Roky R, Chapotot F, Benchekroun MT, Benaji B, Hakkou F, Elkhalifi H, Buguet A (2003) Daytime sleepiness during Ramadan intermittent fasting: polysomnographic and quantitative waking EEG study. J Sleep Res 12(2):95–101

    Article  PubMed  Google Scholar 

  10. Roky R, Iraki L, HajKhlifa R, Lakhdar Ghazal N, Hakkou F (2000) Daytime alertness, mood, psychomotor performances, and oral temperature during Ramadan intermittent fasting. Ann Nutr Metab 44(3):101–107

    Article  CAS  PubMed  Google Scholar 

  11. Chamari K, Briki W, Farooq A, Patrick T, Belfekih T, Herrera CP (2016) Impact of Ramadan intermittent fasting on cognitive function in trained cyclists: a pilot study. Biology of sport 33(1):49–56

    Article  CAS  PubMed  Google Scholar 

  12. Johns MW, Tucker A, Chapman R, Crowley K, Michael NJ (2007) Monitoring eye and eyelid movements by infrared reflectance oculography to measure drowsiness in drivers. Somnologie 11:234–242

    Article  Google Scholar 

  13. BaHammam AS, Nashwan S, Hammad O, Sharif MM, Pandi-Perumal SR (2013) Objective assessment of drowsiness and reaction time during intermittent Ramadan fasting in young men: a case-crossover study. Behavioral and Brain Functions: BBF 9(1):32

    Article  PubMed  PubMed Central  Google Scholar 

  14. Tian HH, Aziz AR, Png W, Wahid MF, Yeo D, Constance Png AL (2011) Effects of fasting during ramadan month on cognitive function in muslim athletes. Asian Journal of Sports Medicine 2(3):145–153

    Article  PubMed  PubMed Central  Google Scholar 

  15. Michalsen A, Schlegel F, Rodenbeck A, Ludtke R, Huether G, Teschler H, Dobos GJ (2003) Effects of short-term modified fasting on sleep patterns and daytime vigilance in non-obese subjects: results of a pilot study. Ann Nutr Metab 47(5):194–200

    Article  CAS  PubMed  Google Scholar 

  16. Devoto A, Lucidi F, Violani C, Bertini M (1999) Effects of different sleep reductions on daytime sleepiness. Sleep 22(3):336–343

    Article  CAS  PubMed  Google Scholar 

  17. Rashotte ME, Pastukhov IF, Poliakov EL, Henderson RP (1998) Vigilance states and body temperature during the circadian cycle in fed and fasted pigeons (Columba livia). Am J Phys 275(5 Pt 2):R1690–R1702

    CAS  Google Scholar 

  18. Sakurai T, Amemiya A, Ishii M, Matsuzaki I, Chemelli RM, Tanaka H, Williams SC, Richardson JA, Kozlowski GP, Wilson S, Arch JR, Buckingham RE, Haynes AC, Carr SA, Annan RS, McNulty DE, Liu WS, Terrett JA, Elshourbagy NA, Bergsma DJ, Yanagisawa M (1998) Orexins and orexin receptors: a family of hypothalamic neuropeptides and G protein-coupled receptors that regulate feeding behavior. Cell 92(4):573–585

    Article  CAS  PubMed  Google Scholar 

  19. Xi MC, Morales FR, Chase MH (2001) Effects on sleep and wakefulness of the injection of hypocretin-1 (orexin-A) into the laterodorsal tegmental nucleus of the cat. Brain Res 901(1–2):259–264

    Article  CAS  PubMed  Google Scholar 

  20. Mattson MP (2005) Energy intake, meal frequency, and health: a neurobiological perspective. Annu Rev Nutr 25:237–260

    Article  CAS  PubMed  Google Scholar 

  21. Roky R, Chapotot F, Hakkou F, Benchekroun MT, Buguet A (2001) Sleep during Ramadan intermittent fasting. J Sleep Res 10(4):319–327

    Article  CAS  PubMed  Google Scholar 

  22. Fond G, Macgregor A, Leboyer M, Michalsen A (2013) Fasting in mood disorders: neurobiology and effectiveness. A review of the literature. Psychiatry Res 209(3):253–258

    Article  PubMed  Google Scholar 

  23. Oosterman JE, Kalsbeek A, la Fleur SE, Belsham DD (2015) Impact of nutrients on circadian rhythmicity. Am J Physiol Regul Integr Comp Physiol 308(5):R337–R350

    Article  CAS  PubMed  Google Scholar 

  24. Oike H, Oishi K, Kobori M (2014) Nutrients, clock genes, and chrononutrition. Curr Nutr Rep 3:204–212

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  25. Sangiah S, Caldwell DF (1988) Reduction of rapid eye movement (REM) sleep by glucose alone or glucose and insulin in rats. Life Sci 42(15):1425–1429

    Article  CAS  PubMed  Google Scholar 

  26. Born J, Spath-Schwalbe E, Schwakenhofer H, Kern W, Fehm HL (1989) Influences of corticotropin-releasing hormone, adrenocorticotropin, and cortisol on sleep in normal man. J Clin Endocrinol Metab 68(5):904–911

    Article  CAS  PubMed  Google Scholar 

  27. Jouvet M, Buda C, Debilly G, Dittmar A, Sastre JP (1988) Central temperature is the principal factor of regulation of paradoxical sleep in pontile cats. C R Acad Sci III 306(2):69–73

