Too tired to learn: insomnia, sleep quality, and sleep aid practices among Kasr Al Ainy medical students: a...

Medical students face a unique set of challenges, including high academic stress, irregular schedules, and clinical responsibilities, which place them at increased risk for sleep disturbance, particularly insomnia.

This study aimed to assess the prevalence of insomnia using the DSM-5-TR core symptoms, evaluate sleep quality using the Pittsburgh Sleep Quality Index (PSQI), and investigate the use and safety of sleep aid medications in this population. A cross-sectional survey was conducted among 1,640 Kasr Al Ainy medical students, Cairo, Egypt. Data collected included demographic characteristics, medical history, insomnia symptoms, and PSQI scoring. Sleep aid utilization, including off-label use of medications like quetiapine, was specifically examined.

The mean age of participants was 20.53 ± 2.08 years, with 58.7% being female. A total of 80% reported at least one insomnia symptom, and 93.7% had poor sleep quality (PSQI ≥ 5). Psychiatric conditions were reported by 29.2% of participants, significantly more common among females (p < 0.001). Although 259 participants were taking medications with sedative properties, only 8.8% sought medical advice for insomnia and just 157 explicitly reported using sleep aids. Melatonin was the most used (n = 121), followed by herbals, eszopiclone, and diphenhydramine. Seventeen participants reported using quetiapine, of whom 13 (76.5%) experienced adverse effects. Among the 12 participants who reported on its effectiveness, 5 (41.7%) perceived it as having limited efficacy.

This study reveals the burden of sleep disturbance among medical students, with a major gap between the prevalence of insomnia and the utilization of professional sleep interventions. The off-label use of quetiapine, even among a small subset of our sample, raises notable safety concerns. This finding serves as an important pharmacovigilance signal and underscores the need for further investigation into the risks associated with this potentially hazardous practice. Non-pharmacological strategies such as sleep hygiene education and cognitive-behavioral interventions are needed.