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Official websites use. Share sensitive information only on official, secure websites. Diphenhydramine, either alone or in combination with pain relievers, is one of the widely used over-the-counter sleep aids. However, few studies have evaluated the use of diphenhydramine-containing products, such as Panadol Night, in Saudi Arabia. Therefore, the objectives of this study were to assess the prevalence of Panadol Night use and to identify factors associated with its use in the Eastern Province of Saudi Arabia. A cross-sectional study was conducted among adults aged 18 years or older in the Eastern Province of Saudi Arabia. Data were collected through an online self-administered questionnaire from 05 March to 20 March Chi-square tests and multivariable logistic regression models were used to examine the associations between Panadol Night use in the past month and independent variables. A total of adults participated in the survey. Approximately, The majority of the Panadol Night users The multivariable logistic regression models showed that gender, health related fields, perceived safety and effectiveness of Panadol Night, a history of insomnia, trouble sleeping due to pain, and sleep quality were significantly associated with the use of Panadol Night in the past month. Also, adults in non-health related fields were more likely to use Panadol Night compared to those in health related fields. This suggests the need for raising awareness about the appropriate use of Panadol Night. Community pharmacists can play an essential role in educating patients during the time of purchase. Sleep disorders are a common public health problem affecting adults worldwide with a prevalence varying from 1. One of the most common sleep disorders is insomnia. The prevalence of insomnia was estimated to be as high as Insomnia and other sleep disorders can negatively impact daily activities, productivity, and overall quality of life Centers for Disease Control and Prevention, , Hinz et al. To treat these disorders and avoid their negative consequences, sleep aid medications can be used. Some of these medications require prescription such as benzodiazepines and non-benzodiazepine hypnotics i. Diphenhydramine, a first-generation antihistamine with sedative and anticholinergic properties, works by blocking the effects of histamine and causing drowsiness Church and Church, Due to its sedative properties, diphenhydramine has been used to treat sleep problems Culpepper and Wingertzahn, Diphenhydramine is not only used alone but also in combination with other medications such as pain relievers. The prevalence of using sleep aids containing diphenhydramine has been measured in different countries. In the United States US , Among adults taking diphenhydramine or doxylamine products in the US, A recent study has surveyed adults in Saudi Arabia and revealed that The frequent use of these products could result in inappropriate use and negative health consequences Nam et al. For example, long-term use of diphenhydramine-containing products is considered inappropriate and is associated with adverse effects such as orthostatic hypotension, fall risk, and dementia Gray et al. With that being said, it is important to understand the characteristics of Panadol Night users. Currently, few studies have evaluated the use of sleep aids containing diphenhydramine in Saudi Arabia. Panadol Night, a combination of 25 mg of diphenhydramine hydrochloride and mg of paracetamol, is one of the common OTC sleep aids in Saudi Arabia Aljohani and Aldughaither, To our knowledge, factors associated with Panadol Night use have not been investigated yet. Therefore, the objectives of the current study were to assess the prevalence of Panadol Night use and to identify factors associated with its use in the Eastern Province of Saudi Arabia. This was a cross-sectional study using an anonymous, self-administered online survey. Responses gathered from the cognitive interviews were used to finalize the survey, but not included in the final analysis. After finalizing the survey, the online survey was sent to those who participated in the cognitive interviews to be included in the study sample. The final survey was converted into Google Forms and distributed from 05 March to 20 March Eligible study participants were adults who aged 18 years or older, resided in the Eastern Province of Saudi Arabia, and were able to read and write in Arabic. We excluded participants who stated cities outside the Eastern Province. The participants in this study were recruited using a convenience sampling technique through social media platforms e. Panadol Night use was measured by asking three questions; each question has a specified time. First, participants were asked if they ever used Panadol Night to help them fall asleep. Second, they were asked if they used Panadol Night to help them fall asleep in the past month. The demographic data collected included age, gender, education, marital status, area of residence, employment status, and whether participants were studying or working in health