Prevalence and Correlates of Nonrestorative Sleep Complaints

Stanford Sleep Epidemiology Research Center, Stanford University School of Medicine, Stanford, Calif., USA.
Archives of Internal Medicine (Impact Factor: 17.33). 01/2005; 165(1):35-41. DOI: 10.1001/archinte.165.1.35
Source: PubMed


Nonrestorative sleep (NRS) has been little studied in the general population, even though this symptom has an important role in several medical conditions such as heart disease, fibromyalgia, and chronic fatigue syndrome, as well as various sleep disorders.
A total of 25,580 individuals (age range, 15-100 years) from the noninstitutionalized general population representative of 7 European countries (France, the United Kingdom, Germany, Italy, Portugal, Spain, and Finland) were interviewed by telephone using the Sleep-EVAL system. Nonrestorative sleep was analyzed in relationship to sociodemographic determinants, environmental factors, life habits, health, sleep-wake schedule, and psychological factors.
The prevalence of NRS was 10.8% (95% confidence interval, 10.4%-11.2%) in the sample, was higher in women than in men (12.5% vs 9.0%; P<.001), and decreased with age. The United Kingdom (16.1%) and Germany (15.5%) had the highest prevalence of NRS and Spain (2.4%), the lowest. In multivariate analyses, several factors were positively associated with NRS. The most important were younger age, dissatisfaction with sleep, difficulty getting started in the morning, stressful life, presence of anxiety, bipolar or a depressive disorder, and having a physical disease. When compared with subjects who have difficulty initiating or maintaining sleep (without NRS), subjects with NRS reported more frequently a variety of daytime impairment (irritability, physical, and mental fatigue) and consulted a physician twice as frequently for their sleeping difficulties than did other subjects with insomnia.
Nonrestorative sleep is a frequent symptom in the general population, but its prevalence largely varies between countries. It is often associated with mental disorders and characteristics of sleep deprivation (such as extra sleep time on weekends). Nonrestorative sleep affected more frequently the active classes of the population and caused greater daytime impairment than difficulty initiating or maintaining sleep.

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    • "With the lack of large-scale epidemiological research on mental health among musicians, further research is needed to look at prevalence and associations between insomnia, NRS and mental health in this specific group. As insomnia and NRS is known to be related to both anxiety and mood disorders (Ohayon, 2005; Roberts & Duong, 2012; Sivertsen et al., 2012), further research, using prospective designs, is needed to see how these phenomenon is manifested among musicians in different contexts and settings (freelance, orchestra, touring/not touring etc.). "
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    ABSTRACT: Sleep problems are reported as common among performing artists and musicians. However, epidemiological research comparing musicians to different groups of the general population is lacking. 4,168 members of the Norwegian Musician’s Union were invited to an online survey regarding work and health. Of the 2,121 (51%) respondents, 1,607 were active performing musicians. We measured prevalence of insomnia symptoms using the Bergen Insomnia Scale (BIS), and compared this sample to a representative sample of the general Norwegian population (n=2,645). Overall, musicians had higher prevalence of insomnia symptoms compared to the general population (Prevalence Difference 6.9, 95% Confidence Interval 3.9-10.0). Item response analysis showed that this difference was mainly explained by nonrestorative sleep and dissatisfaction with sleep among musicians. An additional analysis, comparing musicians to the general Norwegian workforce (n=8,518) on sleep difficulties, confirmed this tendency (Prevalence Difference 6.2, 95% Confidence Interval 4.3-8.1). Musicians performing classical, contemporary, rock, and country music reported the highest prevalence of insomnia, and these genres might be of special interest when developing preventative measures, treatment strategies and further research on sleep difficulties among musicians.
    Behavioral Sleep Medicine 09/2015; DOI:10.1080/15402002.2015.1007991 · 2.34 Impact Factor
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    • "Pain may be associated with sleep instability, disruption of non-rapid eye movement (REM) to REM sleep cycles continuity and excessive sleep fragmentation [24], which may in turn increase the perception of unrefreshing or nonrestorative sleep (NRS). Non-restorative sleep refers to the subjective experience of sleep as insufficiently refreshing or to the feeling that sleep is restless , light or of poor quality, even though traditionally assessed objective sleep parameters (eg, total duration, sleep stage distribution ) appear to be normal [25] [28]. Different etiologies for NRS and insomnia symptoms, such as difficulty initiating or maintaining sleep, are discussed in the literature [29]. "
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    ABSTRACT: Patients with temporomandibular disorders (TMD) and/or orofacial pain (OFP) frequently experience poor sleep quality or suffer from comorbid sleep disorders. Study results suggest that in chronic pain patients, an improvement in sleep quality critically influences the outcomes of interventions on mood and pain. Yet, only a few studies have systematically sought to evaluate the sleep quality of TMD/OFP patients. Standardized and validated self-reported instruments designed for screening sleep disturbances or for the evaluation of treatment outcomes in this population would therefore enhance evidence and improve treatment options. The objectives of the present study were: (1) to review the self-reported instruments that measure sleep dysfunction in studies on TMD/OFP patients, by conducting a systematic literature search; (2) to evaluate their clinimetric evidence; and (3) to provide guidance for future research using such instruments. A total of 26 papers, using eight different instruments, were identified. The most frequently used questionnaires and the only ones with good clinimetric properties were the Insomnia Severity Index followed by the Pittsburgh Sleep Quality Index and the Epworth Sleepiness Scale. They were most reliable, valid and time-effective for measuring sleep dysfunctions in patients with TMD/OFP, with only a few practical constraints. Yet, in future studies, an assessment of the relationship between sleep disturbances and chronic pain will have to include instruments measuring the effect of mediator variables such as cognitive or emotional arousal. Research is required to clarify if existing self-reported questionnaires measuring these aspects will promote further insights or if there is a need for new instruments. This future research direction would blend into the overall biopsychosocial concept of TMD/OFP diagnoses and treatment.
    Sleep Medicine 11/2014; 16(1). DOI:10.1016/j.sleep.2014.07.023 · 3.15 Impact Factor
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    • "Sleep alterations are common among patients with major depression (MD) and form part of the diagnostic criteria for this disease. Patients with MD frequently demonstrate difficulty in initiating sleep, frequent awakenings during the night, earlier than desired awakenings and nonrestorative sleep [4] [5] [6]. Other main symptoms are decreased total sleep and disturbing nightmares [7]. "
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    ABSTRACT: Sleep disturbances in depression are up to 70%. Patients frequently have difficulty in falling asleep, frequent awakenings during the night and non-restorative sleep. Sleep abnormalities in depression are mainly characterized by increased rapid eye movement (REM) sleep and reduced slow wave sleep. Among the mechanisms of sleep disturbances in depression are hyperactivation of the hypothalamic-pituitary-adrenal axis, CLOCK gene polymorphism and primary sleep disorders. The habenula is a structure regulating the activities of monoaminergic neurons in the brain. The hyperactivation of the habenula has also been implicated, together with sleep disturbances, in depression. The presence of depression in primary sleep disorders is common. Sleep disturbances treatment include pharmacotherapy or Cognitive Behavioral Therapy.
    Sleep Science 09/2014; 1156(3). DOI:10.1016/j.slsci.2014.09.015
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