Trauma, environmental insecurity, and coping strategies as determinants of sleep disturbances among adults in Gaza during wartime

Abstract Background Armed conflict disrupts sleep through an interplay of trauma, environmental insecurity, and material deprivation. This study examined the prevalence, determinants, and coping mechanisms of sleep disturbances among adults displaced during the Gaza war. Methods A cross-sectional survey was conducted in July 2025 among 930 adults residing in houses, shelters, and tents across the Gaza Strip, using multistage sampling. The primary outcome was sleep disturbances, assessed using an expanded version of PSQI Item 5, which included the item’s 10 original subitems, subitem 10 expanded into three context-specific categories: (i) fear, (ii) exposure to loud explosions, and (iii) feeling unsafe. The total disturbances score thus ranged from 0 to 36. Measures of trauma exposure, coping strategies, and sociodemographic, environmental, and health factors potentially influencing sleep were also assessed. Ordinal logistic regression identified significant predictors of more severe sleep disturbances. Results The median expanded sleep disturbance score was 21/36 (IQR 12–30). Nearly half of participants (47%) reported frequent nighttime awakenings, and over 80% attributed sleep disruption to loud explosions, anxiety, or feeling unsafe. One-third lacked essential sleep items (mattress, pillow, or cover). Nearly one in four participants (26.5%) had used a sleep aid medication during the past month, with a significant portion using prescription or controlled drugs such as anticonvulsants, gabapentin, and baclofen. Common non-pharmacologic coping strategies included sleeping in the dark (69.8%), spiritual recitation or prayer (53.8%), and sleeping with company (43.7%). Older age, greater trauma exposure, chronic illness, residence in shelters, and medication use predicted higher sleep disturbances, while mattress and cover availability were protective. Conclusions Addressing sleep health among populations in active war settings should be a public health and humanitarian priority. Trauma-informed, culturally adapted interventions and improvements in sleeping conditions may provide scalable relief and should be systematically integrated into humanitarian response frameworks.