Prevalence and Factors Associated with The Use of Over-the-counter Sleep Aids Among Training Residents at King Fahad Medical City, Riyadh, Saudi Arabia.

Prevalence and Factors Associated with The Use of Over-the-counter Sleep Aids Among Training Residents at King Fahad Medical City, Riyadh, Saudi Arabia. | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Prevalence and Factors Associated with The Use of Over-the-counter Sleep Aids Among Training Residents at King Fahad Medical City, Riyadh, Saudi Arabia. Anas Alonezan, Abdulmhsen Alobidan, Alhassna Alkahmous, Nora Alhumaid, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6563372/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 24 Sep, 2025 Read the published version in Sleep Science and Practice → Version 1 posted 17 You are reading this latest preprint version Abstract Introduction: Sleep quality is a key factor in the overall health and performance of healthcare professionals, especially medical residents, whose irregular schedules and high-stress levels frequently result in poor sleep and dependence on over-the-counter (OTC) sleep aids. This study examined the prevalence of OTC sleep aid usage, contributing factors, and effects on sleep quality. Methods : A cross-sectional study was conducted among medical residents at King Fahad Medical City, Riyadh, Saudi Arabia. The data were collected using a validated self-administered questionnaire. Sleep quality was evaluated using the Pittsburgh Sleep Quality Index (PSQI). Demographic characteristics and data related to the use of OTC sleep aids were also collected. Results : The study involved 329 residents, 47.4% of whom reported using OTC sleep aids primarily on an as-needed basis (76.8%). The mean PSQI score for all participants was 8.16 ± 3.57, indicating generally poor sleep quality. Sleep quality was significantly worse among OTC sleep aid users, as shown by higher global PSQI scores compared to non-users (9.15 ± 3.61 vs. 7.28 ± 3.29, respectively, p < 0.001). Surgical residents had the highest prevalence of OTC sleep aid use (57.1%) and demonstrated poorer sleep quality (PSQI 9.20 ± 3.73) compared to medical residents (46.8%, PSQI: 7.97 ± 3.51, p = 0.02). Work-related demands were the most common reason for using sleep aids (57.24%), followed by resetting circadian rhythms (48.03%) and emotional stress (30.92%). Side effects were reported by 38.4% of users, with fatigue and drowsiness being the most frequent complaints. Conclusion : The use of OTC sleep aids was highly prevalent among medical residents. These results suggest the need for interventions to improve residents' sleep quality and reduce reliance on OTC sleep aids. Implementing work schedule reforms, providing non-pharmacological solutions, and promoting sleep hygiene education are essential to address the causes of sleep disturbances. Figures Figure 1 Figure 2 Figure 3 Figure 4 1. Introduction Sleep is essential to health and well-being and affects cognitive performance, emotional stability, and physical health. It is also crucial for immune function and cardiovascular stability [1,2]. Recently, sleep disorders have emerged as a public health concern. Various studies showed a 10% – 30% prevalence of insomnia in the population, and some even reported rates as high as 50%–60% [3,4]. The prevalence was even higher in older adults, females, and those with medical and mental illnesses [5]. Sleep disorders significantly impact the quality of life and increase the risk of chronic disease states such as hypertension, diabetes, and depression [6,7]. Studies also showed that insufficient sleep is prevalent among working adults, adolescents, and children, which could be attributed to lifestyle factors, pressure from society, and increased screen time [8]. Over-the-counter (OTC) sleep aids have emerged in response to these concerns to reduce the morbidities associated with such conditions and improve the quality of life. These medications include diphenhydramine, a sedating antihistamine, and melatonin, a natural hormone regulating sleep-wake cycles. They are often used as first-line treatments for sleep disturbances as they are readily available, and most have minimal side effects [9]. Nonetheless, there is still conflicting evidence regarding the efficacy of these medications [10] , and the short-term relief provided by OTC sleep aids still poses risks such as dependency and tolerance and adverse effects such as daytime drowsiness and cognitive impairment [11]. They may also cause next-day sedation, cognitive impairments, and dependency that can be harmful to both personal health and job performance [12]. Furthermore, studies suggest that sleep disorders are associated with the development of long-term health issues such as insulin resistance, obesity, and metabolic syndrome [13,14]. Healthcare professionals (HCPs), especially medical residents, are at higher risk of sleep disorders due to the nature of their work schedule, high-stress levels, and irregular working hours [15,16]. These factors disrupt their normal circadian rhythms, leading to poor and inadequate sleep [17]. Research showed that approximately 84% of emergency medicine physicians had insomnia while practicing, with 67% reporting the use of pharmacological sleep aids to overcome sleep loss. In addition, a systematic review showed a high prevalence of sleep disorders among physicians, including sleep deprivation (71%), daytime sleepiness (52%), and insomnia (37%), with burnout rates at approximately 50% which indicates an urgent need for sleep health management to enhance physician well-being and patient safety [18]. Sleep aid dependence itself is much more common among HCPs than among non-clinicians because of their workplace stress. A study conducted in Saudi Arabia showed that 36.6% of emergency health providers used sleeping aids, with antihistamines being the most consumed drugs [19]. In addition to the effect on health, dependency on OTC sleep aids has other negative consequences. The residual cognitive impairments from these medications increase the risk of medical errors, which negatively affects patients’ safety [20,21]. Moreover, the long-term use of sleep aids could mask the underlying chronic sleep disorder, which hinders the appropriate diagnosis and treatment of such disorders [10]. These findings highlight the urgency of the call for policies and education that positively promote healthy sleep behaviors and minimize reliance on pharmacologic remedies among HCPs. The study aimed to assess the prevalence of OTC sleep aid use among medical residents at King Fahad Medical City (KFMC), Riyadh, and to identify the factors associated with their utilization. The study further examines the association between the use of OTC sleep aids and sleep quality and the motivations for use. 2. Methods 2.1 Study Design and Setting This cross-sectional observational study was conducted at King Fahad Medical City (KFMC) in Riyadh, Saudi Arabia. The study aimed to explore the prevalence and associated factors of over-the-counter (OTC) sleep aid use among medical residents. Data were collected using self-administered questionnaires distributed manually and electronically over five months from August 1 to December 30, 2024. Recruitment was carried out via social media platforms and on-site distribution of questionnaires to maximize participation. 2.2 Study Participants The study included all male and female medical residents actively practicing at KFMC during the data collection period. Residents were excluded if they had been diagnosed with sleep disorders or psychiatric conditions affecting sleep or were on medications that could influence sleep quality. 2.3 Data Collection Tool Data were collected using a validated and modified questionnaire divided into three sections. The first section captured demographic and professional information, including gender, age, marital status, specialty, and residency level. The second section assessed sleep quality using the Pittsburgh Sleep Quality Index (PSQI), which measures seven components: subjective sleep quality, sleep latency, sleep duration, habitual sleep efficiency, sleep disturbances, use of sleep medication, and daytime dysfunction. Each element is scored on a scale from 0 (no difficulty) to 3 (severe difficulty). These component scores are then summed to produce a global PSQI score ranging from 0 to 21. A higher global PSQI score indicates poorer sleep quality [22]. The third section focused on OTC sleep aid use, capturing frequency, duration, motivations, side effects, and alternative methods for improving sleep quality. 2.4 Reliability analysis The reliability of the PSQI was assessed using Cronbach's alpha, a measure of internal consistency. Cronbach's alpha values range from 0 to 1, with values greater than 0.7 indicating greater reliability, suggesting that the items within each questionnaire consistently measure the same underlying construct [23]. The PSQI showed acceptable internal consistency (α = 0.80), indicating moderate reliability. 2.5 Statistical Analysis Statistical analysis was performed using R v 4.3. Counts and percentages were used to summarize categorical variables. The mean ± standard deviation (SD) and the median/interquartile range (IQR) were used for continuous normal and non-normal data, respectively. One-way ANOVA was used to assess factors associated with the global PSQI . For associations involving ordinal variables, Spearman's rank correlation was used. Mann-Whitney U tests were used to compare differences in sleep quality components between groups (e.g., users vs. non-users of OTC sleep aids). Statistical significance was performed at 5% level of significance. 3. Results Table 1. Descriptive statistics for the study sample [ALL] N=329 Gender: Female 154 (46.8%) Male 175 (53.2%) Age: 24-29 279 (84.8%) 30-34 48 (14.6%) 35-39 2 (0.61%) Marital status: Divorced 3 (0.91%) Married 74 (22.5%) Single 252 (76.6%) Specialty: Emergency Medicine 40 (12.2%) Family Medicine 86 (26.1%) Medicine and Medical Specialties 68 (20.7%) OB/GYN 23 (6.99%) Pediatric and Pediatric specialties 52 (15.8%) Preventive Medicine 4 (1.22%) Radiology 28 (8.51%) Surgery and Surgical specialties 28 (8.51%) Residency level: R1 98 (29.8%) R2 106 (32.2%) R3 71 (21.6%) R4 39 (11.9%) R5 13 (3.95%) R6 and more 2 (0.61%) Ever use of OTC sleep aids containing diphenhydramine No 173 (52.6%) Yes 156 (47.4%) Frequency of using OTC sleeping aids: (N = 155) As needed. 119 (76.8%) Daily 13 (8.39%) Monthly 10 (6.45%) Weekly 13 (8.39%) Duration of using OTC sleeping aids (N = 112) Rarely / Single-Use 26 (23.2%) 5 years 11 (9.82%) OTC sleeping aids help improve your sleep quality (N = 155) No 58 (37.4%) Yes 97 (62.6%) Ever experienced any side effects from using over-the-counter sleep aids (N = 151) No 93 (61.6%) Yes 58 (38.4%) Ever tried any other methods for improving sleep quality besides the OTC aids No 225 (68.4%) Yes 104 (31.6%) Data were summarized using counts and percentages. A total of 329 participants completed the study questionnaire, as demonstrated in (Table 1). Regarding gender , slightly more than half (53.2%) were male, while 46.8% were female. The majority of respondents (84.8%) were aged 24–29 years, followed by 14.6% aged 30–34 years, and only 0.6% aged 35–39 years. For marital status , most participants were single (76.6%), while 22.5% were married, and 0.9% were divorced. Concerning specialty , the highest proportion of respondents specialized in Family Medicine (26.1%), followed by Medicine and Medical Specialties (20.7%), Pediatrics and Pediatric Specialties (15.8%), Emergency Medicine (12.2%), Radiology (8.5%), Surgery and Surgical Specialties (8.5%), Obstetrics and Gynecology (7.0%), and Preventive Medicine (1.2%). Residency level showed that the largest group was R2 (32.2%), followed by R1 (29.8%), R3 (21.6%), R4 (11.9%), R5 (4.0%), and R6 or higher (0.6%). Regarding the use of over-the-counter (OTC) sleep aids containing diphenhydramine or melatonin, 47.4% of participants reported using them, while 52.6% had not. Among those who used OTC sleep aids (n = 155), the majority (76.8%) reported using them "as needed," while 8.4% used them daily, 8.4% weekly, and 6.5% monthly. Additionally, 62.6% of sleep aid users indicated that these aids improved their sleep quality, while 37.4% reported no improvement. The duration of using OTC sleeping aids among participants who reported usage (N = 112) varied significantly. Approximately 23.2% of participants reported rare or single-time use, while 29.5% had used OTC sleep aids for less than a year. Those with longer durations of use included 16.1% who reported usage for 1–2 years, 21.4% for 3–5 years, and 9.82% for more than 5 years. These findings suggest that while short-term or infrequent use is common, a notable proportion of participants engage in prolonged usage, raising potential concerns about long-term dependency or effectiveness. Side effects from OTC sleep aids were reported by 38.4% of users, while 61.6% reported no side effects. Regarding alternative methods for improving sleep quality, 31.6% of participants tried methods other than OTC sleep aids, while 68.4% did not. The most frequently reported side effects (Figure 1) reported by users of OTC sleep medications were fatigue (n = 31, 20.53%) and drowsiness (n = 30, 19.87%). Headache followed as the third most common AE (n = 26, 17.22%). Insomnia was reported by 17 individuals (11.26%). Increased heart rate was reported by 13 respondents (8.61%), while less common AEs included nightmares (n = 5, 3.31%), abdominal problems (n = 5, 3.31%), and dry mouth (n = 2, 1.32%). The most frequently reported motivator (Figure 2) for using OTC sleep aids among users (N = 151) was work hours or demands of work , as reported by 57.24% (n = 87) of respondents. This was followed by the need to reset circadian rhythms or the natural sleep cycle , which was reported by 48.03% (n = 73). Work-related emotional stress was a motivator for 30.92% (n = 47), while 21.05% (n = 32) indicated personal or family-related stressors as a reason for use. Lastly, family commitments were cited by 6.58% (n = 10) of respondents as a motivator for using OTC sleep aids. 3.1 Descriptive Statistics for the PSQI For subjective sleep quality (Figure 3), 8.5% of respondents reported no difficulty, 55.9% reported mild difficulty, 29.2% moderate difficulty, and 6.4% severe difficulty. Sleep latency showed that 14.9% of