Short-Term Sulfurous Balneotherapy and Self-Reported Sleep Quality: An Exploratory Retrospective Real-World Pre–Post Observational Study at Terme di Saturnia (Italy)

<b>Background:</b> Sleep disturbances are highly prevalent, affecting approximately 21% of the European population, with chronic insomnia disorder estimated at 6%. Non-pharmacological alternatives to pharmacotherapy are needed. Sulfurous balneotherapy represents a potential intervention, yet real-world evidence remains limited. <b>Objective:</b> To explore changes in self-reported sleep quality following sulfurous balneotherapy at Terme di Saturnia (Italy). <b>Methods:</b> Retrospective single-arm observational study of 76 participants (mean age 47.3 years, 54% female) undergoing a 7-12-day consecutive balneotherapy cycle with daily sulfurous thermal water immersion sessions (60-90 min/session). The Oviedo Sleep Questionnaire (OSQ) was administered pre- and post-treatment. Participants were stratified by baseline insomnia severity into Group A (OSQ ≥ 22, n = 47) and Group B (OSQ < 22, n = 29). The primary outcome was change in OSQ insomnia score in Group A. Statistical analysis was performed using the Wilcoxon signed-rank test. <b>Results:</b> In Group A, insomnia severity decreased significantly from 26.4 ± 8.3 at baseline to 20.1 ± 7.5 post-treatment (Δ = -6.3, 95% CI: -7.9 to -4.7, <i>p</i> < 0.001, r = 0.54). Sleep satisfaction also improved significantly from 3.2 ± 1.1 to 4.6 ± 1.2 (Δ = +1.4, 95% CI: 1.1-1.7, <i>p</i> < 0.001, r = 0.60). In Group B, no statistically significant changes were observed, consistent with ceiling effects. However, in an open-ended question, 72.4% (21/29; 95% CI: 54.3-85.3) of Group B participants reported enhanced relaxation during the spa stay. Due to the single-arm observational design without control groups, the observed improvements cannot be distinguished from non-specific factors, including the vacation effect, reduced work-related stress, placebo and expectancy responses, regression to the mean, or the effects of warm water immersion itself independent of sulfurous mineral content. <b>Conclusions:</b> This exploratory study documents pre-post improvements in self-reported sleep quality in a cohort undergoing sulfurous balneotherapy during a spa vacation. The absence of control groups and unmeasured confounders precludes causal inferences. Future randomized trials with heated non-mineral water controls are needed to isolate specific therapeutic contributions of sulfurous thermal waters.