Insomnia and the use of sleep medications among nurses in northwest Iran: A web-based survey of prevalence and correlates
-
Atefe Asadpour Asl
,
Elnaz Asghari
,
Farnaz Rahmani
,
Leili Zialame
,
Parvin Sarbakhsh
,
Amir Saberi Kojabadi
Abstract
Background & Aim: There is a growing global reliance on sleep medications among healthcare professionals, raising concerns about dependency and health outcomes. This study aimed to assess the prevalence of insomnia, sleep medication usage, and their correlates among nurses.
Methods & Materials: This cross-sectional study employed a web-based survey to recruit 1,213 nurses from university hospitals in East Azerbaijan Province, Iran, via institutional portals. Participants completed the Insomnia Severity Index and a profile of insomnia medication usage. The data were analyzed using descriptive statistics, analytical tests, and multiple linear regression in SPSS 21 (p< 0.05).
Results: Among 1,213 participants (84.3% female, mean age 36.9 ± 8.5 years), the majority had subclinical (52.6%) or moderate (38.3%) insomnia. While 41.2% reported using non-drug methods for insomnia, 73.5% did not use any sleep medication. Among medication users, benzodiazepines (10.5%) and herbal remedies (9.5%) were most common. Nurses working rotating shifts (t = -5.93, p< 0.001) and those with >3-night shifts per week (F=19.41, p< 0.001) had higher insomnia severity scores. Multiple linear regression revealed that female gender (β= 1.780, p= 0.009), married status (β= 0.740, p= 0.009), non-use of benzodiazepines (β=-1.284, p = 0.004), and use of non-drug methods (β = -1.789, p< 0.001) were significantly associated with higher ISI score.
Conclusion: Nurses exhibit high insomnia rates and medication dependence, necessitating urgent integration of non-drug approaches like optimized shifts and sleep hygiene programs to reduce severity and improve well-being.
1. Zhang Y, Murphy J, Lammers‐van der Holst HM, Barger LK, Lai YJ, Duffy JF. Interventions to improve the sleep of nurses: A systematic review. Research in Nursing & Health. 2023 Oct;46(5):462-84. https://doi.org/10.1002/nur.22337
2. Salehi H, Amini A, Feizzy-Amiry B, Pakpour V. Assessing the quality of sleep among nurses working at educational hospitals of Zanjan University of Medical Sciences and its related factors. Nursing Practice Today. 2017;4(4):164-9.
3. Azoulay E, Cariou A, Bruneel F, Demoule A, Kouatchet A, Reuter D, Souppart V, Combes A, Klouche K, Argaud L, Barbier F. Symptoms of anxiety, depression, and peritraumatic dissociation in critical care clinicians managing patients with COVID-19. A cross-sectional study. American Journal of Respiratory and Critical Care Medicine. 2020 Nov 15;202(10):1388-98. https://doi.org/10.1164/rccm.202006-2568OC
4. Dorrian J, Paterson J, Dawson D, Pincombe J, Grech C, Rogers AE. Sleep, stress, and compensatory behaviors in Australian nurses and midwives. Revista de saude publica. 2011;45:922-30. https://doi.org/10.1590/S0034-89102011005000059
5. Ielapi N, Andreucci M, Bracale UM, Costa D, Bevacqua E, Bitonti A, Mellace S, Buffone G, Candido S, Provenzano M, Serra R. Insomnia prevalence among Italian night-shift nurses. Nursing Reports. 2021 Jul 12;11(3):530-5. https://doi.org/10.3390/nursrep11030050
6. Wang MF, Shao P, Wu C, Zhang LY, Zhang LF, Liang J, Du J. The relationship between occupational stressors and insomnia in hospital nurses: the mediating role of psychological capital. Frontiers in Psychology. 2023 Feb 14;13:1070809. https://doi.org/10.3389/fpsyg.2022.1070809
7. Sadeghniiat-Haghighi K, Najafi A, Eftekhari S, Tarkhan S. Insomnia and its association with absenteeism: A cross-sectional study among Iranian nursing team. Sleep Science. 2021 Dec;14(04):305-10. https://doi.org/10.5935/1984-0063.20200106
8. Hwang E, Yu Y. Effect of sleep quality and depression on married female nurses' work-family conflict. International Journal of Environmental Research and Public Health. 2021 Jul 23;18(15):7838. https://doi.org/10.3390/ijerph18157838