respondents reported no difficulty, 34.0% mild difficulty, 25.8% moderate difficulty, and 25.2% severe difficulty. Sleep duration revealed that 19.4% reported no difficulty, 43.2% mild difficulty, 24.6% moderate difficulty, and 12.8% severe difficulty. For sleep efficiency, 55.6% of respondents reported no difficulty, 16.1% mild difficulty, 8.2% moderate difficulty, and 20.1% severe difficulty. Sleep disturbances were reported as no difficulty by 9.4%, mild difficulty by 68.7%, moderate difficulty by 21.3%, and severe difficulty by 0.6%. The use of sleep medication was reported as no use by 69.0% of respondents, occasional use by 14.9%, frequent use by 7.3%, and regular use by 8.8%. For daytime dysfunction, 18.2% of respondents reported no difficulty, 42.2% mild difficulty, 31.6% moderate difficulty, and 7.9% severe difficulty. Table 2. Descriptive statistics for PSQI and its components variable Min Max Median Q1 Q3 Mean SD Subjective Sleep Quality 0 3 1 1 2 1.33 0.72 Sleep Latency 0 3 2 1 3 1.61 1.02 Sleep Duration 0 3 1 1 2 1.31 0.93 Sleep Efficiency 0 3 0 0 2 0.93 1.20 Sleep Disturbances 0 3 1 1 1 1.13 0.56 Use of Sleep Medication 0 3 0 0 1 0.56 0.96 Daytime Dysfunction 0 3 1 1 2 1.29 0.85 Global_PSQI_Score 0 19 8 6 10 8.16 3.57 The PSQI components (Table 2) showed variability among participants. Subjective sleep quality had a median of 1 [IQR: 1, 2] and a mean of 1.33 ± 0.72. Sleep latency had a median of 2 [IQR: 1, 3] and a mean of 1.61 ± 1.02. Sleep duration had a median of 1 [IQR: 1, 2] and a mean of 1.31 ± 0.93. Sleep efficiency had a median of 0 [IQR: 0, 2] and a mean of 0.93 ± 1.20. Sleep disturbances had a median of 1 [IQR: 1, 1] and a mean of 1.13 ± 0.56. The use of sleep medication had a median of 0 [IQR: 0, 1] and a mean of 0.56 ± 0.96. Daytime dysfunction had a median of 1 [IQR: 1, 2] and a mean of 1.29 ± 0.85. Lastly, the Global PSQI score had a median of 8 [IQR: 6, 10] and a mean of 8.16 ± 3.57. Table 3. Comparison of sleep quality based on any use of OTC sleep medications No use Ever use p.overall N=173 N=156 Subjective Sleep Quality 1.00 [1.00;2.00] 1.00 [1.00;2.00] 0.058 Sleep Latency 1.00 [1.00;2.00] 2.00 [1.00;3.00] <0.001 Sleep Duration 1.00 [1.00;2.00] 1.00 [1.00;2.00] 0.286 Sleep Efficiency 0.00 [0.00;1.00] 0.50 [0.00;2.00] 0.055 Sleep Disturbances 1.00 [1.00;1.00] 1.00 [1.00;1.00] 0.106 Use of Sleep Medication 0.00 [0.00;0.00] 1.00 [0.00;2.00] <0.001 Daytime Dysfunction 1.00 [1.00;2.00] 1.00 [1.00;2.00] 0.103 Global PSQI Score 7.00 [5.00;9.00] 9.00 [6.00;11.0] <0.001 Analysis was performed using the Mann-Whitney test Data were summarized using median [IQR] For subjective sleep quality (Table 3) , the median score was similar between both groups with no statistically significant difference (p = 0.058). Sleep latency was significantly worse in the group that reported using OTC sleep medications, with a median score of 2.00 [IQR 1.00; 3.00] compared to 1.00 [IQR 1.00; 2.00] in the non-user group (p < 0.001). Sleep duration showed no significant difference between both groups (p = 0.286). For sleep efficiency , a trend toward significance was observed, with OTC medication users reporting a slightly higher median score of 0.50 [IQR 0.00; 2.00] compared to 0.00 [IQR 0.00; 1.00] among non-users (p = 0.055). Sleep disturbances were not significantly different between groups (p = 0.106). The use of sleep medication was considerably higher in the group that used OTC medications, with a median score of 1.00 [IQR 0.00; 2.00] compared to 0.00 [IQR 0.00; 0.00] among non-users (p < 0.001). For daytime dysfunction , the median score was not significantly different between groups (p = 0.103). The global PSQI score was significantly higher among OTC sleep medication users, with a median of 9.00 [IQR 6.00; 11.0] compared to 7.00 [IQR 5.00; 9.00] in non-users (p < 0.001). Table 4. Association between demographic characteristics, use of sleep aids, and global PSQI score Variable Level n Mean SD F p Age 24-29 279 8.08 3.54 0.48 0.62 30-34 48 8.62 3.61 35-39 2 8.50 7.78 Frequency of using OTC sleeping aids As needed. 119 8.71 3.60 5.28 < 0.001 Monthly 10 8.20 2.82 Weekly 13 11.77 3.27 Daily 13 11.46 2.79 Gender Female 154 8.53 3.42 3.11 0.08 Male 175 7.84 3.67 Marital status Divorced 3 12.33 5.03 2.10 0.12 Married 74 8.07 3.73 Single 252 8.14 3.49 Specialty Emergency Medicine 40 8.40 3.45 1.37 0.22 Family Medicine 86 7.48 3.73 Medicine and Medical Specialties 68 7.99 3.44 OB/GYN 23 8.78 3.93 1.37 Pediatric and Pediatric specialties 52 8.56 3.23 Preventive Medicine 4 8.50 4.04 Radiology 28 7.71 3.58 Surgery and Surgical specialties 28 9.54 3.58 Specialty Medical 278 7.97 3.51 5.12 0.02 Surgical 51 9.20 3.73 5.12 0.02 Rarely / Single-Use 26 8.65 3.42 Duration of OTC sleep aids 5 years 11 8.18 5.79 Experienced side effects No 93 8.77 3.51 3.45 0.06 Yes 58 9.90 3.77 OTC sleep aids help improve your sleep quality No 58 9.57 3.67 0.97 0.33 Yes 97 8.98 3.56 Residency R1 98 8.03 3.35 1.26 0.28 R2 106 7.79 3.44 R3 71 8.46 3.11 R4 39 8.49 4.57 R5 13 8.85 4.65 R6 and more 2 13.00 5.66 Use of OTC sleeping aids No 173 7.28 3.29 24.14 < 0.001 Yes 156 9.15 3.61 Analysis was performed using one-way ANOVA Data were summarized using mean ± SD. Medical specialties include Family medicine, ER, Medicine, pediatric, radiology, and preventive Surgical specialties include surgery and OBGYN. Age did not show significant differences, with mean scores ranging from 8.08 ± 3.54 for participants aged 24–29 to 8.50 ± 7.78 for those aged 35–39 (p = 0.62). Frequency of OTC sleep aid use, however, highlighted significant differences, with weekly users reporting the highest mean score (11.77 ± 3.27), followed by daily users (11.46 ± 2.79) and as-needed users (8.71 ± 3.60). In contrast, monthly users had the lowest score (8.20 ± 2.82) (p < 0.001). Gender differences were not statistically significant, though females had a slightly higher mean score compared to males (8.53 ± 3.42 vs. 7.84 ± 3.67, respectively, p = 0.08). Regarding the duration of OTC sleep aid use, participants using them for 1–2 years had the highest score (9.83 ± 4.32), while those using them for more than 5 years reported the lowest (8.18 ± 5.79) (p = 0.60). These results are shown in Table 4 . Participants in surgical specialties had higher mean global PSQI scores compared to those in medical specialties (9.20 ± 3.73 vs. 7.97 ± 3.51, p = 0.02). This indicates that residents in surgical specialties, such as Surgery and OB/GYN, reported poorer overall sleep quality than those in medical specialties, including Family Medicine, Emergency Medicine, and Pediatrics. Interestingly, participants who experienced side effects reported slightly higher scores (9.90 ± 3.77) than those who did not (8.77 ± 3.51) although the results were not statistically significant at the 0.05 level (p = 0.06). Similarly, participants who found OTC sleep aids helpful had a mean score of 8.98 ± 3.56, compared to 9.57 ± 3.67 for those who did not perceive an improvement. However, the results were not statistically significant (p = 0.33). Residency level showed no significant association with PSQI scores (p = 0.28). However, participants who used OTC sleep aids had significantly higher scores than non-users (9.15 ± 3.61 vs. 7.28 ± 3.29, respectively, p < 0.001). Table 5. Demographic characteristics associated with using OTC sleep aids Non-users Users p.overall N=173 N=156 Gender: 0.441 Female 77 (50.0%) 77 (50.0%) Male 96 (54.9%) 79 (45.1%) Age: 0.675 24-29 150 (53.8%) 129 (46.2%) 30-34 22 (45.8%) 26 (54.2%) 35-39 1 (50.0%) 1 (50.0%) Marital status: 0.230 Divorced 1 (33.3%) 2 (66.7%) Married 45 (60.8%) 29 (39.2%) Single 127 (50.4%) 125 (49.6%) Specialty: 0.785 Emergency Medicine 19 (47.5%) 21 (52.5%) Family Medicine 47 (54.7%) 39 (45.3%) Medicine and Medical Specialties 33 (48.5%) 35 (51.5%) OB/GYN 13 (56.5%) 10 (43.5%) Pediatric and Pediatric specialties 32 (61.5%) 20 (38.5%) Preventive Medicine 2 (50.0%) 2 (50.0%) Radiology 15 (53.6%) 13 (46.4%) Surgery and Surgical specialties 12 (42.9%) 16 (57.1%) Residency level: 0.084 R1 47 (48.0%) 51 (52.0%) R2 66 (62.3%) 40 (37.7%) R3 31 (43.7%) 40 (56.3%) R4 22 (56.4%) 17 (43.6%) R5 7 (53.8%) 6 (46.2%) R6 and more 0 (0.00%) 2 (100%) Specialty_cat: 0.688 Medical 148 (53.2%) 130 (46.8%) Surgical 25 (49.0%) 26 (51.0%) Data were summarized using counts and percentages Analysis was performed using the Chi-square test of independence No significant associations were found between the sociodemographic characteristics and the use of OTC sleep aids ( P > 0.05 for all comparisons)(See Table 5). Regarding specialty, the highest proportion of OTC sleep aid users was observed in Surgery and Surgical specialties (57.1%), followed by Emergency Medicine (52.5%) and Medicine/Medical specialties (51.5%). The lowest proportion of users was reported in Pediatrics and Pediatric specialties (38.5%), while Family Medicine (45.3%) and OB/GYN (43.5%) showed moderate levels of use. No significant differences were found between specialties (p = 0.785). Regarding OTC (Over-The-Counter) sleep aid usage (Figure 4), there are weak but significant positive correlations between frequency and OTC ever use (r = 0.257, p < 0.01), as well as between PSQI score and OTC ever use (r = 0.249, p < 0.001). Some negative correlations, though not statistically significant, were present, including the relationships between residency level and OTC-improved sleep quality (r = -0.102) and between PSQI score and OTC-improved sleep quality (r = -0.104). Table 6. Other methods for improving sleep quality besides OTC sleep aids Method / Category n % Sleep hygiene (consistent schedule, dim lights, limit caffeine/screen) 42 43% Exercise / physical activity (gym, cardio, yoga as workout) 26 27% Meditation/breathing/relaxation (mindfulness, breathing drills) 20 21% Herbal/natural remedies (chamomile, lavender, ashwagandha, Mg, etc.) 18 19% Spiritual / Quran (listening to Qur’an, spiritual recitation) 12 12% Prescription meds (quetiapine, trazodone, SSRIs, mirtazapine, etc.) 10 10% Environment manipulations (hot/cold shower, cold/dark room, new pillow) 10 10% Other (e.g. “sleep cycle alarm,” “forcing long wake,” “CPAP,” “OSA device”) 9 9% Sleep hygiene was the most frequently mentioned other method for improving sleep (43%), as shown in Table 6. One-quarter of respondents (27%) favored exercise or physical activity . Another 21% adopted meditation or breathing exercises like mindfulness or guided relaxation before bed. Around 19% reported using herbal or natural remedies , while 12% relied on spiritual or Quranic recitations for calming the mind. Roughly 10% turned to prescription medications such as quetiapine or SSRIs. Environmental adjustments—like taking a hot or cold shower or ensuring a dark, cool bedroom—were reported by 10% of participants. Finally, 9% used other methods , including sleep cycle alarms, intentional long wake times, or medical devices (e.g., CPAP). 4. Discussion The current study highlights the significant use of OTC sleep aids among medical residents, with 47.4% reporting their use. Three-quarters of the users used them as needed (76.8%), which indicates an occasional but widespread dependency on pharmacological options to manage sleep disturbances. These findings align with other studies, which showed that the use of sleep aids among healthcare professionals is high, which can be explained by the demanding nature of the profession and irregular schedules [19,24]. Residents are often challenged by extended work hours, emotional stress, and disruptions in the circadian rhythm, which are associated with poor sleep quality and dependency on pharmacological options to improve sleep quality [25,26]. There appears to be a paradox in the relationship between OTC sleep aid use and sleep quality. At the same time, 62.6% of respondents using OTC sleep aids reported that the use improved sleep quality; the PSQI showed poorer sleep quality among users than non-users. This is most likely because perceived sleep quality is self-assessed, with users perceiving a temporary benefit but not sustaining an improvement. OTC sleep aids primarily address symptoms, such as sleep initiation, without treatment of the underlying causes that lead to disturbances in sleep, such as stress, irregular schedules, or poor sleep hygiene [27]. An important contributor to this paradox is the sporadic use of OTC sleep aids. Most users (76.8%) took these aids as needed rather than on a regular schedule. This erratic use pattern may not be consistent enough to establish a stable sleep routine or effectively treat chronic sleep disturbances. This would leave users having the benefit only on nights the aids are taken, yet still experience overall poor-quality sleep. Evidence from studies indicates that inconsistent patterns of sleep aid use often do not result in significant long-term improvement in sleep outcomes [26]. Another explanation for this paradox was the duration of use of sleep aid medication. Whereas the majority of survey respondents took OTC sleep aids for less than a year, almost half of them reported having been using them for 1–5 or more years (47.3%). Of these users, 9.82% report use over five years. When taken for several years, medications for sleep disturbances may cause tolerance and thus work less effectively the longer they are used. Moreover, individuals experiencing chronic sleep disturbances are more likely to resort to long-term medication, which leads them into a cycle of dependence. It is supported by studies that long-term medication usually bypasses crucial variables in sleep hygiene, stress management, and the psychological causes of sleeping poorly [28]. It is also important to note that using sleeping aids is typically regarded as a quick fix rather than part of a holistic approach to sleep improvement. While many users report improved sleep on certain nights, they usually suffer from poor sleep because their core issues are unresolved. This is further ascertained by the evidence of findings that sleep disturbance has mostly been related to general psychosocial factors, such as occupational stress, irregular schedules, and poor mental health, which sleep aids alone cannot handle [29,30]. Other critical contributions to the disparities in effectiveness brought about by sleep aid medication concern gender and occupational patterns. For instance, it is no surprise that women generally report a disturbance of sleep, thus accounting for their