What Is Restless Sleep & What Causes It?

Understanding Restless Sleep

Restless sleep is a subjective experience that can be objectively measured through various factors, such as poor sleep quality, frequent muscle movements at night, and daytime impairment. Due to the lack of a defined medical diagnosis, people have different interpretations of what constitutes restless sleep.

In general, restless sleep refers to disrupted and unrefreshing sleep, often characterized by arousals and brief awakenings that affect the overall quality of sleep.

In 1979, the Association of Sleep Disorders Centers and the Association for the Psychophysiological Study of Sleep introduced "restlessness" as a symptom of sleep disorders like sleep apnea and insomnia. They described it as persistent or recurrent body movements, arousals, and brief awakenings that occur during sleep.

Emerging sleep medicine literature identifies restless sleep disorder as a new, unrecognized sleep disorder affecting children. The disorder is characterized by frequent large body movements and repositioning during sleep, at least five times per hour, and a significant impact on daytime behaviors.

Common Symptoms of Restless Sleep

Restless sleep can be characterized by a range of symptoms that impact a person's ability to sleep well and function effectively during the day. Here are some common signs of restless sleep:

• Difficulty falling asleep

• Waking up multiple times during the night

• Frequent tossing and turning

• Falling off the bed or restless movements during sleep

• Feeling only partially asleep

• Waking up feeling tired and unrefreshed

• Irritability during the day

• Excessive daytime sleepiness

• Poor physical and cognitive performance during the day

What Triggers Restless Sleep?

Restless sleep is a disruptive experience that can negatively impact the quality, duration, and effectiveness of sleep. Several factors can contribute to or cause restlessness during sleep.

• Sleep Environment

  The ideal sleep environment should be quiet, dark, and cool, but various factors such as noise, uncomfortable bedding, bright light, and extreme temperatures can disrupt a person's ability to achieve this sleep environment, leading to a restless night.
  
  

• Underlying Medical Conditions

  Certain medical conditions, whether physical, mental, or emotional, can affect a person's ability to sleep soundly at night. Restless sleep can be a symptom of sleep disorders such as sleep apnea, delayed sleep phase disorder, narcolepsy, restless leg syndrome (RLS), and sleepwalking. Other medical conditions such as depression, anxiety, multiple sclerosis, rheumatoid arthritis, and pain can also contribute to poor sleep quality.
  
  

• Pain

  Chronic pain can make it difficult for a person to fall asleep and can cause fragmented and unrefreshing sleep. Poor sleep can also increase chronic pain symptoms and lower pain tolerance, leading to more restless nights.
  
  

• Stress

  Daily and traumatic stress can also affect a person's ability to sleep soundly. Stress can cause difficulty initiating sleep and lead to multiple awakenings throughout the night. Studies show that almost half of US adults experience stress-induced sleep interruptions.
  
  

• Diet

  Heavy or spicy meals, caffeine, tobacco, chocolate, and alcohol consumption in the evening can make it difficult to wind down and fall asleep.
  
  

• Exercise

  Vigorous exercise close to bedtime can disturb sleep, but regular exercise can improve sleep quality, promote healthy aging, and prevent chronic illnesses.
  
  

• Loneliness

  Although not a recognized medical disorder, loneliness can significantly affect a person's health and well-being, leading to vigilance and preventing restful sleep.
  
  

• Napping

  Short naps during the day can improve productivity and performance, but longer evening naps can interfere with sleep duration and efficiency.
  
  

• Poor Sleep Hygiene

  Poor sleep hygiene, which includes practices such as irregular sleep schedules, heavy meals, alcohol, caffeine, lack of physical activity, uncomfortable sleep environment, and excessive screen time, can affect a person's ability to sleep well at night.

How Insomnia Differs from Restless Sleep

Insomnia is a sleep disorder characterized by difficulty falling and staying asleep, as well as poor sleep quality and duration, even when a person has favorable sleep conditions. To receive an insomnia diagnosis, a person must show symptoms that result in significant functional impairment and occur for at least three nights a week for three months, and not be caused by other physical or mental disorders. Only a healthcare professional can diagnose insomnia.

