Nonrestorative Sleep Symptoms And Health Impact
May 20, 2021
 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 and blood sugar.  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.

How is Nonrestorative Sleep Diagnosed? Headline

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.

DIFFICULTY INITIATING SLEEP (DIS)
People who lay in bed and can’t easily fall asleep.

DIFFICULTY MAINTAINING SLEEP (DMS)
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:

1. Helps you fall asleep (DIS)
2. 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.

1. You have been diagnosed with a disease or medical condition.
2. Fluctuations in mood during the day.
3. After laying in bed, you struggle to fall asleep.

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.


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