PSQI score, which often happens to be higher. On the other hand, work that involves night shifts or irregular hours disrupts the circadian rhythms significantly and is common in the profession of medical residents, thereby reducing further the efficacy of sleep aids [27,31]. Furthermore, the high prevalence of residual side effects, such as fatigue and residual drowsiness, may reduce the perceived benefits of sleep aids. These adverse effects can lead to impairment in next-day functioning, especially in populations with high-stress environments like healthcare professionals [32]. Finally, some evidence suggests that non-pharmacological approaches, such as improved sleep hygiene and mindfulness-based interventions, may provide more durable improvements in sleep quality without the disadvantages of long-term medication use [33,34]. Surgical residents reported higher use of OTC sleep aids, 57.1%, as compared to 46.8% among medical residents. This could be explained by the nature of work schedules in surgical disciplines that are very demanding, extended hours spent in the operation theatre, undertaking emergency surgeries, and night shifts that disturb the normal circadian rhythm. Consequently, this group has a greater dependence on pharmacological interventions to manage sleep disturbances. Indeed, other studies have also shown such trends, whereby health professionals working in high-pressure settings, such as casualty or theatre, have shown higher reliance on sleeping medications because of irregular working hours and stressors associated with work [25,35,36]. The emotional demands of surgery, such as managing critical cases, further contribute to stress-related insomnia and increased dependence on sleep aids [19]. Surgical residents had significantly poorer sleep quality, as reflected in higher global PSQI scores (mean 9.20 ± 3.73) when compared with the medical residents (mean 7.97 ± 3.51, p = 0.02). This reflects the increased physical and cognitive demands of surgical practice. Long working hours, high-stress decision-making, and the need for sharp focus during surgery disrupt sleep patterns and increase stress. Evidence has shown that surgical residents experience a higher rate of sleep deprivation, which is a known risk factor for poor sleep quality and increased use of sleep aids [37]. In general, sleep disturbances experienced by surgical specialties are mainly attributed to irregular hours. In addition, work schedules, night duties, and procedures disrupt the circadian rhythm, impacting negatively on the pursuit of a normal sleep regimen. Indeed, several studies confirm that irregular schedules result in poor quality sleep and the use of sleep aids among HCPs, especially among specialties requiring night shifts [38]. Emotional stress is also higher in surgical residents which can be attributed to the pressure to handle life-and-death cases, and the fear of making surgical mistakes, which contributes to stress-induced insomnia. Other factors associated with sleep disturbance in surgical residency include physical tiredness. The long working hours and the intensive nature of performing surgeries paradoxically impair the ability of residents to fall asleep. The resultant fatigue drives residents towards sleep aids as a convenient solution. In alignment with other research, physical fatigue along with high-stakes ecology led to a higher prevalence of the usage of sleep aids [39]. Furthermore, surgical residents face challenges due to the side effects of sleep aids, such as drowsiness or cognitive impairments, which can affect decision-making and increase the risk of errors during surgeries [40]. Several strategies should be implemented to address the high prevalence of OTC sleep aid use and improve sleep quality among residents. First, implementing better work schedules that minimize night shifts and ensure adequate rest periods, can reduce the disruptions in circadian rhythm [41]. Hospitals should provide non-pharmacological solutions, such as cognitive-behavioral therapy for insomnia, mindfulness-based stress reduction, and sleep hygiene training. These techniques have been effective in managing sleep disturbances [42]. Residents should also receive education about sleep hygiene and the risks of long-term OTC sleep aid use, including dependency, tolerance, and potential cognitive impairments [43]. Stress management programs and counseling services should be provided to help overcome high-stress levels and address the psychological burden associated with poor sleep. Finally, creating a supportive workplace culture could reduce sleep disturbances, improve work-life balance, and promote non-pharmacological approaches to achieving better sleep [44]. 5. Limitations There are several limitations to this study. First, data were self-reported using questionnaires, which is susceptible to recall bias or subjective misrepresentation concerning estimating sleep quality and the use of sleep aids. The cross-sectional design doesn't allow for making any causal inferences between the use of OTC sleep aids and the quality of sleep. Longitudinal studies can more successfully capture the long-term effects associated with using OTC sleep aids and related sleep quality. Finally, this was a single-center study, and although done in an institution, it is impossible to fully generalize to other regions or health systems with different residency structures or cultural attitudes towards the use of sleep aids. 6. Conclusion This study highlights the high prevalence of OTC sleep aid use among medical residents. The findings highlight the need for interventions to address sleep quality and reduce dependency on pharmacological solutions among healthcare professionals. Implementing tailored work schedules, non-pharmacological therapies, and stress management programs can help improve sleep quality and minimize reliance on OTC sleep aids. 7. Declarations 7.1 Funding This research did not receive specific grants from any funding agency within the public, commercial, or non-profit sectors. 7.2 Ethical Considerations Written informed consent was obtained from all participants through a consent form attached to the questionnaire on the front page explaining the study title and its purpose. The study was done in accordance to the Declaration of Helsinki standards, and ethical approval for the study was granted by the KFMC Institutional Review Board (IRB Log Number: 24-366). Confidentiality and anonymity were also maintained by excluding any identifiable participant information. 7.3 Data Availability The datasets obtained and analyzed in this study are available from the corresponding author upon request. 7.4 Competing Intrest The authors declare that they have no competing interests. 7.5 Consent to publish Not Applicable 8. Acknowledgment The authors would like to express their gratitude to all residents who participated in this study and appreciate the support of the administration at King Fahad Medical City for their cooperation and facilitation. References N. Toschi, L. Passamonti and M. Bellesi, Sleep quality relates to emotional reactivity via intracortical myelination , Sleep 44 (2021), . M.R. Irwin, Why sleep is important for health: A psychoneuroimmunology perspective , Annu. Rev. Psychol. 66 (2015), pp. 143–172. DJ Taylor, LJ Mallory, KL Lichstein, HH Durrence, BW RIEDEL and AJ Bush, Comorbidity of chronic insomnia with medical problems , Sleep 30 (2007), pp. 213–218. M. Daniel J. Buysse, M. ; Jules Angst, P. ; Alex Gamma, P. ; Vladeta Ajdacic, M. ; Dominique Eich and M. ; Wulf Rössler, MA, Prevalence, Course, and Comorbidity of Insomnia and Depression in Young Adults , Sleep SLEEP, Vol (2008), pp. 37–39. S.L. Schutte-Rodin, L. Broch, D. Buysee, C. Dorsey and M. 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Radek, Widely Used, Rarely Studied-the Over-the-Counter Sleep Aids , J. Sleep Disord. Ther. 07 (2018), . V. Clement-Carbonell, I. Portilla-Tamarit, M. Rubio-Aparicio and J.J. Madrid-Valero, Sleep quality, mental and physical health: A differential relationship , Int. J. Environ. Res. Public Health 18 (2021), pp. 1–8. I. Amirian, L.T. Andersen, J. Rosenberg and I. Gögenur, Working night shifts affects surgeons’ biological rhythm , Am. J. Surg. 210 (2015), pp. 389–395. G.W. Williams, B. Shankar, E.M. Klier, A.Z. Chuang, S. El Marjiya-Villarreal, O.O. Nwokolo et al., Sensorimotor and Executive Function Slowing in Anesthesiology Residents After Overnight Shifts , Surv. Anesthesiol. 61 (2017), pp. 123. A.D. Esen, G. Nizamoğlu Mercan, E. Kaçar and D. Toprak, Sleep Quality and Related Factors in Medical Residents , Turkish J. Fam. Med. Prim. Care (2017), pp. 271–277. L.P. Schwartz, S.R. Hursh, L. Boyle, J.E. Davis, M. Smith and S.C. Fitzgibbons, Fatigue in surgical residents an analysis of duty-hours and the effect of hypothetical naps on predicted performance , Am. J. Surg. 221 (2021), pp. 866–871. R.K. Reznick and J.R. Folse, Effect of sleep deprivation on the performance of surgical residents , Am. J. Surg. 154 (1987), pp. 520–525. P.I. Ellman, I.L. Kron, J.S. Alvis, C. Tache-Leon, T.S. Maxey, T.B. Reece et al., Acute sleep deprivation in the thoracic surgical resident does not affect operative outcomes , Ann. Thorac. Surg. 80 (2005), pp. 60–65. D.A. Reed, K.E. Fletcher and V.M. Arora, Systematic review: Association of shift length, protected sleep time, and night float with patient care, residents’ health, and education , Ann. Intern. Med. 153 (2010), pp. 829–842. N.M. Duggan, M. Adrian Hasdianda, O. Baker, G. Jambaulikar, A.J. Goldsmith, A. Condella et al., The Effect of Noise-Masking Earbuds (SleepBuds) on Reported Sleep Quality and Tension in Health Care Shift Workers: Prospective Single-Subject Design Study , JMIR Form. Res. 6 (2022), . K.F. Chung, C.T. Lee, W.F. Yeung, M.S. Chan, E.W.Y. Chung and W.L. Lin, Sleep hygiene education as a treatment of insomnia: A systematic review and meta-analysis , Fam. Pract. 35 (2018), pp. 365–375. S.H. Rose and T.B. Curry, Fatigue, countermeasures, and performance enhancement in resident physicians , Mayo Clin. Proc. 84 (2009), pp. 955–957. Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6563372","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":456265767,"identity":"915ab1d5-7d36-4aa0-9396-c809416c6457","order_by":0,"name":"Anas Alonezan","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA7UlEQVRIiWNgGAWjYFAC5gYIzd7G8AHCSiCkhRGqhecY4wwStUikEamFv/1g4+OCijp5c8lniU03ahii+dkTmD/8wKNF4kxis/GMM2yGO2enHWzOOcaQO7PnAZtkDz5rDiS2SfO28TBuuJ3e/ji3gSF3w40ENgYePDrkzz8EavknYb/h5vHGZpCW/TcSmD/+waPF4AbIlgaDxA032A6CtWyQSGCQxmeL4Y2HzcY8xxKSN5xJSwT6RSJ3xhmgvTJ4tMidTz74mKemznbD8WOGzTk1Nrn97cmHP77B5300IMGAiKlRMApGwSgYBWQDAO54UyxrtJM8AAAAAElFTkSuQmCC","orcid":"","institution":"King Fahd Medical City","correspondingAuthor":true,"prefix":"","firstName":"Anas","middleName":"","lastName":"Alonezan","suffix":""},{"id":456265768,"identity":"ff9e3907-4485-45e8-ba8b-3460a2791602","order_by":1,"name":"Abdulmhsen Alobidan","email":"","orcid":"","institution":"King Fahd Medical 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09:23:21","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6563372/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6563372/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s41606-025-00149-4","type":"published","date":"2025-09-24T15:57:17+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":82896700,"identity":"623a25ae-a1bb-450c-a835-59b24316070b","added_by":"auto","created_at":"2025-05-16 13:01:04","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":117350,"visible":true,"origin":"","legend":"\u003cp\u003eAdverse events experienced by OTC sleep aid users\u003c/p\u003e\n\u003cp\u003e% was calculated from the patients who reported using OTC sleep medication (N = 151)\u003c/p\u003e","description":"","filename":"image1.png","url":"https://assets-eu.researchsquare.com/files/rs-6563372/v1/d85992961f8994ea18334635.png"},{"id":82896698,"identity":"c4e8befa-f1c2-470b-bef9-419ce363dd93","added_by":"auto","created_at":"2025-05-16 13:01:04","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":129862,"visible":true,"origin":"","legend":"\u003cp\u003eMotivators for using OTC sleep aids\u003c/p\u003e\n\u003cp\u003e% was calculated from the patients who reported using OTC sleep medication (N = 151)\u003c/p\u003e","description":"","filename":"image2.png","url":"https://assets-eu.researchsquare.com/files/rs-6563372/v1/91f3f1ef8712d9142f1853d0.png"},{"id":82896697,"identity":"110dada1-db3e-4315-a5c6-fd90da6135c3","added_by":"auto","created_at":"2025-05-16 13:01:04","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":161031,"visible":true,"origin":"","legend":"\u003cp\u003eDescriptive statistics for the PSQI components\u003c/p\u003e\n\u003cp\u003e0 = No difficulty, 3 = Severe difficulty\u003c/p\u003e","description":"","filename":"image3.png","url":"https://assets-eu.researchsquare.com/files/rs-6563372/v1/72e5068bc580346b36fe2f6f.png"},{"id":82898243,"identity":"f4aa0165-8e29-4e07-ad5f-61ff97dbe5df","added_by":"auto","created_at":"2025-05-16 13:09:04","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":201637,"visible":true,"origin":"","legend":"\u003cp\u003eCorrelation between sleep quality, sleep aids use, and demographic characteristics\u003c/p\u003e\n\u003cp\u003eThis figure presents a correlation matrix heatmap illustrating the relationships between the Global PSQI Score, demographic characteristics, and the use of sleep aids. The color intensity represents the strength of correlations, with blue indicating positive and red indicating negative correlations. Darker shades signify stronger associations. Asterisks denote significance levels (* p \u0026lt; 0.05, ** p \u0026lt; 0.01, *** p \u0026lt; 0.001).\u003c/p\u003e","description":"","filename":"image4.png","url":"https://assets-eu.researchsquare.com/files/rs-6563372/v1/1f137a4d8e49d918acb94e1d.png"},{"id":92430441,"identity":"23e34cf5-017b-4bdd-bdec-c5da8cd2347f","added_by":"auto","created_at":"2025-09-29 16:04:10","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1844699,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6563372/v1/88f9e22f-8b41-47c2-a80e-94da27d5deca.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Prevalence and Factors Associated with The Use of Over-the-counter Sleep Aids Among Training Residents at King Fahad Medical City, Riyadh, Saudi Arabia.","fulltext":[{"header":"1. Introduction","content":"\u003cp\u003eSleep is essential to health and well-being and affects cognitive performance, emotional stability, and physical health. It is also crucial for immune function and cardiovascular stability [1,2].