Nonrestorative sleep | Insomnia | Fibromyalgia and Chronic Fatigue Syndrome

Nonrestorative sleep is considered a sleep that has poor quality, and as a consequence, despite all your efforts to get enough sleep, you still wake up tired in the morning as if you haven’t slept at all.

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Last Updated: Thu, October 3, 2019

One of the most satisfying things in the world is waking up in the morning (probably on the weekend) and starting your day with a cup of joe while feeling refreshed and ready to tackle anything that comes your way throughout the day — the joy of good quality sleep. 

It is a known fact that sleep is essential for our wellbeing and it’s not just our subjective feeling. Science backs it up too. Research shows that our cardiovascular and immune system go through the process of restoration like other organs. Quality of sleep also affects the proper functioning of our nervous system. The little amount of it can cause drowsiness and mood swings. We can go on and on about these facts, but what if you don’t feel rested? What if despite all efforts to get enough sleep you still feel tired as if you haven’t slept at all?

That my friend means you might be experiencing a nonrestorative sleep.

Nonrestorative sleep is considered a sleep that has poor quality. Even though not all doctors and researchers can agree that it is a sleep disorder, this term keeps popping up in scientific literature and manuals for diagnostics, despite the fact that we don’t have an official definition of it.

People who experience nonrestorative sleep often complain that they feel fatigued and in pain. Also, their score is lower on the psychomotor vigilance test.

Although they don’t feel or notice it, their sleep is fragmented based on the results of polysomnograms that show micro-awakenings, but whatever is the cause of nonrestorative sleep it does not show up during testing and standard diagnostics.

Some experts conclude that nonrestorative sleep is part of the symptoms of insomnia, but it can also affect people who sleep normally, causing them to feel sleepy during the day.

Information about the personal experience of feeling fatigued even if the proper amount of sleep has been achieved without having a sleep disorder is the closest thing to a definition we have at the moment.

Since many aspects of NRS are still unknown, it is hard to determine the right therapy. More research is needed to understand it.

But let’s see how the information about NRS is connected with sleep disorders like insomnia, fibromyalgia and chronic fatigue syndrome.


Psychomotor vigilance test is a helpful tool to measure behavioral alertness of a person. It is a visual-based test that follows the speed at which someone reacts to stimuli that are visual. Standard PVT lasts about 10 minutes, but there is also a shorter option form 3-5 minutes.  

PVT is also a very successful method to measure sleep deprivation, misalignment of circadian rhythm in relation to behavioral alertness. Organizations like NASA have also taken this test while on training or in space to follow possible misalignments in circadian rhythm as well as potential sleep deprivation.

Nonrestorative Sleep and Insomnia

Recent research and studies have suggested that NRS symptoms can be different from symptoms of insomnia. One of them conducted a trial with over ten thousand individuals age 20 or above.  

They were all classified by the absence or presence of nonrestorative sleep and nocturnal insomnia syndrome. A connection was found between NRS and other sleep disorders such as sleep apnea, restless leg syndrome and snoring. Increased CRP levels, as well thyroid issues appeared to be associated with NRS.  

The information that was found suggests that there are considerable differences between nocturnal insomnia syndrome and nonrestorative sleep regarding comorbidity associated with other physical and sleep disorders as well as sociodemographic factors. Response to inflammation can possibly play an interesting role in NRS pathogenesis (disease development).  

Nonrestorative Sleep and Fibromyalgia

Nonrestorative sleep, or unrefreshing sleep as some call it, is considered to be connected to fibromyalgia but some studies show that it is linked to abnormalities in the chemistry of the brain as well as immune system. Those abnormalities can both be a consequence and a cause to fibromyalgia.

Research shows that low sleep quality is linked to many fibromyalgia symptoms including:

Unfortunately, we do not entirely understand why people who have this condition feel unrefreshed. Of course, it is normal to conclude that pain impacts quality of sleep in many ways and many fibromyalgia patients say that even lying down on muscles that are excessively tender can lead to high pain. As they have a tendency to overheat and sweat excessively, sleep problems can occur more often.

Nervous system dysfunction can also play a big part in causing those sleep disruptions. According to recent fibromyalgia theory, the sympathetic part of the nervous system (the fight or flight mode) gets stuck which prevents the patient’s body to completely relax during sleep. It’s something similar to what parents who got their first baby experience as they are alert to help the baby whenever it cries. Just like the people with fibromyalgia are alert and continuously check the time when they are anxious that they’ll sleep in.

Some studies say that fibromyalgia participants had an abnormal heart rate which supports the raised sympathetic activity theory. Pain causes sleep disruptions, and lack of quality sleep causes pain, so it goes round and round.

Nonrestorative Sleep Treatment In Fibromyalgia

Some medication can alleviate the pain and improve the quality of sleep in fibromyalgia:

The FDA approves Cymbalta, Savella, and Lyrica for this type of illness. Xyrem is a drug that has to be controlled strictly, and Elavil is antidepressant tricyclic.

Additionally, melatonin supplements can help relieve the pain and improve the quality of sleep but consult your doctor before deciding to use any of the stated medication.

Nonrestorative Sleep and Chronic Fatigue Syndrome

One of the main features of chronic fatigue syndrome (CFS/ ME) is that the quality of sleep is reduced which means it cannot relieve fatigue. Those are also symptoms of nonrestorative sleep. Researchers are still trying to get a better understanding of how nonrestorative sleep impacts CFS/ME.  

People with CFS/ME are mostly complaining that they always wake up feeling tired no matter the length of their sleep. Consequences of nonrestorative sleep are more than just feeling tired. Experts believe that it is caused by a problem in the regulation of our sleep – homeostasis. People with CFS/ME might have some sleep disorders, but many studies support the idea that intense and constant fatigue is due to homeostasis impairment and not from sleep disorders of a different kind.

One study that was released in Sleep Medicine Reviews shows that they didn’t find any evidence to support the theory that relief of fatigue in this condition can be achieved by comorbid treatment of sleep disorders.

Nonrestorative sleep can cause the following symptoms of CFS/ME:

The differences in sleep at people who have CFS/ME

Autonomic dysfunction is a consequence of the ANS problem. If the parasympathetic and sympathetic are not in balance because of autonomic dysfunction, that can put a person in an increased state of awareness and arousal when it’s time to sleep.

Nonrestorative Sleep Treatment In Chronic Fatigue Syndrome

Unfortunately, researchers haven’t found the best way to improve the quality of sleep and alleviate excessive fatigue in CFS/ME. So far no medicine has been FSA approved for this disease. However, in 2010 one study showed positive results when it comes to narcolepsy Xyrem drug, but its usage should be strictly controlled, and most of the time it can be a challenge to get a prescription.

There are some other alternatives such as melatonin, but more studies need to be conducted to determine how effective it is. Some say that antidepressants and supplements help them sleep, but we do not have enough research material to support these claims entirely.

Sleep specialists recommend relaxing techniques as a way to improve sleep hygiene and habits. The most important thing is to find a reliable and experienced doctor that can help you by offering different types of treatment to alleviate nonrestorative sleep.

Since there aren’t many medicines that are reliable enough, let’s check out some helpful tips on what you can do today (or better tonight) that can help you sleep better.

How To Get More REM and Deep Sleep?  

There are many things that you can do to enter all essential stages of sleep with ease and consistency.  


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A fashion designer by profession, writer by choice and bookworm – always.  As a person struggling with anxiety for years and someone who loves to sleep, I can relate to the struggles of getting a good night’s rest. When I'm not doing sleep research, I enjoy reading books, being involved in creative activities and discovering the best use of my Moka pot.

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