Why so many people in the Middle East are suffering from sleep deprivation and disorders

In Saudi Arabia, sleep issues seem to be significantly worse than in many other countries. (Shutterstock)
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Updated 17 March 2023

Why so many people in the Middle East are suffering from sleep deprivation and disorders

  • On World Sleep Day, doctors in Saudi Arabia and the UAE explain why getting enough quality rest is essential for health
  • Anxiety, excessive screen time, and the consequences of the COVID-19 pandemic have all impacted sleep quality

DUBAI: The average person spends almost one-third of their life asleep — a necessary biological function that allows our bodies to rest and recover, support mental wellbeing, restock our immune system, and regulate our metabolism.

However, one of the most common complaints among people of all backgrounds is a persistent feeling of tiredness and a sense we are not getting enough quality sleep, leaving us unable to focus, regulate our emotions, fend off illness, or control our appetite.

For decades, studies on the topic of sleep have confirmed a growing prevalence of sleep disorders, threatening the health and quality of life of at least 45 percent of the world’s population.

On World Sleep Day, marked every year on March 17, experts emphasize the importance of getting at least seven to eight hours of sleep per night. This year, sleep health awareness activities are taking place under the theme “Sleep is essential for health.”

Anxiety, excessive screen time, and more recently the consequences of the coronavirus pandemic have all been cited as common causes of disturbed sleep and sleepless nights.

Dr. Rasha Mahmoud, head of the pulmonology and sleep unit at the Almana Group of Hospitals in Saudi Arabia, told Arab News: “Almost 40 percent of people in the Middle East are affected by sleep disorders, with obstructive sleep apnea syndrome being the most common disorder.”

A study on the global prevalence and burden of OSA, published in June by the US National Library of Medicine, showed that almost 1 billion people worldwide were affected by the sleep condition, with prevalence exceeding 50 percent in some countries.

OSA occurs when the throat muscles intermittently relax and block the airways during sleep, obstructing normal breathing for around 10 seconds before the sufferer jolts awake.

“Symptoms of this disorder include snoring, excessive daytime sleepiness, and morning headaches,” Mahmoud said.

In Saudi Arabia, sleep issues seem to be significantly worse than in many other countries.

According to a 2015 report from the mobile app Sleep Cycle, the Kingdom ranked second only to Japan in its list of the world’s five worst countries for average sleeping hours.

The Saudi Medical Journal confirmed that short sleep duration per night was prevalent in Saudi Arabia and affects one in every three Saudi adults.

“There are multiple factors that impact the quality and duration of sleep, starting with anxiety along with sedentary lifestyle diseases,” Mahmoud added.

Specific jobs that require long or unfixed working hours and night shifts are another factor impacting the quality of sleep among Saudis.

Mahmoud said: “High screen time, be it on social media or even gaming, can also affect the quality of sleep leading to various sleep disorders.”

The Kingdom ranks third globally for smartphone usage, at 24.2 million users, with almost 75 percent of the population using smartphones and more than 95 percent the internet.

Dr. Vishwanath Gowraiah, head of the pediatric sleep medicine department at Danat Al-Emarat Hospital in Abu Dhabi, told Arab News: “Globally, we are seeing a rise in sleep disorders due to several lifestyle changes.

Dr. Rasha Mahmoud, head of the pulmonology and sleep unit at the Almana Group of Hospitals in Saudi Arabia.

“This has come to impact both the quality of sleep that individuals are receiving and quantity.”

He noted that sleeping disorders could affect young children from birth and persist into middle childhood and beyond.

Such disorders include OSA, parasomnias such as teeth grinding and sleepwalking, sleep terrors, confusional arousals known as ‘sleep drunkenness’ and nightmares, as well as delayed sleep-wake phase disorder, which is often seen in adolescents.

Meanwhile, adults generally suffer from sleep disorders such as obesity-related OSA, insomnia, narcolepsy, which makes people very drowsy during the day, shift work disorders and sleep-related movement disorders.