\u0026nbsp; Recently, sleep disorders have emerged as a public health concern. Various studies showed a 10% \u0026ndash; 30% prevalence of insomnia in the population, and some even reported rates as high as 50%\u0026ndash;60% [3,4]. The prevalence was even higher in older adults, females, and those with medical and mental illnesses [5]. Sleep disorders significantly impact the quality of life and increase the risk of chronic disease states such as hypertension, diabetes, and depression [6,7]. Studies also showed that insufficient sleep is prevalent among working adults, adolescents, and children, which could be attributed to lifestyle factors, pressure from society, and increased screen time [8].\u003c/p\u003e\n\u003cp\u003eOver-the-counter (OTC) sleep aids have emerged in response to these concerns to reduce the morbidities associated with such conditions and improve the quality of life. These medications include diphenhydramine, a sedating antihistamine, and melatonin, a natural hormone regulating sleep-wake cycles. They are often used as first-line treatments for sleep disturbances as they are readily available, and most have minimal side effects [9]. Nonetheless, there is still conflicting evidence regarding the efficacy of these medications [10] , and the short-term relief provided by OTC sleep aids still poses risks such as dependency and tolerance and adverse effects such as daytime drowsiness and cognitive impairment [11]. They may also cause next-day sedation, cognitive impairments, and dependency that can be harmful to both personal health and job performance [12]. Furthermore, studies suggest that sleep disorders are associated with the development of long-term health issues such as insulin resistance, obesity, and metabolic syndrome [13,14].\u003c/p\u003e\n\u003cp\u003eHealthcare professionals (HCPs), especially medical residents, are at higher risk of sleep disorders due to the nature of their work schedule, high-stress levels, and irregular working hours [15,16]. These factors disrupt their normal circadian rhythms, leading to poor and inadequate sleep [17]. Research showed that approximately 84% of emergency medicine physicians had insomnia while practicing, with 67% reporting the use of pharmacological sleep aids to overcome sleep loss. In addition, a systematic review showed a high prevalence of sleep disorders among physicians, including sleep deprivation (71%), daytime sleepiness (52%), and insomnia (37%), with burnout rates at approximately 50% which indicates an urgent need for sleep health management to enhance physician well-being and patient safety [18]. Sleep aid dependence itself is much more common among HCPs than among non-clinicians because of their workplace stress. A study conducted in Saudi Arabia showed that 36.6% of emergency health providers used sleeping aids, with antihistamines being the most consumed drugs [19].\u003c/p\u003e\n\u003cp\u003eIn addition to the effect on health, dependency on OTC sleep aids has other negative consequences. The residual cognitive impairments from these medications increase the risk of medical errors, which negatively affects patients\u0026rsquo; safety [20,21]. Moreover, the long-term use of sleep aids could mask the underlying chronic sleep disorder, which hinders the appropriate diagnosis and treatment of such disorders [10]. These findings highlight the urgency of the call for policies and education that positively promote healthy sleep behaviors and minimize reliance on pharmacologic remedies among HCPs. The study aimed to assess the prevalence of OTC sleep aid use among medical residents at King Fahad Medical City (KFMC), Riyadh, and to identify the factors associated with their utilization. The study further examines the association between the use of OTC sleep aids and sleep quality and the motivations for use.\u003c/p\u003e"},{"header":"2. Methods","content":"\u003ch2\u003e2.1\u0026nbsp; \u0026nbsp; \u0026nbsp;Study Design and Setting\u003c/h2\u003e\n\u003cp\u003eThis cross-sectional observational study was conducted at King Fahad Medical City (KFMC) in Riyadh, Saudi Arabia. The study aimed to explore the prevalence and associated factors of over-the-counter (OTC) sleep aid use among medical residents. Data were collected using self-administered questionnaires distributed manually and electronically over five months from August 1 to December 30, 2024. Recruitment was carried out via social media platforms and on-site distribution of questionnaires to maximize participation.\u003c/p\u003e\n\u003ch2\u003e2.2\u0026nbsp; \u0026nbsp; \u0026nbsp;Study Participants\u003c/h2\u003e\n\u003cp\u003eThe study included all male and female medical residents actively practicing at KFMC during the data collection period. Residents were excluded if they had been diagnosed with sleep disorders or psychiatric conditions affecting sleep or were on medications that could influence sleep quality.\u003c/p\u003e\n\u003ch2\u003e2.3\u0026nbsp; \u0026nbsp; \u0026nbsp;Data Collection Tool\u003c/h2\u003e\n\u003cp\u003eData were collected using a validated and modified questionnaire divided into three sections. The first section captured demographic and professional information, including gender, age, marital status, specialty, and residency level. The second section assessed sleep quality using the Pittsburgh Sleep Quality Index (PSQI), which measures seven components: subjective sleep quality, sleep latency, sleep duration, habitual sleep efficiency, sleep disturbances, use of sleep medication, and daytime dysfunction. Each element is scored on a scale from 0 (no difficulty) to 3 (severe difficulty). These component scores are then summed to produce a global PSQI score ranging from 0 to 21. A higher global PSQI score indicates poorer sleep quality [22]. The third section focused on OTC sleep aid use, capturing frequency, duration, motivations, side effects, and alternative methods for improving sleep quality.\u003c/p\u003e\n\u003ch2\u003e2.4\u0026nbsp; \u0026nbsp; \u0026nbsp;Reliability analysis\u003c/h2\u003e\n\u003cp\u003eThe reliability of the PSQI was assessed using Cronbach's alpha, a measure of internal consistency. Cronbach's alpha values range from 0 to 1, with values greater than 0.7 indicating greater reliability, suggesting that the items within each questionnaire consistently measure the same underlying construct [23]. The PSQI showed acceptable internal consistency (α = 0.80), indicating moderate reliability.\u003c/p\u003e\n\u003ch2\u003e2.5\u0026nbsp; \u0026nbsp; \u0026nbsp;Statistical Analysis\u003c/h2\u003e\n\u003cp\u003eStatistical analysis was performed using R v 4.3. Counts and percentages were used to summarize categorical variables. The mean ± standard deviation (SD) and the median/interquartile range (IQR) were used for continuous normal and non-normal data, respectively. One-way ANOVA was used to assess factors associated with the \u003cstrong\u003eglobal PSQI\u003c/strong\u003e. For associations involving ordinal variables, Spearman's rank correlation was used. Mann-Whitney U tests were used to compare differences in sleep quality components between groups (e.g., users vs. non-users of OTC sleep aids). Statistical significance was performed at 5% level of significance.\u003c/p\u003e"},{"header":"3. Results","content":"\u003cp\u003eTable 1. Descriptive statistics for the study sample\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"635\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;[ALL] \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; N=329 \u0026nbsp;\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eGender:\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Female\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e154 (46.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Male\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e175 (53.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eAge:\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; 24-29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e279 (84.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; 30-34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e48 (14.6%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; 35-39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;2 (0.61%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMarital status:\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Divorced\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;3 (0.91%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Married\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e74 (22.5%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Single\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e252 (76.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eSpecialty:\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Emergency Medicine\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e40 (12.2%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Family Medicine\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e86 (26.1%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Medicine and Medical Specialties\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e68 (20.7%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; OB/GYN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e23 (6.99%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Pediatric and Pediatric specialties\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e52 (15.8%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Preventive Medicine\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;4 (1.22%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Radiology\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e28 (8.51%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Surgery and Surgical specialties\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e28 (8.51%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eResidency level:\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; R1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e98 (29.8%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; R2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e106 (32.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; R3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e71 (21.6%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; R4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e39 (11.9%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; R5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e13 (3.95%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; R6 and more\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;2 (0.61%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eEver use of OTC sleep aids containing diphenhydramine\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; No\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e173 (52.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Yes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e156 (47.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eFrequency of using OTC sleeping aids: (N = 155)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; As needed.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e119 (76.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Daily\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e13 (8.39%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Monthly\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e10 (6.45%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Weekly\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e13 (8.39%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eDuration of using OTC sleeping aids (N = 112)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Rarely / Single-Use\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e26 (23.2%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026lt;1 year\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e33 (29.5%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; 1\u0026ndash;2 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e18 (16.1%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; 3\u0026ndash;5 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e24 (21.4%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026gt;5 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e11 (9.82%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eOTC sleeping aids help improve your sleep quality (N = 155)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; No\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e58 (37.4%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Yes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e97 (62.6%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eEver experienced any side effects from using over-the-counter sleep aids (N = 151)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; No\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e93 (61.6%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Yes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e58 (38.4%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eEver tried any other methods for improving sleep quality besides the OTC aids\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; No\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e225 (68.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Yes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e104 (31.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eData were summarized using counts and percentages.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eA total of 329 participants completed the study questionnaire, as demonstrated in (Table 1). Regarding \u003cstrong\u003egender\u003c/strong\u003e, slightly more than half (53.2%) were male, while 46.8% were female. The majority of respondents (84.8%) were aged 24\u0026ndash;29 years, followed by 14.6% aged 30\u0026ndash;34 years, and only 0.6% aged 35\u0026ndash;39 years. For \u003cstrong\u003emarital status\u003c/strong\u003e, most participants were single (76.6%), while 22.5% were married, and 0.9% were divorced. Concerning \u003cstrong\u003especialty\u003c/strong\u003e, the highest proportion of respondents specialized in Family Medicine (26.1%), followed by Medicine and Medical Specialties (20.7%), Pediatrics and Pediatric Specialties (15.8%), Emergency Medicine (12.2%), Radiology (8.5%), Surgery and Surgical Specialties (8.5%), Obstetrics and Gynecology (7.0%), and Preventive Medicine (1.2%). \u003cstrong\u003eResidency level\u003c/strong\u003e showed that the largest group was R2 (32.2%), followed by R1 (29.8%), R3 (21.6%), R4 (11.9%), R5 (4.0%), and R6 or higher (0.6%).