9. Membrive-Jiménez MJ, Gómez-Urquiza JL, Suleiman-Martos N, Velando-Soriano A, Ariza T, De la Fuente-Solana EI, Cañadas-De la Fuente GA. Relation between Burnout and Sleep Problems in Nurses: A Systematic Review with Meta-Analysis. Healthcare (Basel). 2022 May 21;10(5):954. https://doi.org/10.3390/healthcare10050954
10. Forthun I, Waage S, Pallesen S, Moen BE, Bjorvatn B. Sleep medication and melatonin use among Norwegian nurses-A cross‐sectional study. Nursing Open. 2022 Jan;9(1):233-44. https://doi.org/10.1002/nop2.1057
11. Sayehmiri K, Mohammadi E. Sleep disturbances among nurses in Iran: A meta-analysis. Iranian Red Crescent Medical Journal. 2018 Nov 1;20(11):92. https://doi.org/10.5812/ircmj.62089
12. Guo W, Nazari N, Sadeghi M. Cognitive-behavioral treatment for insomnia and mindfulness-based stress reduction in nurses with insomnia: A non-inferiority internet-delivered randomized controlled trial. PeerJ. 2024 Jul 24;12:e17491. https://doi.org/10.7717/peerj.17491
13. Joshaghani FB, Sarahroodi S. Pharmacists' Counseling and Benzodiazepines Dispensing for Sleep Disorders: A Simulated Patient Study in Iran. Journal of Research in Pharmacy Practice. 2024 Jan 1;13(1):1-6. https://doi.org/10.4103/jrpp.jrpp_24_24
14. Chaiard J, Deeluea J, Suksatit B, Songkham W, Inta N. Short sleep duration among Thai nurses: Influences on fatigue, daytime sleepiness, and occupational errors. Journal of Occupational Health. 2018 Sep;60(5):348-55. https://doi.org/10.1539/joh.2017-0258-OA
15. Sadeghniiat-Haghighi K, Montazeri A, Khajeh-Mehrizi A, Nedjat S, Aminian O. The Insomnia Severity Index: cross-cultural adaptation and psychometric evaluation of a Persian version. Quality of Life Research. 2014 Mar;23(2):533-7. https://doi.org/10.1007/s11136-013-0489-3
16. Qi J, Xu J, Li BZ, Huang JS, Yang Y, Zhang ZT, Yao DA, Liu QH, Jia M, Gong DK, Ni XH. The evaluation of sleep disturbances for Chinese frontline medical workers under the outbreak of COVID-19. Sleep Medicine. 2020 Aug 1;72:1-4. https://doi.org/10.1016/j.sleep.2020.05.023
17. Zhan Y, Liu Y, Liu H, Li M, Shen Y, Gui L, Zhang J, Luo Z, Tao X, Yu J. Factors associated with insomnia among Chinese front‐line nurses fighting against COVID‐19 in Wuhan: A cross‐sectional survey. Journal of Nursing Management. 2020 Oct;28(7):1525-35. https://doi.org/10.1111/jonm.13094
18. Pappa S, Ntella V, Giannakas T, Giannakoulis VG, Papoutsi E, Katsaounou P. Prevalence of depression, anxiety, and insomnia among healthcare workers during the COVID-19 pandemic: A systematic review and meta-analysis. Brain, Behavior, and Immunity. 2020 Aug 1;88:901-7. https://doi.org/10.1016/j.bbi.2020.05.026
19. Huang Q, Tian C, Zeng XT. Poor sleep quality in nurses working or having worked night shifts: A cross-sectional study. Frontiers in Neuroscience. 2021 Aug 3;15:638973. https://doi.org/10.3389/fnins.2021.638973
20. Rocha MC, Martino MM. Stress and sleep quality among registered nurses who use sleeping pills. Acta Paulista de Enfermagem. 2009;22:658-65. https://doi.org/10.1590/S0103-21002009000500010
21. Ebatetou EA, Atipo-Galloye P, Moukassa D. Shift work: Impact on nurses' health and quality life in pointe-noire (Congo). Open Journal of Epidemiology. 2020 Dec 17;11(01):16-30. https://doi.org/10.4236/ojepi.2021.111002
22. Di Muzio M, Diella G, Di Simone E, Pazzaglia M, Alfonsi V, Novelli L, Cianciulli A, Scarpelli S, Gorgoni M, Giannini A, Ferrara M. Comparison of sleep and attention metrics among nurses working shifts on a forward-vs backward-rotating schedule. JAMA Network Open. 2021 Oct 1;4(10):e2129906. https://doi.org/10.1001/jamanetworkopen.2021.29906
23. Jensen HI, Larsen JW, Thomsen TD. The impact of shift work on intensive care nurses' lives outside work: A cross‐sectional study. Journal of Clinical Nursing. 2018 Feb;27(3-4):e703-9. https://doi.org/10.1111/jocn.14197
24. Shin S, Kim S. Rotating between day and night shifts: Factors influencing sleep patterns of hospital nurses. Journal of Clinical Nursing. 2021 Nov;30(21-22):3182-93. https://doi.org/10.1111/jocn.15819
2. Salehi H, Amini A, Feizzy-Amiry B, Pakpour V. Assessing the quality of sleep among nurses working at educational hospitals of Zanjan University of Medical Sciences and its related factors. Nursing Practice Today. 2017;4(4):164-9.
