This systematic review and meta-analysis investigated the prevalence of insomnia among university students in Saudi Arabia. Our findings indicate significant variation in insomnia prevalence across studies, with rates ranging from 19.3% to 98.7%. This wide range can be attributed to differences in study design, sample characteristics, and diagnostic tools. The pooled prevalence estimates of 43.3% (95% CI 28.9–58.2%) underscores the high burden of insomnia in this population.

Our results are consistent with regional studies, such as Chaabane and et al. [37], which reported a similar range of insomnia prevalence among medical students in the Middle East and North Africa (MENA) region. Chaabane and colleagues highlighted that insomnia prevalence in medical students ranged from 30.4% in Jordan to 59.1% in Morocco, underscoring the pervasive nature of this condition across the region.

The high heterogeneity (I2 = 99.17%) observed in our meta-analysis reflects the diverse environmental and academic pressures faced by university students. For instance, Alshehri [36] reported the highest prevalence rate of 98.7%, which could be attributed to the unique stressors and lifestyle factors specific to the study population during the COVID-19 pandemic.

This study found notable gender differences in insomnia prevalence, with female students exhibiting higher rates (pooled prevalence of 38.7%, 95% CI 32.8–44.8%) compared to their male counterparts. This finding aligns with Tang and colleagues [38], who also reported higher insomnia rates among females than males. Possible explanations for this gender disparity include hormonal differences, higher susceptibility to stress and anxiety, and societal roles that disproportionately affect women. The higher prevalence of insomnia among female students may also reflect the cumulative impact of multiple stressors, including academic pressure, social expectations, and personal health concerns.

The academic environment plays a critical role in the prevalence of insomnia among university students. Studies included in our review highlighted the significant impact of academic stress, with higher prevalence rates observed during examination periods and among students in advanced years of study. For example, Alrashed [32], noted an increased prevalence of insomnia among students in their third-to-fifth years of medical school, a period characterized by heightened academic demands and clinical responsibilities. Similarly, a previous study found that insomnia disorders were significantly associated with being in clinical or late clinical years, reflecting the intense pressure experienced by medical students during these stages of their education [27].

The COVID-19 pandemic has exacerbated sleep disturbances among university students, as evidenced by several studies included in our meta-analysis. Some studies reported increased insomnia prevalence during the pandemic, which can be attributed to heightened anxiety, disruptions in daily routines, and increased screen time due to online learning. The shift to remote learning and the uncertainties surrounding the pandemic likely contributed to the disruption of students' sleep patterns [39]. Chaabane et al. [37] also highlighted similar trends, with significant increases in insomnia rates during the pandemic lockdown in Saudi Arabia and Morocco. The increased prevalence of insomnia during the pandemic underscores the need for targeted interventions to address the mental health and well-being of students in times of crisis.

The prevalence of insomnia among university students in Saudi Arabia is comparable to global trends. Insomnia and other sleep disorders are common among university students worldwide due to factors such as academic pressure, lifestyle changes, and mental health issues. For instance, a meta-analysis by Jiang et al. [40] reported a global prevalence of insomnia among university students ranging from 9 to 38%, similar to our findings. The consistency of these trends highlights the universal nature of insomnia as a significant public health issue among young adults in higher education.

The multifaceted nature of insomnia among university students in Saudi Arabia, revealing a complex interplay between psychological, lifestyle, and medical factors. The prominence of academic stress as a contributing factor, as highlighted in studies like those by Alrashed and [32, 36], aligns with existing literature that identifies stress as a major driver of sleep disturbances in student populations [12, 41]. These findings are particularly relevant in the context of medical students, who face intense academic pressures that significantly impact their sleep quality [32]. However, the inconsistent focus on specific psychological traits, such as anxiety or obsessive tendencies, suggests that further research is needed to explore these dimensions more comprehensively. Mohamed stands out in this regard, providing a clear linkage between anxiety and insomnia, which could serve as a foundation for future studies aimed at understanding the psychological underpinnings of sleep disorders in this demographic [16, 19].

Moreover, the varying emphasis on lifestyle factors such as physical activity and dietary habits highlights a potential gap in the current research. Studies like Albikawi and Mansour demonstrate the importance of considering these elements, showing how lifestyle choices can exacerbate or mitigate sleep issues [19, 35]. Yet, the fact that some studies, such as Albasheer, did not explore these factors indicates an area where further investigation could be beneficial [29]. In addition, the relatively limited attention given to chronic medical or neurological conditions, despite the significant findings by Alhadi, points to a need for more in-depth exploration of how these health issues interact with sleep patterns in students [33].

[1, 6, 12, 13] Given the high prevalence of insomnia among university students, there is a critical need for targeted interventions to address this public health issue [5]. Universities should consider implementing comprehensive mental health programs that include sleep hygiene education, stress management workshops, and counselling services [10]. Promoting good sleep hygiene practices, such as maintaining a regular sleep schedule, creating a conducive sleep environment, and limiting the use of electronic devices before bedtime, can significantly improve sleep quality [10]. Stress management workshops can equip students with techniques to manage academic and personal stressors effectively, reducing their impact on sleep [42]. Counselling services should be readily accessible to students experiencing mental health issues, providing them with the necessary support to manage their conditions and improve their overall well-being.

In parallel, further studies in Saudi Arabia should prioritize a more comprehensive investigation into the understudied etiologies and conditions contributing to insomnia among university students. Future research should delve deeper into psychological traits such as anxiety and obsessive–compulsive tendencies, exploring their specific impacts on sleep patterns, which have only been partially addressed in current studies. In addition, lifestyle factors, particularly dietary habits and physical activity levels, warrant more rigorous examination, as their influence on insomnia has not been consistently explored. The role of chronic medical and neurological conditions in exacerbating sleep disturbances should also be a focal point, with future studies aiming to understand how these conditions interact with the academic and social pressures faced by students. A holistic approach that integrates these psychological, lifestyle, and medical factors will provide a more nuanced understanding of insomnia and inform more effective interventions in this population.

Despite the comprehensive nature of our review, several limitations should be acknowledged. First, the included studies varied significantly in their methodological quality, as reflected in the moderate to high quality scores. This variability may have introduced bias into our pooled estimates. In addition, the cross-sectional design of the included studies limits the ability to infer causal relationships between insomnia and associated factors. Second, the reliance on self-reported measures of insomnia may have introduced reporting bias, as students might underreport or overreport their sleep disturbances. Future studies should incorporate objective measures, such as actigraphy or polysomnography, to validate self-reported data. Third, our review was limited to studies published in English and Arabic, potentially excluding relevant research published in other languages. Expanding the language scope in future reviews could provide a more comprehensive understanding of insomnia prevalence among university students.