Gowraiah said: “Sleep helps the body undertake restorative measures to help us feel better, more alert, energetic, and awake.

“It helps us perform our day-to-day tasks and protects us from potential mental health triggers and allows the body to undergo vital maintenance to repair and regrow tissue, build bone and muscle, while also restoring the immune system.”

In fact, deep sleep has proven to support the release of growth hormones, to repair damage in the body, and to allow various systems to recover.

A lack of sleep, meanwhile, affects everything from memory, learning and performance to appetite and the ability to think clearly.

“If a person is chronically sleep-deprived, they may even experience neurological issues like mood swings and hallucinations,” Gowraiah added.


Regulating your sleep schedule: Try going to bed and waking up at the same time even on the weekends. This consistency will help your body develop a sleep-wake cycle.

Eating habits: Avoid heavy meals a few hours before your scheduled bedtime. Stimulants including nicotine, caffeine, and alcohol can also interfere with your sleep.

Create a peaceful setting: Calming yourself down before bed will help you deepen your sleep. Avoid the use of light-emitting screens just before bedtime. Include calming activities such as taking a bath or reading.

Physical activity during the day: Regular physical activity can promote better sleep. Stress management: Attempt to settle any of your worries or stresses before bedtime by getting organized or setting your daily priorities.

Source: Dr. Rasha Mahmoud, head of the pulmonology and sleep unit at the Almana Group of Hospitals in Saudi Arabia

Additionally, there is a higher risk of developing various health conditions or chronic health problems including obesity, diabetes, heart disease, high blood pressure, or sleep apnea.

“Some studies have shown that deprived rapid eye movement stage shortens lifespan and decreases immune function,” he said.

REM is one of several stages in the architecture of sleep. It happens about one hour after falling asleep and is when we tend to have our most vivid dreams. If the architecture of REM and non-REM sleep is disrupted, we can wake up feeling poorly rested.

As sleep problems are becoming more common among adults, experts are keen to develop better public understanding of the causes of disrupted sleep, and greater awareness of the available remedies can help reduce the burden of sleep disorders on society.

Dr. Vishwanath Gowraiah, head of the pediatric sleep medicine department at Danat Al-Emarat Hospital in Abu Dhabi.

A study published by the American Journal of Managed Care in 2007 estimated the annual costs of insomnia to be between $92.5 billion and $107.5 billion. This figure is likely to be far higher today.

Another study published by the Journal of Occupational and Environmental Medicine in 2010, based on staff questionnaires at four US corporations, said that fatigue-related productivity losses resulting from bad sleep were estimated to cost $1,967 per employee per year.

So why do so many people still underestimate the power of sleep and the impact it has on their well-being and quality of life?

Dr. Saliha Afridi, managing director of The LightHouse Arabia, a Dubai-based mental health and wellness clinic, told Arab News: “They think of sleep as rest, but they don’t realize that poor sleep impacts every part of your physical and mental health, even on a cellular level.”

Most people were operating “from a place of sleep debt,” she said, while also failing to understand that learning how to get a good night’s sleep was an important stress management and life skill.

“Sleep is done at night but is created in the day. Everything you do from the moment you wake up to the time it is time to lay in bed will impact how deeply you will rest that night.”

Afridi pointed out that a person’s risk of heart disease increased by 45 percent if they were sleep deprived, while those who slept six hours a night or less were five times more likely to suffer a heart attack than those who slept a full eight hours.

The same increased risk applies to conditions such as diabetes, high blood pressure, stroke, cancer, and hyperglycemia.

“Not all sleep is created equal. You require sufficient levels of deep sleep at night for your body to recover as well as for learning to consolidate,” Afridi added.

Healthy adults should get between seven and eight hours of sleep every night between the hours of 10 p.m. and 5 a.m., she said. “If they wake up in the middle of the night, they should be able to go back to sleep in 20 minutes or so.”

Dr Saliha Afridi.

Daytime naps are not recommended for those who are trying to regulate their sleep, she added.