\u003c/p\u003e\n\u003cp\u003eRegarding the \u003cstrong\u003euse of over-the-counter (OTC) sleep aids\u003c/strong\u003e containing diphenhydramine or melatonin, 47.4% of participants reported using them, while 52.6% had not. Among those who used OTC sleep aids (n = 155), the majority (76.8%) reported using them \u0026quot;as needed,\u0026quot; while 8.4% used them daily, 8.4% weekly, and 6.5% monthly. Additionally, 62.6% of sleep aid users indicated that these aids improved their sleep quality, while 37.4% reported no improvement. The duration of using OTC sleeping aids among participants who reported usage (N = 112) varied significantly. Approximately 23.2% of participants reported rare or single-time use, while 29.5% had used OTC sleep aids for less than a year. Those with longer durations of use included 16.1% who reported usage for 1\u0026ndash;2 years, 21.4% for 3\u0026ndash;5 years, and 9.82% for more than 5 years. These findings suggest that while short-term or infrequent use is common, a notable proportion of participants engage in prolonged usage, raising potential concerns about long-term dependency or effectiveness. \u003cstrong\u003eSide effects from OTC sleep aids\u003c/strong\u003e were reported by 38.4% of users, while 61.6% reported no side effects. Regarding alternative methods for improving sleep quality, 31.6% of participants tried methods other than OTC sleep aids, while 68.4% did not.\u003c/p\u003e\n\u003cp\u003eThe most frequently reported side effects (Figure 1) reported by users of OTC sleep medications were fatigue (n = 31, 20.53%) and drowsiness (n = 30, 19.87%). Headache followed as the third most common AE (n = 26, 17.22%). Insomnia was reported by 17 individuals (11.26%). Increased heart rate was reported by 13 respondents (8.61%), while less common AEs included nightmares (n = 5, 3.31%), abdominal problems (n = 5, 3.31%), and dry mouth (n = 2, 1.32%).\u003c/p\u003e\n\u003cp\u003eThe most frequently reported motivator (Figure 2) for using OTC sleep aids among users (N = 151) was \u003cstrong\u003ework hours or demands of work\u003c/strong\u003e, as reported by 57.24% (n = 87) of respondents. This was followed by the need \u003cstrong\u003eto reset\u003c/strong\u003e\u003cstrong\u003ecircadian rhythms or the natural sleep cycle\u003c/strong\u003e, which was reported by 48.03% (n = 73). \u003cstrong\u003eWork-related emotional stress\u003c/strong\u003e was a motivator for 30.92% (n = 47), while 21.05% (n = 32) indicated \u003cstrong\u003epersonal or family-related stressors\u003c/strong\u003e as a reason for use. Lastly, \u003cstrong\u003efamily commitments\u003c/strong\u003e were cited by 6.58% (n = 10) of respondents as a motivator for using OTC sleep aids.\u003c/p\u003e\n\u003ch2\u003e3.1 \u0026nbsp; \u0026nbsp; Descriptive Statistics for the PSQI\u003c/h2\u003e\n\u003cp\u003eFor subjective sleep quality (Figure 3), 8.5% of respondents reported no difficulty, 55.9% reported mild difficulty, 29.2% moderate difficulty, and 6.4% severe difficulty. Sleep latency showed that 14.9% of respondents reported no difficulty, 34.0% mild difficulty, 25.8% moderate difficulty, and 25.2% severe difficulty. Sleep duration revealed that 19.4% reported no difficulty, 43.2% mild difficulty, 24.6% moderate difficulty, and 12.8% severe difficulty. For sleep efficiency, 55.6% of respondents reported no difficulty, 16.1% mild difficulty, 8.2% moderate difficulty, and 20.1% severe difficulty. Sleep disturbances were reported as no difficulty by 9.4%, mild difficulty by 68.7%, moderate difficulty by 21.3%, and severe difficulty by 0.6%. The use of sleep medication was reported as no use by 69.0% of respondents, occasional use by 14.9%, frequent use by 7.3%, and regular use by 8.8%. For daytime dysfunction, 18.2% of respondents reported no difficulty, 42.2% mild difficulty, 31.6% moderate difficulty, and 7.9% severe difficulty.\u003c/p\u003e\n\u003cp\u003eTable 2. Descriptive statistics for PSQI and its components\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"571\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003evariable\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMin\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMax\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMedian\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eQ1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eQ3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMean\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eSD\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eSubjective Sleep Quality\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.72\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eSleep Latency\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.61\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.02\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eSleep Duration\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.93\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eSleep Efficiency\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.93\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.20\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eSleep Disturbances\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.56\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eUse of Sleep Medication\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.56\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.96\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eDaytime Dysfunction\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.85\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eGlobal_PSQI_Score\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e8.16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e3.57\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eThe PSQI components (Table 2) showed variability among participants. \u003cstrong\u003eSubjective sleep quality\u003c/strong\u003e had a median of 1 [IQR: 1, 2] and a mean of 1.33 \u0026plusmn; 0.72. \u003cstrong\u003eSleep latency\u003c/strong\u003e had a median of 2 [IQR: 1, 3] and a mean of 1.61 \u0026plusmn; 1.02. \u003cstrong\u003eSleep duration\u003c/strong\u003e had a median of 1 [IQR: 1, 2] and a mean of 1.31 \u0026plusmn; 0.93. \u003cstrong\u003eSleep efficiency\u003c/strong\u003e had a median of 0 [IQR: 0, 2] and a mean of 0.93 \u0026plusmn; 1.20. \u003cstrong\u003eSleep disturbances\u003c/strong\u003e had a median of 1 [IQR: 1, 1] and a mean of 1.13 \u0026plusmn; 0.56. \u003cstrong\u003eThe use of sleep medication\u003c/strong\u003e had a median of 0 [IQR: 0, 1] and a mean of 0.56 \u0026plusmn; 0.96. \u003cstrong\u003eDaytime\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003edysfunction\u003c/strong\u003ehad a median of 1 [IQR: 1, 2] and a mean of 1.29 \u0026plusmn; 0.85. Lastly, the\u003cstrong\u003eGlobal PSQI\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;score\u003c/strong\u003e had a median of 8 [IQR: 6, 10] and a mean of 8.16 \u0026plusmn; 3.57.\u003c/p\u003e\n\u003cp\u003eTable 3. Comparison of sleep quality based on any use of OTC sleep medications\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;No use \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; Ever use \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003ep.overall\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; N=173 \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; N=156 \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eSubjective Sleep Quality\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.00 [1.00;2.00]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.00 [1.00;2.00]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; 0.058 \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eSleep Latency\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.00 [1.00;2.00]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e2.00 [1.00;3.00]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u0026lt;0.001 \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eSleep Duration\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.00 [1.00;2.00]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.00 [1.00;2.00]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; 0.286 \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eSleep Efficiency\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.00 [0.00;1.00]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.50 [0.00;2.00]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; 0.055 \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eSleep Disturbances\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.00 [1.00;1.00]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.00 [1.00;1.00]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; 0.106 \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eUse of Sleep Medication\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.00 [0.00;0.00]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.00 [0.00;2.00]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u0026lt;0.001 \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eDaytime Dysfunction\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.00 [1.00;2.00]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.00 [1.00;2.00]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; 0.103 \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eGlobal PSQI Score\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e7.00 [5.00;9.00]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e9.00 [6.00;11.0]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u0026lt;0.001 \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" valign=\"top\"\u003e\n \u003cp\u003eAnalysis was performed using the Mann-Whitney test\u003c/p\u003e\n \u003cp\u003eData were summarized using median [IQR]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eFor \u003cstrong\u003esubjective sleep quality (Table 3)\u003c/strong\u003e, the median score was similar between both groups with no statistically significant difference (p = 0.058). \u003cstrong\u003eSleep latency\u003c/strong\u003e was significantly worse in the group that reported using OTC sleep medications, with a median score of 2.00 [IQR 1.00; 3.00] compared to 1.00 [IQR 1.00; 2.00] in the non-user group (p \u0026lt; 0.001). \u003cstrong\u003eSleep duration\u003c/strong\u003e showed no significant difference between both groups (p = 0.286). For \u003cstrong\u003esleep efficiency\u003c/strong\u003e, a trend toward significance was observed, with OTC medication users reporting a slightly higher median score of 0.50 [IQR 0.00; 2.00] compared to 0.00 [IQR 0.00; 1.00] among non-users (p = 0.055).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSleep disturbances\u003c/strong\u003e were not significantly different between groups (p = 0.106). \u003cstrong\u003eThe use\u003c/strong\u003e\u003cstrong\u003eof sleep medication\u003c/strong\u003e was considerably higher in the group that used OTC medications, with a median score of 1.00 [IQR 0.00; 2.00] compared to 0.00 [IQR 0.00; 0.00] among non-users (p \u0026lt; 0.001). For \u003cstrong\u003edaytime dysfunction\u003c/strong\u003e\u003cstrong\u003e,\u003c/strong\u003e the median score was not significantly different between groups (p = 0.103). The \u003cstrong\u003eglobal PSQI score\u003c/strong\u003e was significantly higher among OTC sleep medication users, with a median of 9.00 [IQR 6.00; 11.0] compared to 7.00 [IQR 5.00; 9.00] in non-users (p \u0026lt; 0.001).\u003c/p\u003e\n\u003cp\u003eTable 4. Association between demographic characteristics, use of sleep aids, and global PSQI score\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"708\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eVariable\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eLevel\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003en\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMean\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eSD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003ep\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e24-29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e279\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e8.08\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e3.54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.62\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e30-34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e8.62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e3.61\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e35-39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e8.50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e7.78\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\"\u003e\n \u003cp\u003eFrequency of using OTC sleeping aids\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eAs needed.