The Use of Cupping (Hijama) Therapy Among Athletes and Its Relationship With Sleep Quality: A Cross-Sectional Study in Palestine.

Background and Aims: Wet cupping, or Hijama, is commonly used by athletes for recovery, yet evidence regarding its relationship with sleep quality remains limited. This study examined cupping use, perceived benefits, adverse effects, and factors associated with self-reported sleep quality among Palestinian athletes. Methods: A cross-sectional survey was conducted among Palestinian athletes. Of 754 athletes screened at nine sports clubs and training centers across the West Bank, 470 (62.3%) reported previous wet-cupping use; 468 had sufficient primary-outcome data and were analyzed. Data were collected using a structured paper-based questionnaire incorporating the Pittsburgh Sleep Quality Index. Analyses included descriptive statistics, exact and chi-square tests, Spearman correlations, multiple linear regression, and path analysis. Results: Improved mobility (30.8%), reduced muscle cramps (25.6%), enhanced immunity (16.2%), and increased endurance (9.0%) were the most frequently reported intended benefits. Cupping was commonly reported for chronic or recurrent conditions (99.6%), muscle strain (41.5%), and headaches (41.2%). Higher BMI and greater cupping-session frequency were associated with greater perceived cupping benefit ( Conclusion: Cupping-related practices and participant characteristics were associated with sleep quality. More frequent sessions, vitamin use, manual suction, higher BMI, and greater perceived benefit were associated with better sleep quality. These findings do not establish causality. Prospective studies are needed before cupping can be recommended to improve sleep or recovery.