Achieving the required hours of sleep was a particular challenge for many people during the pandemic. In fact, experts coined the term “COVID-somnia” in 2020 to describe difficulty falling asleep or staying asleep due to pandemic-related stressors or worries.

Afridi said: “The uncertainty and volatility that people experienced during the pandemic has continued since then and has impacted people’s mental health.”

She noted that nearly every mental health diagnosis had a sleep component to it, meaning a person’s psychology had a big impact on their sleep.

She also pointed to compromised physical health caused by long COVID or the after-effects of the virus, workplace stress due to hybrid working, and burnout for caregivers and essential workers who overextend themselves during the pandemic, all of which impacted the quality and quantity of sleep many were getting.

“We also see many people suffering with poor sleep due to mental health issues like anxiety and depression.

“Sleep is not just rest. It is the single most effective thing you can do for your brain and your body,” Afridi added.

Daesh group kills 15 truffle hunters in Syria: monitor

Updated 24 March 2023

Daesh group kills 15 truffle hunters in Syria: monitor

  • Syria’s desert truffles fetch high prices in a country battered by 12 years of war

BEIRUT: The Daesh group killed 15 people foraging for desert truffles in conflict-ravaged central Syria by cutting their throats, while 40 others are missing, a war monitor said Friday.
Syria’s desert truffles fetch high prices in a country battered by 12 years of war and a crushing economic crisis.
Since February, at least 150 people — most of them civilians — have been killed by IS attacks targeting truffle hunters or by land mines left by the extremists, according to the Syrian Observatory for Human Rights.
“At least 15 people, including seven civilians and eight local pro-regime fighters, were killed by Daesh fighters who slit their throats while they were collecting truffles on Thursday,” said Observatory head Rami Abdel Rahman.
Forty others are missing following the attack in Hama province, he added.
Syrian state media did not immediately report the incident.
Between February and April each year, hundreds of impoverished Syrians search for truffles in the vast Syrian Desert, or Badia — a known hideout for jihadists that is also littered with land mines.
Foragers risk their lives to collect the delicacies, despite repeated warnings about land mines and Daesh fighters.
Earlier this month, Daesh fighters killed three truffle hunters and kidnapped at least 26 others in northern Syria, according to the monitor, which relies on a vast network of sources inside Syria.
That attack happened near positions held by pro-Iran forces, said the Britain-based Observatory.


Israel’s attorney general: Netanyahu involvement in judicial overhaul is illegal

Updated 24 March 2023

Israel’s attorney general: Netanyahu involvement in judicial overhaul is illegal

  • ‘The legal situation is clear: you must refrain from any involvement in initiatives to change the judiciary’

JERUSALEM: Israeli Prime Minister Benjamin Netanyahu’s violated the law by saying he would get personally involved in a judicial overhaul plan, the attorney-general said on Friday.
In the face of intensifying protests against the proposed changes, Netanyahu said on Thursday that he was putting aside all other considerations and would do “anything it takes” to reach a solution.
Netanyahu added that his hands had been tied, but a new law limiting the circumstances in which a prime minister can be removed gave him more space for maneuver.
However, Attorney-General Gali Baharav-Miara, in a letter addressed to Netanyahu, disagreed.
“The legal situation is clear: you must refrain from any involvement in initiatives to change the judiciary, including the makeup of the committee for the appointment of judges, as such activity is a conflict of interest.”
“Your statement last night and any action you take in violation of this matter is illegal and tainted by a conflict of interest,” Baharav-Miara added.