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e119\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e8.71\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e3.60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e5.28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt; 0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMonthly\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e8.20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e2.82\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eWeekly\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e11.77\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e3.27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eDaily\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e11.46\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e2.79\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eGender\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e154\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e8.53\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e3.42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e3.11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.08\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e175\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e7.84\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e3.67\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eMarital status\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eDivorced\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e12.33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e5.03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e2.10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.12\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e74\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e8.07\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e3.73\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eSingle\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e252\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e8.14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e3.49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eSpecialty\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eEmergency Medicine\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e8.40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e3.45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.22\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eFamily Medicine\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e86\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e7.48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e3.73\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMedicine and Medical Specialties\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e68\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e7.99\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e3.44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eOB/GYN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e8.78\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e3.93\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003ePediatric and Pediatric specialties\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e8.56\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e3.23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003ePreventive Medicine\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e8.50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e4.04\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eRadiology\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e7.71\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e3.58\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eSurgery and Surgical specialties\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e9.54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e3.58\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eSpecialty\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMedical\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e278\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e7.97\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e3.51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e5.12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.02\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eSurgical\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e9.20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e3.73\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e5.12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.02\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eRarely / Single-Use\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e8.65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e3.42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eDuration of OTC sleep aids\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;1 year\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e9.79\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e3.51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.69\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.60\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1\u0026ndash;2 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e9.83\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e4.32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e3\u0026ndash;5 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e9.17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e2.32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026gt;5 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e8.18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e5.79\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eExperienced side effects\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e93\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e8.77\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e3.51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e3.45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.06\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e58\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e9.90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e3.77\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\"\u003e\n \u003cp\u003eOTC sleep aids help improve your sleep quality\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e58\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e9.57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e3.67\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.97\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.33\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e97\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e8.98\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e3.56\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"6\"\u003e\n \u003cp\u003eResidency\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eR1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e98\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e8.03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e3.35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.28\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eR2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e106\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e7.79\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e3.44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eR3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e71\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e8.46\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e3.11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eR4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e8.49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e4.57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eR5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e8.85\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e4.65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eR6 and more\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e13.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e5.66\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\"\u003e\n \u003cp\u003eUse of OTC sleeping aids\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e173\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e7.28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e3.29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e24.14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026lt; 0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e156\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e9.15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e3.61\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"7\" valign=\"top\"\u003e\n \u003cp\u003eAnalysis was performed using one-way ANOVA\u003c/p\u003e\n \u003cp\u003eData were summarized using mean\u0026nbsp;\u0026plusmn;\u0026nbsp;SD.\u003c/p\u003e\n \u003cp\u003eMedical specialties include Family medicine, ER, Medicine, pediatric, radiology, and\u0026nbsp;preventive\u003c/p\u003e\n \u003cp\u003eSurgical specialties include surgery and OBGYN.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eAge did not show significant differences, with mean scores ranging from 8.08 \u0026plusmn; 3.54 for participants aged 24\u0026ndash;29 to 8.50 \u0026plusmn; 7.78 for those aged 35\u0026ndash;39 (p = 0.62). Frequency of OTC sleep aid use, however, highlighted significant differences, with weekly users reporting the highest mean score (11.77 \u0026plusmn; 3.27), followed by daily users (11.46 \u0026plusmn; 2.79) and as-needed users (8.71 \u0026plusmn; 3.60). In contrast, monthly users had the lowest score (8.20 \u0026plusmn; 2.82) (p \u0026lt; 0.001). Gender differences were not statistically significant, though females had a slightly higher mean score compared to males (8.53 \u0026plusmn; 3.42 vs. 7.84 \u0026plusmn; 3.67, respectively, p = 0.08). Regarding the duration of OTC sleep aid use, participants using them for 1\u0026ndash;2 years had the highest score (9.83 \u0026plusmn; 4.32), while those using them for more than 5 years reported the lowest (8.18 \u0026plusmn; 5.79) (p = 0.60). These results are shown in \u003cstrong\u003eTable 4\u003c/strong\u003e. Participants in surgical specialties had higher mean global PSQI scores compared to those in medical specialties (9.20 \u0026plusmn; 3.73 vs. 7.97 \u0026plusmn; 3.51, p = 0.02). This indicates that residents in surgical specialties, such as Surgery and OB/GYN, reported poorer overall sleep quality than those in medical specialties, including Family Medicine, Emergency Medicine, and Pediatrics.\u003c/p\u003e\n\u003cp\u003eInterestingly, participants who experienced side effects reported slightly higher scores (9.90 \u0026plusmn; 3.77) than those who did not (8.77 \u0026plusmn; 3.51) although the results were not statistically significant at the 0.05 level (p = 0.06). Similarly, participants who found OTC sleep aids helpful had a mean score of 8.98 \u0026plusmn; 3.56, compared to 9.57 \u0026plusmn; 3.67 for those who did not perceive an improvement. However, the results were not statistically significant (p = 0.33). Residency level showed no significant association with PSQI scores (p = 0.28). However, participants who used OTC sleep aids had significantly higher scores than non-users (9.15 \u0026plusmn; 3.61 vs. 7.28 \u0026plusmn; 3.29, respectively, p \u0026lt; 0.001).\u003c/p\u003e\n\u003cp\u003eTable 5. Demographic characteristics associated with using OTC sleep aids\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNon-users\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eUsers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003ep.overall\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003eN=173\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003eN=156\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eGender:\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.441\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Female\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e77 (50.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e77 (50.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Male\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e96 (54.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e79 (45.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eAge:\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.675\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; 24-29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e150 (53.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e129 (46.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; 30-34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e22 (45.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e26 (54.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; 35-39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1 (50.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1 (50.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMarital status:\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.230\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Divorced\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1 (33.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e2 (66.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Married\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e45 (60.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e29 (39.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Single\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e127 (50.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e125 (49.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eSpecialty:\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.785\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Emergency Medicine\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e19 (47.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e21 (52.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Family Medicine\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e47 (54.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e39 (45.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Medicine and Medical Specialties\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e33 (48.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e35 (51.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; OB/GYN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e13 (56.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e10 (43.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Pediatric and Pediatric specialties\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e32 (61.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e20 (38.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Preventive Medicine\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e2 (50.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e2 (50.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Radiology\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e15 (53.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e13 (46.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Surgery and Surgical specialties\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e12 (42.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e16 (57.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eResidency level:\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.084\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; R1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e47 (48.