Evaluating community pharmacists’ practices in managing insomnia in Saudi Arabia: a cross-sectional study using simulated patient visits

Background Insomnia prevails globally and nationally as a serious public health issue with a global prevalence of 48% and is significantly linked to morbidity and productivity loss. Community pharmacists play a vital role in addressing the issue through over-the-counter (OTC) medications and lifestyle advice, yet insomnia management practices remain unexplored in Saudi Arabia. Hence, this study addresses the gap using a simulated patient (SP) methodology. Methods A cross-sectional study employing SP was conducted to evaluate community pharmacists’ approach to insomnia management across three regions of Saudi Arabia. A total of 251 visits were identified under the standard scenario. Data collected included pharmacist behavior, consultation duration, and recommendations. Data analysis included descriptive statistics, the chi-square test, Pearson correlation, and binary logistic regression to identify the predictors of pharmacists’ history taking and patient counseling. Results A total of 251 simulated visits to pharmacies were completed (urban area 43.4%, suburban area 49.4%, and rural 7.2%), consultation lasted for only 1.5 min (interquartile range [IQR] 1–2 min), most pharmacists inquired about sleep patterns (55.4%) and triggers (51%), recommended OTC medications (e.g., melatonin, 64.5%), and non-pharmacological advice were less frequent (9.6%). Safety information was infrequent (4.9%). Pharmacist professionalism was high (85.7%), but privacy, self-introduction, and referrals were low, with significant regional variation among pharmacies ( p < 0.001, χ 2 ). Binary logistic regression identified multiple strong predictors across all domains, including day of visit (odds ratio [OR] = 509.979), interaction duration (OR = 0.338), and key questioning behaviors. Discussion Saudi pharmacists opted for safer OTC melatonin for the management of insomnia with brief consultation (IQR = 1–2 min), incomplete history taking, limited safety counseling (<5%), and rare non-pharmacological advice (9.6%). Regional variations and time pressures highlight the need for workflow improvements to enhance patient-centered care. The day of the visit displayed a strong effect (OR = 509.979), whereas longer pharmacist interactions were associated with lower odds of missing key questions (OR = 0.338). Accompanying symptoms (OR = 6567.348) and chronic health issues (OR = 941.751) were identified as strong predictors. Conclusion Although pharmacists were accessible, gaps in insomnia management may risk patient safety. Targeted training for pharmacists (continuous professional development [CPD] programs), formulating community guidelines for pharmacists, and systemic changes are important to optimize their role in sleep health.