Anatomy of a disaster
Two decades later, Iraqis are still paying the price for Bush's ill-judged war

14 dead in US strikes on Syria after drone kills American contractor

Updated 25 min 41 sec ago

14 dead in US strikes on Syria after drone kills American contractor

  • US troops are in Syria as part of a coalition fighting against remnants of the Daesh group
  • US personnel have frequently been targeted in attacks by militia groups

BEIRUT: Fourteen pro-Iran fighters were killed in US air strikes on Syria carried out in retaliation for a drone attack that killed an American and wounded six others, a war monitor said Friday.
A US contractor was killed, and another contractor and five US service personnel wounded, when a kamikaze drone "of Iranian origin" struck a maintenance facility on a base of the US-led coalition near Hasakeh in northeastern Syria, the Pentagon said.
In response, US Defense Secretary Lloyd Austin said Thursday that, at President Joe Biden's direction, he had ordered "precision air strikes tonight in eastern Syria against facilities used by groups affiliated with Iran's Islamic Revolutionary Guard Corps".
"The air strikes were conducted in response to today's attack as well as a series of recent attacks against coalition forces in Syria by groups affiliated with the IRGC," Austin said.
Iran-backed militias have a heavy presence across Syria, especially around the border with Iraq and south and west of the Euphrates in Deir Ezzor province, where the latest US strikes took place.
The Syrian Observatory for Human Rights, a Britain-based monitor with a wide network of sources on the ground, said 14 people had been killed by US strikes, including nine Syrians.
"US strikes targeted a weapons depot inside Deir Ezzor city, killing six pro-Iran fighters, and two other fighters were killed by strikes targeting the desert of Al-Mayadeen, and six others near Albu Kamal," said the Observatory's head Rami Abdel Rahman.
On Friday morning, Iran-backed groups stationed near the city of Al-Mayadeen fired three missiles near a US base, said Abdel Rahman.
Two missiles struck in Syria's largest oil field, Al-Omar, which houses the US base, without causing damage, while the third landed on a civilian house nearby, he added.
The United States deploys about 900 troops in bases and posts across northeastern Syria as part of the international coalition fighting remnants of Daesh.
American troops also support the Syrian Democratic Forces (SDF), the Kurds' de facto army in the area, which led the battle that dislodged Daesh from their last scraps of Syrian territory in 2019.
The US personnel have frequently been targeted in attacks by militia groups.
Two of the US service members wounded on Thursday were treated on site, while the three other troops and one US contractor were medically evacuated to Iraq, the Pentagon said.
"We will always take all necessary measures to defend our people and will always respond at a time and place of our choosing," said General Michael Kurilla, commander of US Central Command.
When the strikes were announced, Biden had already travelled to Canada, where he is set to meet with Prime Minister Justin Trudeau.
In January, the US military said "three one-way attack drones" were launched against the coalition garrison at Al-Tanf in Syria, with one breaching its air defences and wounding two allied Syrian fighters.
The Observatory said it was likely Iran-backed militants had carried out that attack.
Last August, Biden ordered similar retaliatory strikes in Deir Ezzor province after several drones targeted a coalition outpost, without causing any casualties.
That attack came the same day that Iranian state media announced a Revolutionary Guard general had been killed days earlier while "on a mission in Syria as a military adviser".
Iran, a key ally of the government of Syrian President Bashar al-Assad, says it has deployed its forces in Syria at the invitation of Damascus and only as advisers.

Anatomy of a disaster
Two decades later, Iraqis are still paying the price for Bush's ill-judged war

Male guardianship rules in north Yemen restrict women’s aid work

Updated 24 March 2023

Male guardianship rules in north Yemen restrict women’s aid work

  • Conflict divided country between Houthis in north and UN-recognized government in south

DUBAI: Female aid workers in north Yemen cannot do their jobs tackling one of the world’s worst humanitarian crises as tightening male guardianship rules by Houthi authorities restrict their movement, nine female humanitarians have revealed.

When women refuse to take a guardian, they cannot travel to oversee aid projects, collect data and deliver health and other services. When women do take one, gender-sensitive work is difficult and aid budgets must bear extra costs.

One health project manager normally conducts 15-20 visits a year to projects around the country but said she has not made any since the rules requiring Yemeni female aid workers be accompanied by a close male relative — a “mahram” in Arabic — came out a year ago.

“I don’t have a lot of men in my family,” she said, adding that some women struggle to find willing guardians because relatives are against her working. “Sometimes a woman works without informing someone in her family.” She improvises with video calls, but knows other women have lost jobs because they cannot work effectively.

