Adherence to the Mediterranean diet has been linked to better sleep health. However, the relationship between alternate Mediterranean diet (aMED) adherence and specific sleep dimensions remains understudied, particularly among racial/ethnic minority populations. The objective was to examine associations between aMED adherence and sleep health in U.S. adults and assess differences by race/ethnicity. A cross-sectional analysis using data from the 2017-2018 National Health and Nutrition Examination Survey (NHANES), a nationally representative survey of the noninstitutionalized U.S. population, was conducted. Dietary intake was assessed via two 24-hour recalls to calculate a modified aMED score, and sleep health was measured using self-reported dimensions summarized into a composite score. The analytic study sample included 3,005 adults aged ≥18 years from the 2017-2018 NHANES cycle. Analyses were survey-weighted to yield estimates representative of U.S. adults who completed two 24-hour dietary recalls. Sleep health was assessed using five self-reported dimensions, regularity, timing, duration, satisfaction, and alertness, summarized into a composite score, with a score of ≥3 indicating "good" overall sleep health. Survey-weighted logistic regression models were used to examine the associations between aMED adherence and sleep health, while adjusting for confounders. All models incorporated NHANES strata, clusters, and the 2-day dietary recall weight (WTDR2D) to account for the complex survey design and obtain nationally representative estimates. Effect modification by race/ethnicity was assessed using both interaction terms and stratified models. In survey-weighted analyses, the mean age was 47.1 years (SE = 0.6); 51.3% were male. The weighted mean aMED score was 4.0, and 71% of adults were classified as having good sleep health. Higher aMED scores were significantly associated with greater odds of achieving recommended sleep duration (OR per 1-point increase = 1.1, 95% CI: 1.0-1.2, p = 0.03). Stratified analyses revealed that moderate/high aMED adherence was significantly associated with recommended sleep duration among racial/ethnic minority adults (OR = 1.3, 95% CI: 1.1-1.7, p = 0.01), but not among NH White adults (OR = 1.1, 95% CI: 0.7-1.9, p = 0.68). No significant associations were observed for other sleep domains or the overall multidimensional sleep health score. Adherence to the Mediterranean diet was associated with better sleep duration, particularly among racial/ethnic minority adults. These findings underscore the importance of considering cultural and social context in diet-sleep research, suggesting that dietary interventions may be a particularly relevant strategy for supporting sleep health in minority populations. Longitudinal studies with objective measures are needed to build upon these findings.