Medically reviewed by, Russell Braun RPH
There is not much that feels better than waking up in the morning refreshed and energized to take on the day. However, the sad fact is that far too many people do not wake up feeling this way. Sleep is vital to your health and if your sleep is nonrestorative it can wreak havoc on your life. What exactly is nonrestorative sleep anyway?
Nonrestorative sleep (NRS) is defined as feeling unrefreshed when waking from overnight sleep, even though you may have slept for several hours. You know the feeling when you wake up and you know that you’re not recharged. Like you could lay back down and sleep for several more hours. NRS has gotten more attention of late as the importance of sleep is being brought to the forefront.
The impacts of NRS are severe. In fact it has been proven to play a key role in several conditions such as:
- Heart disease
- Obesity
- Fibromyalgia
- Chronic fatigue syndrome
- Daytime drowsiness
- Insomnia
- Mood disorder
- Fatigue
- Pain
- Depression
- Anxiety
- Poor quality of life
What are the 5 Types of Sleep Disorders?
According to the American Sleep Association (ASA) between 50 to 70 million people have a sleep disorder. The most common types include:
- Insomnia – Is difficulty falling or staying asleep.
- Sleep apnea – When you are woken up because your airway is blocked and you stop breathing.
- Narcolepsy – Suddenly falling asleep at any time no matter where you are.
- Restless leg syndrome – An uncontrollable urge to move your legs while sleeping.
- REM sleep disorder – When you act out your dreams as you sleep.
Ironically, NRS is not on the list. The reason for that is NRS has proven hard to define. Consequently, it has not been a routine part of the assessment of sleep in most clinical trials. In fact, it did not appear in the diagnostic criteria for sleep disorders until 1987.
What Causes Nonrestorative Sleep?
NRS is described as feeling that sleep was light, restless and of poor quality. In spite of the duration of sleep the individual does not feel refreshed or restored.
Many claim to feel like they have not slept at all. It has been associated more recently in people with fibromyalgia and Chronic Fatigue Syndrome (CFS). Although recently it seems to be a frequent symptom in the general population as well.
The cause is believed to be due to the Autonomic Nervous System (ANS). The ANS is made up of two different and opposing parts of the nervous system in humans.
- Sympathetic nervous system – Controls fight or flight in response to a threat or danger in the environment.
- Parasympathetic nervous system – Responsible for rest and digest to help repair the body and capture nutrients from foods we eat.
In the stressful world we live in today our sympathetic nervous system is in overdrive. This causes long term health problems for many people. Obviously, when sleeping the parasympathetic nervous system should be in charge helping with the rest and repair of the body.
If you are trying to sleep and there is too much sympathetic nervous system activation then your rest is not going to be restorative. Overstimulation during sleep prevents the body from cycling through the normal patterns of sleep.
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How is Nonrestorative Sleep Diagnosed?
One difficult thing about diagnosis of NRS is trying to distinguish it from other sleep problems. Today most sleep problems are lumped into two buckets by doctors.
People who lay in bed and can’t easily fall asleep.
People who fall asleep fine, but wake frequently in the middle of the night.
Either one could cause what most people think of as “insomnia”. When treatment options are considered these are the factors normally taken into consideration. For instance you might look for an over the counter sleep aid that either:
- Helps you fall asleep (DIS)
- Will help you stay asleep (DMS)
NRS deals with the outcome of your sleep. Instead of did you fall asleep quickly and stay asleep, treating NRS means how refreshed are you from that sleep.
The Functional Outcomes of Sleep Questionnaire (FOSQ) is a test that tries to determine how rested you feel. While it is more in depth than just accessing DIS or DMS, researchers need a better tool to try and capture a diagnosis of NRS.