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e51 (52.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; R2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e66 (62.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e40 (37.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; R3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e31 (43.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e40 (56.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; R4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e22 (56.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e17 (43.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; R5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e7 (53.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e6 (46.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; R6 and more\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0 (0.00%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e2 (100%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eSpecialty_cat:\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.688\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Medical\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e148 (53.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e130 (46.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Surgical\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e25 (49.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e26 (51.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" valign=\"top\"\u003e\n \u003cp\u003eData were summarized using counts and percentages\u003c/p\u003e\n \u003cp\u003eAnalysis was performed using the Chi-square test of independence\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eNo significant associations were found between the sociodemographic characteristics and the use of OTC sleep aids ( P \u0026gt; 0.05 for all comparisons)(See Table 5). Regarding specialty, the highest proportion of OTC sleep aid users was observed in Surgery and Surgical specialties (57.1%), followed by Emergency Medicine (52.5%) and Medicine/Medical specialties (51.5%). The lowest proportion of users was reported in Pediatrics and Pediatric specialties (38.5%), while Family Medicine (45.3%) and OB/GYN (43.5%) showed moderate levels of use. No significant differences were found between specialties (p = 0.785).\u003c/p\u003e\n\u003cp\u003eRegarding OTC (Over-The-Counter) sleep aid usage (Figure 4), there are weak but significant positive correlations between frequency and OTC ever use (r = 0.257, p \u0026lt; 0.01), as well as between PSQI score and OTC ever use (r = 0.249, p \u0026lt; 0.001). Some negative correlations, though not statistically significant, were present, including the relationships between residency level and OTC-improved sleep quality (r = -0.102) and between PSQI score and OTC-improved sleep quality (r = -0.104).\u003c/p\u003e\n\u003cp\u003eTable 6. Other methods for improving sleep quality besides OTC sleep aids\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMethod / Category\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003en\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eSleep hygiene\u003cbr\u003e\u0026nbsp;(consistent schedule, dim lights, limit caffeine/screen)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e43%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eExercise / physical activity\u003cbr\u003e\u0026nbsp;(gym, cardio, yoga as workout)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e27%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMeditation/breathing/relaxation\u003cbr\u003e\u0026nbsp;(mindfulness, breathing drills)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e21%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eHerbal/natural remedies\u003cbr\u003e\u0026nbsp;(chamomile, lavender, ashwagandha, Mg, etc.)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e19%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eSpiritual / Quran\u003cbr\u003e\u0026nbsp;(listening to Qur\u0026rsquo;an, spiritual recitation)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e12%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003ePrescription meds\u003cbr\u003e\u0026nbsp;(quetiapine, trazodone, SSRIs, mirtazapine, etc.)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e10%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eEnvironment manipulations\u003cbr\u003e\u0026nbsp;(hot/cold shower, cold/dark room, new pillow)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e10%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eOther (e.g. \u0026ldquo;sleep cycle alarm,\u0026rdquo; \u0026ldquo;forcing long wake,\u0026rdquo; \u0026ldquo;CPAP,\u0026rdquo; \u0026ldquo;OSA device\u0026rdquo;)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e9%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eSleep hygiene was the most frequently mentioned other method for improving sleep (43%), as shown in Table 6. One-quarter of respondents (27%) favored \u003cstrong\u003eexercise or physical activity\u003c/strong\u003e. Another 21% adopted \u003cstrong\u003emeditation or breathing\u003c/strong\u003e\u003cstrong\u003eexercises\u003c/strong\u003e like mindfulness or guided relaxation before bed. Around 19% reported using \u003cstrong\u003eherbal or natural remedies\u003c/strong\u003e, while 12% relied on \u003cstrong\u003espiritual or Quranic recitations\u003c/strong\u003e for calming the mind. Roughly 10% turned to \u003cstrong\u003eprescription medications\u003c/strong\u003e such as quetiapine or SSRIs. Environmental adjustments\u0026mdash;like taking a hot or cold shower or ensuring a dark, cool bedroom\u0026mdash;were reported by 10% of participants. Finally, 9% used \u003cstrong\u003eother methods\u003c/strong\u003e, including sleep cycle alarms, intentional long wake times, or medical devices (e.g., CPAP).\u003c/p\u003e"},{"header":"4. Discussion","content":"\u003cp\u003eThe current study highlights the significant use of OTC sleep aids among medical residents, with 47.4% reporting their use. Three-quarters of the users used them as needed (76.8%), which indicates an occasional but widespread dependency on pharmacological options to manage sleep disturbances. These findings align with other studies, which showed that the use of sleep aids among healthcare professionals is high, which can be explained by the demanding nature of the profession and irregular schedules [19,24]. Residents are often challenged by extended work hours, emotional stress, and disruptions in the circadian rhythm, which are associated with poor sleep quality and dependency on pharmacological options to improve sleep quality [25,26].\u003c/p\u003e\n\u003cp\u003eThere appears to be a paradox in the relationship between OTC sleep aid use and sleep quality. At the same time, 62.6% of respondents using OTC sleep aids reported that the use improved sleep quality; the PSQI showed poorer sleep quality among users than non-users. This is most likely because perceived sleep quality is self-assessed, with users perceiving a temporary benefit but not sustaining an improvement. OTC sleep aids primarily address symptoms, such as sleep initiation, without treatment of the underlying causes that lead to disturbances in sleep, such as stress, irregular schedules, or poor sleep hygiene [27]. An important contributor to this paradox is the sporadic use of OTC sleep aids. Most users (76.8%) took these aids as needed rather than on a regular schedule. This erratic use pattern may not be consistent enough to establish a stable sleep routine or effectively treat chronic sleep disturbances. This would leave users having the benefit only on nights the aids are taken, yet still experience overall poor-quality sleep. Evidence from studies indicates that inconsistent patterns of sleep aid use often do not result in significant long-term improvement in sleep outcomes [26].\u003c/p\u003e\n\u003cp\u003eAnother explanation for this paradox was the duration of use of sleep aid medication. Whereas the majority of survey respondents took OTC sleep aids for less than a year, almost half of them reported having been using them for 1–5 or more years (47.3%). Of these users, 9.82% report use over five years. When taken for several years, medications for sleep disturbances may cause tolerance and thus work less effectively the longer they are used. Moreover, individuals experiencing chronic sleep disturbances are more likely to resort to long-term medication, which leads them into a cycle of dependence. It is supported by studies that long-term medication usually bypasses crucial variables in sleep hygiene, stress management, and the psychological causes of sleeping poorly [28]. It is also important to note that using sleeping aids is typically regarded as a quick fix rather than part of a holistic approach to sleep improvement. While many users report improved sleep on certain nights, they usually suffer from poor sleep because their core issues are unresolved. This is further ascertained by the evidence of findings that sleep disturbance has mostly been related to general psychosocial factors, such as occupational stress, irregular schedules, and poor mental health, which sleep aids alone cannot handle [29,30].\u003c/p\u003e\n\u003cp\u003eOther critical contributions to the disparities in effectiveness brought about by sleep aid medication concern gender and occupational patterns. For instance, it is no surprise that women generally report a disturbance of sleep, thus accounting for their PSQI score, which often happens to be higher. On the other hand, work that involves night shifts or irregular hours disrupts the circadian rhythms significantly and is common in the profession of medical residents, thereby reducing further the efficacy of sleep aids [27,31].\u003c/p\u003e\n\u003cp\u003eFurthermore, the high prevalence of residual side effects, such as fatigue and residual drowsiness, may reduce the perceived benefits of sleep aids. These adverse effects can lead to impairment in next-day functioning, especially in populations with high-stress environments like healthcare professionals [32]. Finally, some evidence suggests that non-pharmacological approaches, such as improved sleep hygiene and mindfulness-based interventions, may provide more durable improvements in sleep quality without the disadvantages of long-term medication use [33,34].\u003c/p\u003e\n\u003cp\u003eSurgical residents reported higher use of OTC sleep aids, 57.1%, as compared to 46.8% among medical residents. This could be explained by the nature of work schedules in surgical disciplines that are very demanding, extended hours spent in the operation theatre, undertaking emergency surgeries, and night shifts that disturb the normal circadian rhythm. Consequently, this group has a greater dependence on pharmacological interventions to manage sleep disturbances. Indeed, other studies have also shown such trends, whereby health professionals working in high-pressure settings, such as casualty or theatre, have shown higher reliance on sleeping medications because of irregular working hours and stressors associated with work [25,35,36]. The emotional demands of surgery, such as managing critical cases, further contribute to stress-related insomnia and increased dependence on sleep aids [19].\u003c/p\u003e\n\u003cp\u003eSurgical residents had significantly poorer sleep quality, as reflected in higher global PSQI scores (mean 9.20 ± 3.73) when compared with the medical residents (mean 7.97 ± 3.51, p = 0.02). This reflects the increased physical and cognitive demands of surgical practice. Long working hours, high-stress decision-making, and the need for sharp focus during surgery disrupt sleep patterns and increase stress. Evidence has shown that surgical residents experience a higher rate of sleep deprivation, which is a known risk factor for poor sleep quality and increased use of sleep aids [37]. In general, sleep disturbances experienced by surgical specialties are mainly attributed to irregular hours. In addition, work schedules, night duties, and procedures disrupt the circadian rhythm, impacting negatively on the pursuit of a normal sleep regimen. Indeed, several studies confirm that irregular schedules result in poor quality sleep and the use of sleep aids among HCPs, especially among specialties requiring night shifts [38]. Emotional stress is also higher in surgical residents which can be attributed to the pressure to handle life-and-death cases, and the fear of making surgical mistakes, which contributes to stress-induced insomnia.\u003c/p\u003e\n\u003cp\u003eOther factors associated with sleep disturbance in surgical residency include physical tiredness. The long working hours and the intensive nature of performing surgeries paradoxically impair the ability of residents to fall asleep. The resultant fatigue drives residents towards sleep aids as a convenient solution. In alignment with other research, physical fatigue along with high-stakes ecology led to a higher prevalence of the usage of sleep aids [39]. Furthermore, surgical residents face challenges due to the side effects of sleep aids, such as drowsiness or cognitive impairments, which can affect decision-making and increase the risk of errors during surgeries [40].\u003c/p\u003e\n\u003cp\u003eSeveral strategies should be implemented to address the high prevalence of OTC sleep aid use and improve sleep quality among residents. First, implementing better work schedules that minimize night shifts and ensure adequate rest periods, can reduce the disruptions in circadian rhythm [41]. Hospitals should provide non-pharmacological solutions, such as cognitive-behavioral therapy for insomnia, mindfulness-based stress reduction, and sleep hygiene training. These techniques have been effective in managing sleep disturbances [42]. Residents should also receive education about sleep hygiene and the risks of long-term OTC sleep aid use, including dependency, tolerance, and potential cognitive impairments [43]. Stress management programs and counseling services should be provided to help overcome high-stress levels and address the psychological burden associated with poor sleep. Finally, creating a supportive workplace culture could reduce sleep disturbances, improve work-life balance, and promote non-pharmacological approaches to achieving better sleep [44].