Practical recommendations to improve sleep during Ramadan observance in healthy practitioners of physical activity.

Background: During the month of Ramadan, many Muslims continue to exercise and/or to compete in sporting events. However, the combination of Ramadan observance (RO) and physical activity (PA) is likely to be associated with disrupted sleep-wake patterns.

Objectives: to (i) evaluate the effects of RO on sleep patterns in practitioners of PA and (ii) provide some evidence-based practical recommendations to improve an active individual's sleep patterns during RO.

Methods: The entire content of two databases, PubMed/MEDLINE and Web of Science was searched for relevant articles through March, 25 2019. All accepted articles concerned healthy practitioners of PA and have assessed sleep quantity and/or quality and/or daily naps, whether based on objective or subjective methods.

Results: Thirteen studies evaluated total sleep time (TST) of active individuals in relation to RO; TST decreased in five studies, increased in one and remained unchanged in seven studies. Sleep quality was self-estimated in five studies, with three noting a decreased quality of sleep and two reporting no change. The duration of daily naps was increased in two studies. Conclusions and practical recommendations: Continuation of PA during RO did not decrease TST. However, no firm conclusions can be drawn regarding sleep quality/characteristic and daily naps durations. Sleep quantity and quality should be evaluated in order to counteract sleep disturbances. Physically active individuals should avoid large late night meal, and if possible take 20- to 30- minute daytime naps. A 10- minute shower at ∼40°C and a self-administered 6-min mindfulness induction video may be helpful immediately before bedtime. Tryptophan (1g/day) or melatonin (5- 8mg) supplements may also improve sleep characteristics.