related fields. These medications were selected because they are common in Saudi Arabia. Knowledge about the right indications for Panadol Night was assessed. Perceived safety of Panadol Night was measured using a single item i. They were also asked if they experienced any adverse reactions due to Panadol Night, and how they dealt with those adverse reactions if occurred. Participants were asked if they have ever been diagnosed with insomnia. Health status was assessed by asking two questions. The first question regarding general health was adopted from the SF health survey i. Poor; 2. Fair; 3. Good; 4. Very good; 5. Chi-square tests were used to examine the unadjusted associations between Panadol Night use in the past month and independent variables. Adjusted multivariable logistic regression models were performed to examine the associations between Panadol Night use in the past month and independent variables. Among the Panadol Night use variables, Panadol Night use in the past month was selected as the model outcome because it has the same time interval of assessment as sleep problem variables. Sleep problem variables were only measured in the past month. The other independent variables included in the logistic regression models were demographics, knowledge about OTC sleep aids, perceived safety of Panadol Night, perceived effectiveness of Panadol Night, a history of insomnia, sleep problem variables, and perceived general and mental health. A total of adults residing in the Eastern Province of Saudi Arabia participated in the survey; their characteristics are presented in Table 1. Most of the participants were aged 18—24 years About Participants with bachelor's degrees constituted The majority of the participants More than half of the participants thought that Panadol Night is used to treat insomnia, while 6. Regarding the drug safety, In our sample, In regard with sleep problems, 8. Among Panadol Night users, Nearly a fifth of Panadol Night users reported that they used Panadol Night at specific times in the year; for example, during exam periods and stressful events at work. Regarding the duration of use, 5. About one-fourth of the users experienced adverse reactions including anticholinergic effects 6. Among those who experienced adverse reactions, In the bivariate analysis, there were statistically significant associations between Panadol Night use in the past month and numerous factors including age, gender, health related fields, marital status, history of insomnia, perceived safety of Panadol Night, perceived effectiveness of Panadol Night, trouble sleeping due to pain, sleep quality, and perceived general health see Table 3. The percentage of men using Panadol Night in the past month was higher than women Moreover, it was observed that a higher proportion of adults in non-health related fields reported using Panadol Night in the past month compared to those in health related fields Panadol Night use was found to be higher among adults who believed that Panadol Night is safe compared to those who did not Note : Other sleep aid medications included valerian, melatonin, St. John wort, and Histop chlorpheniramine. In multivariable logistic regression, we observed statistically significant associations between Panadol Night use and several factors including gender, health related fields, a history of insomnia, perceived safety of Panadol Night, perceived effectiveness of Panadol Night, trouble sleeping due to pain, and sleep quality in the past month. Adults who thought Panadol Night could successfully treat insomnia were 2. Adults studying or working in non-health related fields were 1. We also found that adults who believed that Panadol Night is safe were 1. Other sleep aid medications included valerian, melatonin, St. In our sample, we found that The lifetime prevalence of Panadol Night is lower than what was previously observed Our study only focused on the Eastern Province in Saudi Arabia, whereas the previous study included different regions. However, regions included were not clearly stated. Furthermore, the proportion of women in our sample was higher than that in the previous study Despite the differences between the current and previous studies, results from both studies highlight the frequent use of Panadol Night in Saudi Arabia. A possible explanation for this could be the accessibility and affordability of Panadol Night as it is available as an OTC medication. This behavior might result in inappropriate use such as long-term use. In our sample, we found that 5. Long-term use of Panadol Night is associated with adverse effects such as orthostatic hypotension, fall risk, and dementia, particularly in elderly Gray et al. To better understand factors associated with Panadol Night use among adults, we performed a multivariable logistic regression analysis in which we adjusted for independent variables. Findings from this analysis indicated that perceived effectiveness and safety of Panadol Night were significant factors for its use. Adults were more likely to use Panadol Night if they believed it was safe and would help them sleep. This