NRS seems to be accompanied by other diseases. This has led to the theory that an inflammatory component may be a work leading to both the disease and NRS. This may mean that NRS is really just another symptom of the underlying disease. Some examples of disease states that are thought to cause NRS include:
- Increased C-reactive protein (a marker of inflammation) seen elevated in autoimmune diseases
- Chronic pain
- Restless leg syndrome
- Fibromyalgia
- Respiratory disease (chronic obstructive pulmonary disease (COPD) & emphysema)
- Cancer
- Thyroid disease
- Sleep apnea
- Grinding of teeth
What Are NRS Symptoms?
Diagnosing NRS has been challenging and therefore clearly laying out symptoms has also been difficult. Most symptoms are based on daytime issues you may notice. Despite sleeping for a normal duration, the most common NRS symptoms include:
- Hard to wake up
- Feeling unrested
- A sense that normal activities take more effort
- Fatigue
- Sleepiness in daytime hours
- Brain fog (unable to think straight or concentrate)
- Heightened sense of pain
In general you might be getting non restorative sleep if you have the following issues.
- You have been diagnosed with a disease or medical condition.
- Fluctuations in mood during the day.
- After laying in bed, you struggle to fall asleep.
What is The Best Sleep Stage?
Many studies have looked at differences in the sleep stages for people with NRS compared to others.
When you sleep the body is always cycling through different stages of sleep. There are four stages to sleep
| Sleep stage # | Definition of stage | What happens during phase |
| Stage 1 | Light, non-REM sleep | Body slows down heart rate, breathing, eye movement and brain waves |
| Stage 2 | Deeper, non-REM sleep | Muscles relax, body temperature drops and eye movement stops |
| Stage 3 | Deepest stage of sleep | Heart rate, breathing and brain waves become normal. Hardest to awaken from and if do awake during this time will feel brain fog |
| Stage 4 | REM (Rapid Eye Movements) sleep cycle | Breathing increases, heart rate and blood pressure fluctuate. Dreaming occurs and temporary muscle paralysis to keep you from acting out dreams |
During the night the body cycles through the stages of sleep typically, 4 to 6 times. Most stage 3 sleep happens earlier in the night. Conversely, REM sleep goes from around 10 minutes in the first cycle up to an hour by the last.
The most important stage of sleep is the third stage, when you are in deep sleep. Researchers think the average person who sleeps 8 hours per night gets 1 to 2 hours of stage 3 sleep per night.
Many think that for those suffering from NRS they have a lack of stage 3 sleep. Stage 3 has the most evidence showing it is required for feeling rested and improving health.
Does Sleep Help With Chronic Fatigue Syndrome?
Chronic fatigue syndrome (CFS) as the name implies leaves people feeling tired and exhausted. One key feature of CFS is that sleep does not seem to bring relief of fatigue. This perfectly aligns with the concept of NRS. The difference being that CFS is ongoing and not just for a short period of time.
As mentioned above, some researchers believe that NRS is actually a symptom of other diseases. A study of CFS patients found that patients may have structural differences in their brain leading to NRS. It is clear that poor qulity sleep is a key feature of CFS. Finding ways to resolve the sleep problems would certainly help patients with CFS feel better.
While getting better sleep at night is good for CFS, what about napping? Studies have shown that napping, especially in the afternoon is not a good idea for CFS. Researchers found decreased cognitive functioning and more daytime sleepiness following afternoon naps.
How do You Get Restorative Sleep?
Sleep is critically important to your overall health. During your sleep the body goes to work repairing damage that took place during the day. Restorative sleep means that your brains activity during sleep is restoring the mind and body for the upcoming day.
