Unraveling the connection between the Mediterranean diet and sleep health: from biological mechanisms to clinical implications.

BACKGROUND: The Mediterranean diet (Med-Diet) is well known for its protective effects against noncommunicable diseases and overall mortality, thanks to its anti-inflammatory, antioxidant, and neuroprotective properties. Simultaneously, sleep is increasingly recognized as a vital modifiable factor that influences health, affecting both physiological and psychological outcomes. This narrative review summarizes epidemiological evidence on how the Med-Diet impacts sleep duration and quality, examines the biological mechanisms behind these effects, and identifies areas for future research. METHODS: A comprehensive search was conducted using PubMed, Scielo, Web of Science, CrossRef, Google Scholar, and Scopus. A total of 191 articles published between 2015 and 2025 were selected based on specific inclusion and exclusion criteria. RESULTS: Greater adherence to the Mediterranean diet is associated with better sleep outcomes, such as longer sleep duration, shorter sleep latency, higher sleep efficiency, and a lower risk of insomnia and obstructive sleep apnea, particularly among individuals with an overweight. Mechanistically, the Med-Diet promotes better sleep through various interconnected pathways, including modulation of the tryptophan-serotonin-melatonin pathway, reduction of systemic inflammation and oxidative stress, enhancement of metabolic and cardiovascular health, protection of endothelial and brain function, and regulation of gut microbiota and circadian rhythms. Nutrients like polyphenols, omega-3 fatty acids, and fiber influence neurotransmitter balance, neuroendocrine signaling, and microbial diversity, all of which support sleep and respiratory regulation. CONCLUSION: The Med-Diet offers a promising non-pharmacological approach to improving sleep health. Further longitudinal and intervention studies are needed to establish causality, assess effects within specific populations, and explore integrated lifestyle strategies, expanding the potential for chronic disease prevention and comprehensive health promotion.