is in line with the health belief model, suggesting that health behaviors are determined by weighing the benefits and risks of a specific health action Janz and Becker, In addition, sleep-related factors such as sleep quality, trouble sleeping due to pain, and history of insomnia were found to be positively associated with Panadol Night use. It was expected that adults having sleep problems would be more likely to use Panadol Night compared to those without sleep problems. However, Panadol Night is only indicated for occasional sleep difficulties due to pain, not for all sleep problems as stated in the package insert. Therefore, adults should be educated about the appropriate use of Panadol Night and other pharmacological and non-pharmacological alternatives. In regard with gender, we surprisingly found that men were more likely to use Panadol Night than women, which is not consistent with previous studies. For example, a study by Alhwimani et al. A similar finding was also observed with the use of prescription sleep aids. In a US study using data from to , it was found that more women used prescription sleep aids than men Chong et al. Another factor associated with Panadol Night use was health related fields. Adults studying or working in non-health related fields were more likely to use Panadol Night compared to those in health related fields. Given the fact that Panadol Night is an OTC medication and most of our sample reported that their use was based on self-medication, this finding could be explained by that adults in health related fields were more aware and knowledgeable about other sleep aids compared to those in non-health related fields. This means they might consider other available options than Panadol Night. Our findings demonstrate the need for raising awareness about OTC sleep aids, particularly Panadol Night, among adults in Saudi Arabia. Adults should be educated about the appropriate use of Panadol Night and other sleep aid alternatives. Additionally, community pharmacists can play a crucial role in counseling adults on the appropriate use of Panadol Night during the time of purchase. This can help minimize overuse and unintentional misuse of Panadol Night. To our knowledge, this was the first study to identify factors associated with Panadol Night use in Saudi Arabia. However, the study findings should be interpreted in the context of its limitations. One of the study limitations was that all data were self-reported and may be subject to recall bias. Further, data were collected via an online survey using a convenience sampling technique; this resulted in a high proportion of young adults and female gender. Future research should study the use of OTC sleep aids, particularly diphenhydramine-containing products, in elderly adults in Saudi Arabia. Given the fact that we used an anonymous online survey, we were unable to verify that the survey was not completed several times by the same participant. Moreover, single items were used to measure the study variables and no formal evaluation of the internal consistency of the questionnaire was performed. However, several questions were adopted from previously validated and reliable surveys including sleep problems as well as general and mental health variables Barile et al. Based on the feedback from the respondents during the cognitive interviews, all questions were clear and straightforward. Finally, the present study was only conducted in the Eastern Province of Saudi Arabia; thus, its findings cannot be generalized to adults in other regions. Overall, Also, adults studying or working in non-health related fields were more likely to use Panadol Night compared to their counterparts in health related fields. These findings reinforce the need for raising awareness about the appropriate use of Panadol Night. Community pharmacists can play an essential role in reducing the frequent and inappropriate use of Panadol Night through patient consultation. Dimah I. Sara M. The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. Peer review under responsibility of King Saud University. Production and hosting by Elsevier. This section collects any data citations, data availability statements, or supplementary materials included in this article. As a library, NLM provides access to scientific literature. Saudi Pharm J. Find articles by Khalid Alhussain. Find articles by Dimah I Almuayli. Find articles by Sara M Aldaej. Yes 78 6. Open in a new tab. Characteristics of study participants by Panadol Night use in the past month. Gender Male 1. Area of residence Al Ahsa 0. Education Bachelor 0. Health related fields No 1. Marital status Married 1. Employment status Employed 1. Perceived safety of Panadol Night i. Ever diagnosed with insomnia Yes 1. Perceived effectiveness of Panadol Night i. Yes 2. Similar articles. Add to Collections. Create a new collection. Add to an existing collection. Choose a collection Unable to load your collection due to an error Please try again. Add Cancel. Using Panadol Night at a specific time in the year e. Using Panadol Night use for more than 10 consecutive nights per month.