When sleep is non restorative you know it almost immediately upon waking the next day. You might be wondering what you can do in order to get restorative sleep. Here are some key points:
Sleep hygiene tips
| Tip | Why it helps |
| Keep the same sleep schedule | Your body operates in a circadian rhythm. Keeping a schedule helps this natural process. |
| Get sun in the morning | Sunlight helps activate your body and shift it out of sleep mode and into awakening. |
| Limit blue light from screens after sunset | Melatonin helps you sleep and is produced when light fades. Blue light from screens can inhibit melatonin production. |
| Keep bedroom for sleep and sex only | Don’t lay in bed on the phone or watching TV. These things confuse your normal cycles. |
| Do not nap during the day | Naps during the day make it harder to fall asleep at night. This shortens the number of sleep cycles you get, which directly impacts restorative sleep. |
| Get daily exercise | Exercise stimulates muscle growth. This will trigger sleep hormones by the body to ensure the repair work can be done. |
| Avoid caffeine, snacks and large meals several hours prior to bedtime | Caffeine is a stimulant, it takes hours to be cleared from your bloodstream. Avoid it after 2pm in the afternoon. Digesting food can interrupt sleep and cause reflux. Eat well before bed to allow the digestion to complete prior to bedtime. |
| Avoid drinking water and alcohol several hours prior to bedtime | Water will eventually cause the need to urinate and that can wake you from sleep. Alcohol can be a sedative, however it impairs the sleep cycles and leads to non restorative sleep. |
| Keep your bedroom dark and at a constant temperature | You need dark to maintain melatonin levels to regulate sleep. Additionally, temperature changes can cause awakening during the night. |
What is Non restorative Therapy?
Anyone who has had a night of non restorative sleep wants to know what can be done to remedy the issue. Aside from getting good sleep hygiene there are other things that can be done to improve sleep. Most of them will help with the underlying disease that the NRS could just be a symptom of.
Sleep diary
In order to effectively try to treat your sleep problems you have to know what is going on first. There are questions you should consider every night before going to bed and when awakening in the morning. To track these questions over time you can grab a journal or few sheets of paper to create a sleep diary.
Questions to answer before bedtime:
| What medications did you take today? | How much caffeine did you consume today? |
| Did you drink any alcohol today & when? | Did you exercise and for how long? |
| Were you sleepy during the day? | Did you take a nap, when and how long? |
| What time did you eat your last meal? | Any activities within two hours of bedtime? |
Questions to answer upon awakening:
| What time did you go to bed? | How many times did you wake up? |
| Do you know why you woke up? | What time did you wake up in the morning? |
| How alert do you feel after brushing your teeth? | Did you snore? |
Keeping track of your sleep either with a journal or an app on your phone can make a huge difference. Many times you will notice trends that lead to NRS. That can help you to avoid those causes and sleep better overall.
Treatments
| Meditation | Studies have shown that meditation before bedtime can improve sleep quality. |
| Biofeedback | Using feedback techniques to help calm yourself before bedtime can be useful for inducing sleep. Biofeedback can be training you do on your own for sleep problems. |
| Binaural beats | Listening to different frequency sounds prior to going to bed can actually induce a meditative state. This is a great low cost option for people who do not like to meditate. |
| Neurofeedback | This process is done by a practitioner using electroencephalogram to look for patterns and then retrain your brain for sleep. |
| Dietary supplements | Melatonin is a hormone that is produced by the body to induce sleep. Taking it as a supplement can help shift the bodies sleep rhythm. Valerian is an herb that is used for sleep. A review of studies done by the American Journal of Medicine notes that valerian might improve sleep quality without side effects. |
| Over the counter (OTC) medications | Antihistamine drugs are commonly used by people as a way to help with sleep. These drugs may help with insomnia on a short term basis. However, long term they may impair sleep and increase the risk of falls due to numerous side effects. |
Click here to get Dr. Jason Reed’s exclusive list of medication questions you MUST ask your doctor, for FREE!
Share Your Story
Do you have problems with non restorative sleep? Also, please share and tips or tricks you have used to sleep better. Chime in below with your comments and thoughts.
References:
Ohayon, Maurice et. al, Prevalence and correlates of non restorative sleep complaints. Arch Intern Med 2005 Jan;165(1): 35-41.
Nacul, Luis et. al, How Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) Progress. Frontiers in Neurology 2020 Aug;(11): 826.