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Non-restorative sleep

Medical symptom From Wikipedia, the free encyclopedia

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Non-restorative sleep (NRS), also known as unrefreshing sleep,[1] is a subjective symptom in which sleep is experienced as insufficiently refreshing and hence subjective sleep quality as poor.[2][3][4] This can be despite the appearance of otherwise normal sleep, like adequate sleep duration and lack of nighttime awakenings.[2][3] NRS is associated with daytime cognitive dysfunction, affective symptoms, fatigue, sleepiness, and increased pain sensitivity.[2][3][5][4] It is diagnosed exclusively via self-report or sleep questionnaires.[2][6]

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Conditions

NRS is often a symptom of sleep disorders such as insomnia and shift work sleep disorder.[2][3] It can also occur in hypersomnia and narcolepsy.[2][3] In addition, NRS is frequently a symptom of conditions like fibromyalgia, myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), long COVID, autoimmune disorders like rheumatoid arthritis and systemic lupus erythematosus (SLE), and infections.[2][3][7][5][8][4] NRS has been especially associated with fibromyalgia and ME/CFS, with approximately 65 to 95% of people with fibromyalgia and 85 to 95% of people with ME/CFS reporting unrefreshing sleep.[2][3][5] NRS may in fact be related to the cognitive impairment, fatigue, and myalgia (muscle pain) experienced by people with fibromyalgia and ME/CFS.[3][5][4] Other conditions associated with NRS include sleep apnea, periodic limb movement disorder (PLMD), and chronic pain.[2][3][5] Psychiatric disorders such as depression or anxiety have been associated with NRS as well.[2][3] On the other hand, NRS can occur without any comorbidity.[2][3]

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Correlates

Older age is strongly correlated with NRS, although conflicting findings exist.[3] In addition, women experience NRS more often than men, though this is not always observed.[3] Relatedly, in the case of fibromyalgia, more than 90% of people with this condition are women.[2][5] People who are unemployed or retired have been found to experience more NRS than employed people.[3] Shift workers have a relatively high level of NRS.[3] Moderate to high stress has been associated with NRS.[3]

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Causes

Research on the mechanisms underlying NRS are controversial and inconclusive.[2][3] NRS is correlated with sleep onset latency and to a lesser extent with sleep duration.[3] The symptom might be due to disturbance of slow wave sleep (SWS; non-REM sleep or "deep sleep") and due to insufficiently deep sleep.[3][2][5][4] Alternatively or additionally, it might be related to REM sleep deprivation.[5] Pro-inflammatory cytokines such as interleukin-1 (IL-1), interleukin-6 (IL-6), and tumor necrosis factor α (TNFα) may have negative effects on sleep and increase the likelihood of NRS.[2] These findings provide a possible mechanism by which immune disorders and related conditions may affect sleep and cause NRS.[2]

Treatment

There is little information available on treatment of NRS as of 2008.[3][5] Treatments that might be helpful in some cases of NRS include behavioral measures like cognitive–behavioral therapy (CBT) and hypnotherapy, exercise, hypnotics, and certain antidepressants.[5] Some hypnotics have been found to improve SWS, such as sodium oxybate (γ-aminobutyric acid; GHB)[9][10] and gaboxadol,[11][12] and hypnotics of this sort might be more useful than other hypnotics in the treatment of NRS, though more research is needed to substantiate such notions.[5][13][4]

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References

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