Yemen’s conflict has divided the country between the Houthis in north Yemen and an internationally recognized government in the south.

The conflict has wrecked the economy and destroyed the health system, leaving two-thirds of Yemen’s 30 million population in need of humanitarian assistance. Aid groups say female-headed households are more vulnerable to food insecurity and difficulties accessing aid.

Without female staff in the field, aid groups say they have trouble doing things as simple as identification checks on women, who may need to lift their face veils, to distribute food aid.

“Mahram requirements are making it even more challenging for humanitarian interventions to reach the most marginalized female program participants,” said one representative of an NGO that works on nutrition and sanitation.

For the past year female Yemeni aid workers have had to take a mahram when crossing provincial borders controlled by the Houthi group, a religious, political and military movement that controls north Yemen. In four provinces, they even need a guardian to move within the province.

“Female (Yemeni) staff have not been able to work outside our offices for almost two years which is catastrophic for their development, morale, motivation and also most obviously for us reaching women and girls in the field in a culturally sensitive way,” said an employee of another NGO, describing the situation in some areas.

Project quality in the NGO’s work on food and health provision has been “very damaged,” she said.

The women all requested anonymity due to safety fears.

A spokesman for the Houthis’ aid coordination body SCMCHA said they supported aid delivery, but organizations should respect traditions.

“Mahram is a religious Islamic obligation and a belief culture ... Why do organizations put up obstacles to Islamic teachings and Yemeni culture?” he said.

The Houthis have increasingly promoted conservative social values since ousting the government from the capital, Sanaa, in late 2014.

Movement restrictions increased ad hoc before becoming more systematic and targeting aid workers with mahram requirements.

The UN and governments including the US say the restrictions impact women’s ability to participate in public and political life and must stop.

In protest, most international NGOs have refused to include guardians when applying for aid work travel permits — resulting in those permits being declined. NGOs have also suspended travel on UN flights from Sanaa in protest.

“This smothering rule gives men power over women’s lives and is an unacceptable form of gender-based discrimination,” Amnesty International said.

Yemeni law does not impose male guardianship rules, and authorities in the south do not impose them.

“We want to achieve more, to be stronger, more independent. But they restrict that,” said one city-based aid worker who cannot monitor distant projects due to a lack of male relatives.

While humanitarians are the main target of mahram rules, directives requesting car hire and transport companies ensure mahram compliance extended it to all women – although these are less strictly applied.

“If women have to travel without a mahram, they are detained at checkpoints and kept until a male guardian arrives,” another aid worker said.

The women described taking boy relatives out of school, driving sick relatives around to ensure a man in the car, and last minute meeting cancellations.

“You have the burden to pay for your relative. To pay for accommodation, transportation, food ... It is not cost effective for us or for donors,” said a health worker.

IMF says preparing for first review of Egypt program, dates to be confirmed

Updated 23 March 2023

IMF says preparing for first review of Egypt program, dates to be confirmed

  • Disbursements under the 46-month program are subject to eight reviews

CAIRO: Preparations for the first review of Egypt’s economic reform program with the International Monetary Fund have begun and dates for the review mission will be announced when agreed with the authorities, an IMF spokesperson said on Thursday.
The IMF approved in December a $3 billion Extended Fund Facility loan for Egypt, which has been under acute financial pressure since long-standing problems were exposed by the economic fallout from the war in Ukraine.
Disbursements under the 46-month program are subject to eight reviews, the first of which was dated March 15, 2023 in an IMF staff report published in December.
Among the key commitments that Egypt made to secure the loan were a permanent shift to a flexible exchange rate regime and wide-ranging structural reforms to reduce the state’s footprint in the economy.
Egypt’s currency has lost nearly 50 percent of its value over the past year following three sharp devaluations. In the past two weeks it has traded in a narrow band between 30.75 and 30.95 pounds to the dollar, according to Eikon data, although the pound’s value on the black market has slipped.
Analysts say the pound has come under renewed pressure partly due to delays in expected sales of state assets.