    CAS  PubMed  Google Scholar 

  28. Krieger DT, Glick SM (1974) Sleep EEG stages and plasma growth hormone concentration in states of endogenous and exogenous hypercortisolemia or ACTH elevation. J Clin Endocrinol Metab 39(6):986–1000

    Article  CAS  PubMed  Google Scholar 

  29. Oosterman JE, Kalsbeek A, la Fleur SE, Belsham DD (2015) Impact of nutrients on circadian rhythmicity. American Journal of Physiology Regulatory, Integrative and Comparative Physiology 308(5):R337–R350

    Article  CAS  PubMed  Google Scholar 

  30. de Martino MM (2009) The architecture of day sleeping and the sleep-wake cycle in nurses in their working shifts. Revista da Escola de Enfermagem da U S P 43(1):194–199

    Article  PubMed  Google Scholar 

  31. Mongrain V, Carrier J, Dumont M (2005) Chronotype and sex effects on sleep architecture and quantitative sleep EEG in healthy young adults. Sleep 28(7):819–827

    Article  PubMed  Google Scholar 

  32. Bogdan A, Bouchareb B, Touitou Y (2005) Response of circulating leptin to Ramadan daytime fasting: a circadian study. Br J Nutr 93(4):515–518

    Article  CAS  PubMed  Google Scholar 

  33. BaHammam A, Alrajeh M, Albabtain M, BaHammam S, Sharif M (2010) Circadian pattern of sleep, energy expenditure, and body temperature of young healthy men during the intermittent fasting of Ramadan. Appetite 54(2):426–429

    Article  PubMed  Google Scholar 

  34. Miles ATR (1988) Melatonin—a diagnostic marker in laboratory medicine? Melatonin: clinical perspectives. Oxford University Press, Oxford

    Google Scholar 

  35. Arendt J (1995) Melatonin and the mammalian pineal gland

  36. Bogdan A, Bouchareb B, Touitou Y (2001) Ramadan fasting alters endocrine and neuroendocrine circadian patterns. Meal-time as a synchronizer in humans? Life Sci 68(14):1607–1615

    Article  CAS  PubMed  Google Scholar 

  37. Bahammam A (2013) Intermittent fasting does not influence the circadian pattern of melatonin whencontrolling for meals, light exposure and sleep schedules. Sleep Med 14:e68

  38. Rojdmark S, Wetterberg L (1989) Short-term fasting inhibits the nocturnal melatonin secretion in healthy man. Clin Endocrinol 30(4):451–457

    Article  CAS  Google Scholar 

  39. al-Hadramy MS, Zawawi TH, Abdelwahab SM (1988) Altered cortisol levels in relation to Ramadan. Eur J Clin Nutr 42(4):359–362

    CAS  PubMed  Google Scholar 

  40. Sliman A, Faisal (1993) Effect of fasting on some blood hormones in healthy Muslim males. Mu’tah J Res Stud 8:91–109

    Google Scholar 

  41. Chik CL, Ho AK, Brown GM (1987) Effect of food restriction on 24-h serum and pineal melatonin content in male rats. Acta Endocrinol 115(4):507–513

    CAS  PubMed  Google Scholar 

  42. Azizi F (2002) Research in Islamic fasting and health. Ann Saudi Med 22(3–4):186–191

    Article  PubMed  Google Scholar 

  43. Kotrbacek V, Schweigel M, Honig Z (1990) The effect of short-term fasting on sleep in pigs. Vet Med (Praha) 35(9):547–552

    CAS  Google Scholar 

  44. Alzoghaibi MA, Pandi-Perumal SR, Sharif MM, BaHammam AS (2014) Diurnal intermittent fasting during Ramadan: the effects on leptin and ghrelin levels. PLoS One 9(3):e92214

  45. Horne JA, Ostberg O (1976) A self-assessment questionnaire to determine morningness-eveningness in human circadian rhythms. Int J Chronobiol 4(2):97–110

    CAS  PubMed  Google Scholar 

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Acknowledgements

This study was supported by a grant from the National Plan for Science and Technology Program by the King Saud University Project in Saudi Arabia. The sponsor had no role in the design or conduct of this research.

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Authors and Affiliations

  1. University Sleep Disorders Center, College of Medicine, King Saud University, Box 225503, Riyadh, 11324, Saudi Arabia

    Shaden O. Qasrawi, Seithikurippu R. Pandi-Perumal & Ahmed S. BaHammam

  2. Strategic Technologies Program of the National Plan for Sciences and Technology and Innovation, Riyadh, Saudi Arabia

    Shaden O. Qasrawi, Seithikurippu R. Pandi-Perumal & Ahmed S. BaHammam

Authors
  1. Shaden O. Qasrawi
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  2. Seithikurippu R. Pandi-Perumal
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  3. Ahmed S. BaHammam
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Correspondence to Ahmed S. BaHammam.

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Qasrawi, S.O., Pandi-Perumal, S.R. & BaHammam, A.S. The effect of intermittent fasting during Ramadan on sleep, sleepiness, cognitive function, and circadian rhythm. Sleep Breath 21, 577–586 (2017). https://doi.org/10.1007/s11325-017-1473-x

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  • DOI: https://doi.org/10.1007/s11325-017-1473-x

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