Restless sleep, on the other hand, is not officially recognized as a sleep disorder and is a subjective experience that varies from person to person. While there are some objective measures to assess restless sleep, such as poor sleep quality, nightly sleep disruption, and frequent muscle movements, a person can report feeling restless even without meeting these criteria. Restless sleep may or may not be associated with an underlying sleep disorder or medical condition and can occur frequently or infrequently.

How to Manage Restless Sleep?

While it's not uncommon to experience occasional restless sleep, chronic restlessness that interferes with daily functioning requires medical attention. Here are some tips to help improve your sleep hygiene and reduce the likelihood of restless sleep:

• Avoid substances that can disrupt sleep: Alcohol, caffeine, nicotine, and heavy meals can affect sleep quality and make you feel restless.

• Engage in self-care practices: Activities like journaling, walking, yoga, breathing exercises, warm baths, and hobbies can promote relaxation and reduce stress.

• Exercise regularly: Regular physical activity can regulate your body's internal clock and promote relaxation.

• Follow a regular sleep schedule: Going to bed and waking up at the same time every day supports proper sleep hygiene.

• Create a sleep-conducive environment: Keep your bedroom cool, quiet, and comfortable and limit its use to sleep and relaxation.

• Avoid evening naps: Long and frequent napping can interfere with nighttime sleep.

• Limit electronic device use: Blue light emitted by electronic devices can increase alertness, making it difficult to fall asleep. Avoid using non-essential devices in your bedroom or use blue-light blocking glasses to reduce exposure to blue light.

The Impact of Restless Sleep Across Different Age Groups

Restless sleep affects people of all age groups and can be associated with underlying sleep disorders or medical conditions. Symptoms of restless sleep vary by age group.

• Infants

  Infants typically require 12 to 17 hours of sleep per day. However, from 6 months old, they may start to experience interrupted sleep at night. Although this may not necessarily indicate restless sleep, some symptoms may include difficulty falling asleep, nighttime awakening, and co-sleeping with parents.
  
  

• Toddlers

  Factors like temperament, soothability, and fear can influence a toddler’s sleep. Toddlers with active temperaments and high fear levels may have less sleep, while those with high soothability may have longer sleep time. Fear of sleeping alone or staying up late may also cause restlessness.
  
  

• Children

  Restless sleep is a common complaint in children and can be associated with medical or sleep conditions like sleep-disordered breathing, pain, asthma, teeth grinding, restless legs syndrome, autism spectrum disorders, periodic leg movements, attention-deficit/hyperactivity disorder, sleep terrors, sleepwalking, and sleep talking. Restless sleep disorder is a new and separate disorder in children characterized by fragmented sleep, frequent body movements, and daytime impairment.
  
  

• Teens

  Teens may experience restlessness during sleep due to late bedtimes, difficulty falling asleep, and sleep disturbances caused by habits like excessive social media use, alcohol and drug use, partying, and engaging in other nighttime social activities.
  
  

• Adults

  More than one in three US adults do not get enough sleep, which can be attributed to restless sleep that contributes to poor sleep duration and quality. Sleep disorders that can cause restlessness during sleep include insomnia, sleep apnea, and restless legs syndrome.
  
  

• Older Adults

  Sleep disturbances are common in older adults, and some changes that come with aging, like short sleep duration, frequent daytime naps, increased nighttime awakenings, difficulty falling asleep, and decreased slow-wave sleep, may be associated with restless sleep. Additionally, conditions prevalent in older adults, such as nocturia, loneliness, chronic pain, chronic illnesses, cognitive decline, and sleep apnea, may also contribute to restless sleep.

If you frequently experience restless sleep, it may be helpful to practice good sleep hygiene, but seeing a doctor for treatment may also be necessary.