Introduction

In modern society, people commonly experience sleep that is not refreshing, waking each morning reluctant to get out of bed and struggling through the day.  In addition to feeling tired or sleepy, unrefreshing sleep has an impact on concentration and memory, mood and irritability, so as well as health effects it can affect our work performance and how we interact with family and friends.


What can cause unrefreshing sleep?

Many things can result in unrefreshing sleep, but common causes are depression or stress and anxiety.  Over 70% of people with depression report poor quality sleep, and recent research shows if poor sleep associated with depression or anxiety is addressed not only does sleep improve, but depression and anxiety are also improved.  It had been thought that treating depression itself would also improve sleep, but we now know that specific sleep treatment is required.


Dealing with stress is part of modern life.  However, if we take stress to bed, even though we may sleep, there are subtle changes to sleep that occur with stress that can make it unrefreshing.  It is important to allow enough time at the end of the day to wind down before getting into bed, and if stress is a problem, then setting aside time for relaxation or meditation before bed can improve the quality of sleep.


Medical conditions and sleep disorders can cause unrefreshing sleep

Medical illnesses and the medications used to treat them can also cause unrefreshing sleep.  Chronic pain, or severe heart or lung problems cause constant sleep disruption.  Whilst chronic inflammatory conditions such as rheumatoid arthritis or chronic infections such as hepatitis or HIV also cause unrefreshing sleep and fatigue through sleep-promoting components of the immune response – cytokines.  These same cytokines are what make us have to take to bed with a cold or flu and make sleep for much longer than usual during these acute infections.


Specific sleep disorders such as sleep apnea and leg movements during sleep are common causes of unrefreshing sleep, and these regularly occur together with medical illness or depression, worsening sleep even further.  Looking at the contribution of sleep disorders to unrefreshing sleep is the role of a sleep study in evaluating the symptom of unrefreshing sleep.


Unrefreshing sleep, whilst common, usually has an underlying cause.  By identifying and treating that cause, daytime function can be improved.

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