3. Azoulay E, Cariou A, Bruneel F, Demoule A, Kouatchet A, Reuter D, Souppart V, Combes A, Klouche K, Argaud L, Barbier F. Symptoms of anxiety, depression, and peritraumatic dissociation in critical care clinicians managing patients with COVID-19. A cross-sectional study. American Journal of Respiratory and Critical Care Medicine. 2020 Nov 15;202(10):1388-98. https://doi.org/10.1164/rccm.202006-2568OC
4. Dorrian J, Paterson J, Dawson D, Pincombe J, Grech C, Rogers AE. Sleep, stress, and compensatory behaviors in Australian nurses and midwives. Revista de saude publica. 2011;45:922-30. https://doi.org/10.1590/S0034-89102011005000059
5. Ielapi N, Andreucci M, Bracale UM, Costa D, Bevacqua E, Bitonti A, Mellace S, Buffone G, Candido S, Provenzano M, Serra R. Insomnia prevalence among Italian night-shift nurses. Nursing Reports. 2021 Jul 12;11(3):530-5. https://doi.org/10.3390/nursrep11030050
6. Wang MF, Shao P, Wu C, Zhang LY, Zhang LF, Liang J, Du J. The relationship between occupational stressors and insomnia in hospital nurses: the mediating role of psychological capital. Frontiers in Psychology. 2023 Feb 14;13:1070809. https://doi.org/10.3389/fpsyg.2022.1070809
7. Sadeghniiat-Haghighi K, Najafi A, Eftekhari S, Tarkhan S. Insomnia and its association with absenteeism: A cross-sectional study among Iranian nursing team. Sleep Science. 2021 Dec;14(04):305-10. https://doi.org/10.5935/1984-0063.20200106
8. Hwang E, Yu Y. Effect of sleep quality and depression on married female nurses' work-family conflict. International Journal of Environmental Research and Public Health. 2021 Jul 23;18(15):7838. https://doi.org/10.3390/ijerph18157838
9. Membrive-Jiménez MJ, Gómez-Urquiza JL, Suleiman-Martos N, Velando-Soriano A, Ariza T, De la Fuente-Solana EI, Cañadas-De la Fuente GA. Relation between Burnout and Sleep Problems in Nurses: A Systematic Review with Meta-Analysis. Healthcare (Basel). 2022 May 21;10(5):954. https://doi.org/10.3390/healthcare10050954
10. Forthun I, Waage S, Pallesen S, Moen BE, Bjorvatn B. Sleep medication and melatonin use among Norwegian nurses-A cross‐sectional study. Nursing Open. 2022 Jan;9(1):233-44. https://doi.org/10.1002/nop2.1057
11. Sayehmiri K, Mohammadi E. Sleep disturbances among nurses in Iran: A meta-analysis. Iranian Red Crescent Medical Journal. 2018 Nov 1;20(11):92. https://doi.org/10.5812/ircmj.62089
12. Guo W, Nazari N, Sadeghi M. Cognitive-behavioral treatment for insomnia and mindfulness-based stress reduction in nurses with insomnia: A non-inferiority internet-delivered randomized controlled trial. PeerJ. 2024 Jul 24;12:e17491. https://doi.org/10.7717/peerj.17491
13. Joshaghani FB, Sarahroodi S. Pharmacists' Counseling and Benzodiazepines Dispensing for Sleep Disorders: A Simulated Patient Study in Iran. Journal of Research in Pharmacy Practice. 2024 Jan 1;13(1):1-6. https://doi.org/10.4103/jrpp.jrpp_24_24
14. Chaiard J, Deeluea J, Suksatit B, Songkham W, Inta N. Short sleep duration among Thai nurses: Influences on fatigue, daytime sleepiness, and occupational errors. Journal of Occupational Health. 2018 Sep;60(5):348-55. https://doi.org/10.1539/joh.2017-0258-OA