\u003c/p\u003e"},{"header":"5. Limitations","content":"\u003cp\u003eThere are several limitations to this study. First, data were self-reported using questionnaires, which is susceptible to recall bias or subjective misrepresentation concerning estimating sleep quality and the use of sleep aids. The cross-sectional design doesn't allow for making any causal inferences between the use of OTC sleep aids and the quality of sleep. Longitudinal studies can more successfully capture the long-term effects associated with using OTC sleep aids and related sleep quality. Finally, this was a single-center study, and although done in an institution, it is impossible to fully generalize to other regions or health systems with different residency structures or cultural attitudes towards the use of sleep aids.\u003c/p\u003e"},{"header":"6. Conclusion","content":"\u003cp\u003eThis study highlights the high prevalence of OTC sleep aid use among medical residents. The findings highlight the need for interventions to address sleep quality and reduce dependency on pharmacological solutions among healthcare professionals. Implementing tailored work schedules, non-pharmacological therapies, and stress management programs can help improve sleep quality and minimize reliance on OTC sleep aids.\u003c/p\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e"},{"header":"7.\tDeclarations ","content":"\u003ch2\u003e7.1\u0026nbsp; \u0026nbsp; \u0026nbsp;Funding\u0026nbsp;\u003c/h2\u003e\n\u003cp\u003eThis research did not receive specific grants from any funding agency within the public, commercial, or non-profit sectors.\u003c/p\u003e\n\u003ch2\u003e7.2\u0026nbsp; \u0026nbsp; \u0026nbsp;Ethical Considerations\u003c/h2\u003e\n\u003cp\u003eWritten informed consent was obtained from all participants through a consent form attached to the questionnaire on the front page explaining the study title and its purpose. The study was done in accordance to the Declaration of Helsinki standards, and ethical approval for the study was granted by the KFMC Institutional Review Board (IRB Log Number: 24-366). Confidentiality and anonymity were also maintained by excluding any identifiable participant information.\u003c/p\u003e\n\u003ch2\u003e7.3\u0026nbsp; \u0026nbsp; \u0026nbsp;Data Availability\u0026nbsp;\u003c/h2\u003e\n\u003cp\u003eThe datasets obtained and analyzed in this study are available from the corresponding author upon request.\u003c/p\u003e\n\u003ch2\u003e7.4\u0026nbsp; \u0026nbsp; \u0026nbsp;Competing Intrest\u003c/h2\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u0026nbsp;\u003c/p\u003e\n\u003ch2\u003e7.5\u0026nbsp; \u0026nbsp; \u0026nbsp;Consent to publish\u0026nbsp;\u003c/h2\u003e\n\u003cp\u003eNot Applicable\u0026nbsp;\u003c/p\u003e\n\u003ch2\u003e8. \u0026nbsp; Acknowledgment\u0026nbsp;\u003c/h2\u003e\n\u003cp\u003eThe authors would like to express their gratitude to all residents who participated in this study and appreciate the support of the administration at King Fahad Medical City for their cooperation and facilitation.\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eN. 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Med. 73 (2019), pp. 325\u0026ndash;329.\u003c/li\u003e\n\u003cli\u003e D.A. Handel, A. Raja and C.J. Lindsell, \u003cem\u003eThe use of sleep aids among Emergency Medicine residents: A web based survey\u003c/em\u003e, BMC Health Serv. Res. 6 (2006), .\u003c/li\u003e\n\u003cli\u003e J.M.Y. Cheung, D.C. Jarrin, S. Beaulieu-Bonneau, H. Ivers, G. Morin and C.M. Morin, \u003cem\u003ePatterns of concomitant prescription, over-the-counter and natural sleep aid use over a 12-month period: A population based study\u003c/em\u003e, Sleep 44 (2021), .\u003c/li\u003e\n\u003cli\u003e M.M.G. Rosado, L.S. Carvalho and A. Coelho, \u003cem\u003eEvaluation of the Association between Medication Use and Sleep Quality among Shift Workers versus Day Workers\u003c/em\u003e, Sleep Sci. 17 (2024), pp. 64\u0026ndash;74.\u003c/li\u003e\n\u003cli\u003e S. Lee, J.H. Kin and J.H. Chung, \u003cem\u003eThe association between sleep quality and quality of life: a population-based study\u003c/em\u003e, Sleep Med. 84 (2021), pp. 121\u0026ndash;126.\u003c/li\u003e\n\u003cli\u003e D.M. Lydon-Staley, H.H. Cleveland, A.S. Huhn, M.J. Cleveland, J. Harris, D. Stankoski et al., \u003cem\u003eDaily sleep quality affects drug craving, partially through indirect associations with positive affect, in patients in treatment for nonmedical use of prescription drugs\u003c/em\u003e, Addict. Behav. 65 (2017), pp. 275\u0026ndash;282.\u003c/li\u003e\n\u003cli\u003e N.K.Y. Tang, M. Fiecas, E.F. Afolalu and D. Wolke, \u003cem\u003eChanges in sleep duration, quality, and medication use are prospectively associated with health and well-being: Analysis of the UK household longitudinal study\u003c/em\u003e, Sleep 40 (2017), .\u003c/li\u003e\n\u003cli\u003e L. Chen, J.S. Bell, R. Visvanathan, S.N. Hilmer, T. Emery, L. Robson et al., \u003cem\u003eThe association between benzodiazepine use and sleep quality in residential aged care facilities: a cross-sectional study\u003c/em\u003e, BMC Geriatr. 16 (2016), pp. 1\u0026ndash;9.\u003c/li\u003e\n\u003cli\u003e S.M. Albert, T. Roth, M. Toscani, M. V. Vitiello, P. Zee and R. Pruchno, \u003cem\u003eSleep health and appropriate use of OTC sleep AIDS in older adults - Recommendations of a gerontological society of America workgroup\u003c/em\u003e, Gerontologist 57 (2017), pp. 163\u0026ndash;170.\u003c/li\u003e\n\u003cli\u003e K.S. Radek, \u003cem\u003eWidely Used, Rarely Studied-the Over-the-Counter Sleep Aids\u003c/em\u003e, J. Sleep Disord. Ther. 07 (2018), .\u003c/li\u003e\n\u003cli\u003e V. Clement-Carbonell, I. Portilla-Tamarit, M. Rubio-Aparicio and J.J. Madrid-Valero, \u003cem\u003eSleep quality, mental and physical health: A differential relationship\u003c/em\u003e, Int. J. Environ. Res. Public Health 18 (2021), pp. 1\u0026ndash;8.\u003c/li\u003e\n\u003cli\u003e I. Amirian, L.T. Andersen, J. Rosenberg and I. G\u0026ouml;genur, \u003cem\u003eWorking night shifts affects surgeons\u0026rsquo; biological rhythm\u003c/em\u003e, Am. J. Surg. 210 (2015), pp. 389\u0026ndash;395.\u003c/li\u003e\n\u003cli\u003e G.W. Williams, B. Shankar, E.M. Klier, A.Z. Chuang, S. El Marjiya-Villarreal, O.O. Nwokolo et al., \u003cem\u003eSensorimotor and Executive Function Slowing in Anesthesiology Residents After Overnight Shifts\u003c/em\u003e, Surv. Anesthesiol. 61 (2017), pp. 123.\u003c/li\u003e\n\u003cli\u003e A.D. Esen, G. Nizamoğlu Mercan, E. Ka\u0026ccedil;ar and D. Toprak, \u003cem\u003eSleep Quality and Related Factors in Medical Residents\u003c/em\u003e, Turkish J. Fam. Med. Prim. Care (2017), pp. 271\u0026ndash;277.\u003c/li\u003e\n\u003cli\u003e L.P. Schwartz, S.R. Hursh, L. Boyle, J.E. Davis, M. Smith and S.C. Fitzgibbons, \u003cem\u003eFatigue in surgical residents an analysis of duty-hours and the effect of hypothetical naps on predicted performance\u003c/em\u003e, Am. J. Surg. 221 (2021), pp. 866\u0026ndash;871.\u003c/li\u003e\n\u003cli\u003e R.K. Reznick and J.R. Folse, \u003cem\u003eEffect of sleep deprivation on the performance of surgical residents\u003c/em\u003e, Am. J. Surg. 154 (1987), pp. 520\u0026ndash;525.\u003c/li\u003e\n\u003cli\u003e P.I. Ellman, I.L. Kron, J.S. Alvis, C. Tache-Leon, T.S. Maxey, T.B. Reece et al., \u003cem\u003eAcute sleep deprivation in the thoracic surgical resident does not affect operative outcomes\u003c/em\u003e, Ann. Thorac. Surg. 80 (2005), pp. 60\u0026ndash;65.\u003c/li\u003e\n\u003cli\u003e D.A. Reed, K.E. Fletcher and V.M. Arora, \u003cem\u003eSystematic review: Association of shift length, protected sleep time, and night float with patient care, residents\u0026rsquo; health, and education\u003c/em\u003e, Ann. Intern. Med. 153 (2010), pp. 829\u0026ndash;842.\u003c/li\u003e\n\u003cli\u003e N.M. Duggan, M. Adrian Hasdianda, O. Baker, G. Jambaulikar, A.J. Goldsmith, A. Condella et al., \u003cem\u003eThe Effect of Noise-Masking Earbuds (SleepBuds) on Reported Sleep Quality and Tension in Health Care Shift Workers: Prospective Single-Subject Design Study\u003c/em\u003e, JMIR Form. Res. 6 (2022), .\u003c/li\u003e\n\u003cli\u003e K.F. Chung, C.T. Lee, W.F. Yeung, M.S. Chan, E.W.Y. Chung and W.L. Lin, \u003cem\u003eSleep hygiene education as a treatment of insomnia: A systematic review and meta-analysis\u003c/em\u003e, Fam. Pract. 35 (2018), pp. 365\u0026ndash;375.\u003c/li\u003e\n\u003cli\u003e S.H. Rose and T.B. Curry, \u003cem\u003eFatigue, countermeasures, and performance enhancement in resident physicians\u003c/em\u003e, Mayo Clin. Proc. 84 (2009), pp. 955\u0026ndash;957.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"sleep-science-and-practice","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ssap","sideBox":"Learn more about [Sleep Science and Practice](http://sleep.biomedcentral.com)","snPcode":"41606","submissionUrl":"https://submission.nature.com/new-submission/41606/3","title":"Sleep Science and Practice","twitterHandle":"@BioMedCentral","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-6563372/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6563372/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eIntroduction:\u003c/strong\u003e Sleep quality is a key factor in the overall health and performance of healthcare professionals, especially medical residents, whose irregular schedules and high-stress levels frequently result in poor sleep and dependence on over-the-counter (OTC) sleep aids. This study examined the prevalence of OTC sleep aid usage, contributing factors, and effects on sleep quality.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e: A cross-sectional study was conducted among medical residents at King Fahad Medical City, Riyadh, Saudi Arabia. The data were collected using a validated self-administered questionnaire. Sleep quality was evaluated using the Pittsburgh Sleep Quality Index (PSQI). Demographic characteristics and data related to the use of OTC sleep aids were also collected.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e: The study involved 329 residents, 47.4% of whom reported using OTC sleep aids primarily on an as-needed basis (76.8%). The mean PSQI score for all participants was 8.16 ± 3.57, indicating generally poor sleep quality. Sleep quality was significantly worse among OTC sleep aid users, as shown by higher global PSQI scores compared to non-users (9.15 ± 3.61 vs. 7.28 ± 3.29, respectively, p \u0026lt; 0.001). Surgical residents had the highest prevalence of OTC sleep aid use (57.1%) and demonstrated poorer sleep quality (PSQI 9.20 ± 3.73) compared to medical residents (46.8%, PSQI: 7.97 ± 3.51, p = 0.02). Work-related demands were the most common reason for using sleep aids (57.24%), followed by resetting circadian rhythms (48.03%) and emotional stress (30.92%). Side effects were reported by 38.4% of users, with fatigue and drowsiness being the most frequent complaints.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e: The use of OTC sleep aids was highly prevalent among medical residents. These results suggest the need for interventions to improve residents' sleep quality and reduce reliance on OTC sleep aids. Implementing work schedule reforms, providing non-pharmacological solutions, and promoting sleep hygiene education are essential to address the causes of sleep disturbances.\u003c/p\u003e","manuscriptTitle":"Prevalence and Factors Associated with The Use of Over-the-counter Sleep Aids Among Training Residents at King Fahad Medical City, Riyadh, Saudi Arabia.","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-05-16 13:01:00","doi":"10.21203/rs.3.rs-6563372/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-07-03T14:39:53+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-06-25T06:58:53+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-06-19T15:12:25+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-06-18T05:33:07+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"33347770714773134800595775217155800182","date":"2025-06-16T06:33:41+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-06-15T11:26:25+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"179732321945680894795518742439643327252","date":"2025-06-14T14:34:21+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"27607747533333608833992160630840968335","date":"2025-06-14T05:12:26+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"187399969213550105010182336506068326101","date":"2025-06-13T19:45:02+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"336195547053303496043906368012299543475","date":"2025-06-13T18:59:17+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-05-20T21:25:39+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"174968827710692722529770160326550499064","date":"2025-05-13T17:46:33+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"62407404393984337354853558118203852024","date":"2025-05-13T17:39:13+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-05-13T17:09:43+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-05-01T01:35:16+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-05-01T01:33:35+00:00","index":"","fulltext":""},{"type":"submitted","content":"Sleep Science and Practice","date":"2025-04-30T09:19:29+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"sleep-science-and-practice","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ssap","sideBox":"Learn more about [Sleep Science and Practice](http://sleep.biomedcentral.com)","snPcode":"41606","submissionUrl":"https://submission.nature.com/new-submission/41606/3","title":"Sleep Science and Practice","twitterHandle":"@BioMedCentral","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"2a57b37b-2c68-4a1a-bb9a-5f8c3c0fe5c0","owner":[],"postedDate":"May 16th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-09-29T15:59:43+00:00","versionOfRecord":{"articleIdentity":"rs-6563372","link":"https://doi.org/10.1186/s41606-025-00149-4","journal":{"identity":"sleep-science-and-practice","isVorOnly":false,"title":"Sleep Science and Practice"},"publishedOn":"2025-09-24 15:57:17","publishedOnDateReadable":"September 24th, 2025"},"versionCreatedAt":"2025-05-16 13:01:00","video":"","vorDoi":"10.1186/s41606-025-00149-4","vorDoiUrl":"https://doi.org/10.1186/s41606-025-00149-4","workflowStages":[]},"version":"v1","identity":"rs-6563372","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6563372","identity":"rs-6563372","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}