15. Sadeghniiat-Haghighi K, Montazeri A, Khajeh-Mehrizi A, Nedjat S, Aminian O. The Insomnia Severity Index: cross-cultural adaptation and psychometric evaluation of a Persian version. Quality of Life Research. 2014 Mar;23(2):533-7. https://doi.org/10.1007/s11136-013-0489-3
16. Qi J, Xu J, Li BZ, Huang JS, Yang Y, Zhang ZT, Yao DA, Liu QH, Jia M, Gong DK, Ni XH. The evaluation of sleep disturbances for Chinese frontline medical workers under the outbreak of COVID-19. Sleep Medicine. 2020 Aug 1;72:1-4. https://doi.org/10.1016/j.sleep.2020.05.023
17. Zhan Y, Liu Y, Liu H, Li M, Shen Y, Gui L, Zhang J, Luo Z, Tao X, Yu J. Factors associated with insomnia among Chinese front‐line nurses fighting against COVID‐19 in Wuhan: A cross‐sectional survey. Journal of Nursing Management. 2020 Oct;28(7):1525-35. https://doi.org/10.1111/jonm.13094
18. Pappa S, Ntella V, Giannakas T, Giannakoulis VG, Papoutsi E, Katsaounou P. Prevalence of depression, anxiety, and insomnia among healthcare workers during the COVID-19 pandemic: A systematic review and meta-analysis. Brain, Behavior, and Immunity. 2020 Aug 1;88:901-7. https://doi.org/10.1016/j.bbi.2020.05.026
19. Huang Q, Tian C, Zeng XT. Poor sleep quality in nurses working or having worked night shifts: A cross-sectional study. Frontiers in Neuroscience. 2021 Aug 3;15:638973. https://doi.org/10.3389/fnins.2021.638973
20. Rocha MC, Martino MM. Stress and sleep quality among registered nurses who use sleeping pills. Acta Paulista de Enfermagem. 2009;22:658-65. https://doi.org/10.1590/S0103-21002009000500010
21. Ebatetou EA, Atipo-Galloye P, Moukassa D. Shift work: Impact on nurses' health and quality life in pointe-noire (Congo). Open Journal of Epidemiology. 2020 Dec 17;11(01):16-30. https://doi.org/10.4236/ojepi.2021.111002
22. Di Muzio M, Diella G, Di Simone E, Pazzaglia M, Alfonsi V, Novelli L, Cianciulli A, Scarpelli S, Gorgoni M, Giannini A, Ferrara M. Comparison of sleep and attention metrics among nurses working shifts on a forward-vs backward-rotating schedule. JAMA Network Open. 2021 Oct 1;4(10):e2129906. https://doi.org/10.1001/jamanetworkopen.2021.29906
23. Jensen HI, Larsen JW, Thomsen TD. The impact of shift work on intensive care nurses' lives outside work: A cross‐sectional study. Journal of Clinical Nursing. 2018 Feb;27(3-4):e703-9. https://doi.org/10.1111/jocn.14197
24. Shin S, Kim S. Rotating between day and night shifts: Factors influencing sleep patterns of hospital nurses. Journal of Clinical Nursing. 2021 Nov;30(21-22):3182-93. https://doi.org/10.1111/jocn.15819
| Issue | Articles in Press | |
| Section | Original Article(s) | |
| Keywords | ||
| insomnia severity; nurses; benzodiazepines; shift work; regression analysis | ||
| Rights and permissions | |
|
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
How to Cite
1.
Asadpour Asl A, Asghari E, Rahmani F, Zialame L, Sarbakhsh P, Saberi Kojabadi A. Insomnia and the use of sleep medications among nurses in northwest Iran: A web-based survey of prevalence and correlates. NPT. 2025;:X-X.
