Most people can relate to the experience of restless sleep. Whether it’s tossing and turning or just never settling into deep sleep, you might notice that you don’t feel as refreshed after a night of restless sleep.
Restless sleep isn’t a medical term, but the fact that it’s so relatable makes it worthy of closer consideration. The following sections take a deeper look at what constitutes restless sleep, what causes it, and how it can be addressed.
Restless sleep has no concrete definition. It’s not an identified sleep disorder according to the American Academy of Sleep Medicine (AASM), which means that its meaning is subjective. Despite this, there’s a general sense of what it looks or feels like to have restless sleep.
Restless sleep is in the eye of the beholder; how it is perceived depends on whether you’re the one trying to sleep or if you’re observing someone else.
If you’re the one trying to sleep, restless sleep may involve the following issues:
In addition, a main sign or symptom of restless sleep is often found the next day, when you may feel tired, sluggish, or mentally off. If restless sleep happens regularly, these issues may become increasingly problematic and even dangerous if you’re drowsy while driving or operating heavy machinery.
Some things that you may view as restless sleep if you see them in another person include:
With some of these signs of restlessness, such as talking or moving during sleep, the person is likely to be totally unaware of their behavior and won’t remember it when they wake up. As a result, they may not perceive their sleep to have been restless.
Unlike restless sleep, insomnia is a formally defined sleep disorder diagnosed by a health professional according to specific criteria. Even though some people use the word insomnia colloquially to refer to general sleeping problems, the term has a precise meaning in sleep medicine.
In practice, the majority of people with insomnia probably experience restless sleep; however, not all people who have restless sleep, especially if it happens only occasionally, have insomnia.
Stress and anxiety, including formal anxiety disorders, can keep a person’s mind racing and make them feel unable to relax and settle into quality sleep. Grief, sadness, and depression can also influence a person’s mental state in a way that is detrimental to sleep.
Caffeine, nicotine, and other stimulants can make the brain and body feel wired and unprepared for sleep. Alcohol and sedatives, even though they cause drowsiness, disrupt normal sleep cycles and can make for a restless night’s sleep even after falling asleep quickly.
Various types of health problems can stymie plans for peaceful sleep. Pain, a frequent need to urinate, lung diseases, and heart problems are all examples of conditions that can interrupt sleep. Pain, especially, and the inability to get comfortable in bed, may often be associated with restless sleep.
A bedroom or sleep setting that’s not conducive to good sleep can also contribute to restless sleep. An uncomfortable mattress, lots of noise or light, or excess heat or cold may interfere with dozing off or staying asleep.
Poor sleep habits, which are part of sleep hygiene, are a common cause of insufficient or low-quality sleep. Having an inconsistent sleep schedule, using electronic devices in bed, and eating too late at night are examples of habits and routines that can lead to restless sleep.
In some situations, restless sleep is tied to an underlying sleep disorder like insomnia, Restless Leg Syndrome (RLS), or sleep-related breathing disorders like obstructive sleep apnea (OSA). In RLS, a person feels a strong urge to move their limbs, and in OSA, breathing is repeatedly interrupted, causing brief awakenings that circumvent the ability to sleep deeply.
Restless sleep that you observe in someone else can be caused by these issues, but it may also be related to other conditions like parasomnias. Parasomnias are abnormal behaviors and movements during sleep including sleep talking, sleepwalking, and acting out dreams.
Restless sleep can manifest in different ways based on age. Sleep patterns and sleep needs are different for babies, young children, adolescents, adults, and the elderly, so it’s no surprise that the causes of restless sleep can vary between these groups.
As babies get to be a few months old, they tend to sleep for longer stretches, frequently adopting a day-night sleep pattern at around six months. But according to one study among 12-month-olds, nearly 28% don’t sleep for six hours consecutively, and 43% don’t sleep for eight hours in a row . As a result, parents should know that the inability to sleep through the night, which may seem like restless sleep, isn’t rare among infants and wasn’t found to impact their mental or physical development.
Some babies start to have more restless sleep at around nine months . This can occur from separation anxiety at bedtime, greater recognition and control of their environment, overstimulation, and/or napping too soon before bedtime.
To help newborns and infants sleep soundly, parents should cultivate healthy sleep habits. Reinforcing good habits can resolve restless sleep in babies and pave the way for better sleep as they get older. Parents should also carefully follow safety precautions to prevent sudden infant death syndrome (SIDS).
Though uncommon, restless sleep in infants can be caused by an underlying health problem. Sleep apnea, a breathing disorder, can affect infants, but primarily occurs in preterm babies or those with a low birth weight, or those with underlying medical conditions. Parents who notice abnormal breathing or have other concerns about their baby’s sleep should talk with their doctor.
In toddlers, restless sleep may reflect an inability to self-soothe, calm down, and fall asleep. This may occur at the beginning of the night and/or if they wake up during the night.
Restless sleep in toddlers often initiates at around 18 months and may be the result of separation anxiety, excess stimulation, poor sleep habits, greater ability to walk and talk, or an increased frequency of nightmares.
This restless sleep is usually resolved when parents implement consistent practices that encourage a stable bedtime routine, a fixed schedule, and self-soothing to get back to sleep.
As in other age groups, restless sleep in young children is often traced back to sleep hygiene, but other factors may be involved as well.
Children are more likely to experience parasomnias, which are abnormal behaviors during sleep. These can include sleep talking as well as confusional arousals or sleep terrors during which a child appears partially awake and distressed but is not communicative or responsive. Parasomnias also include sleepwalking, which affects up to 29% of children from 2-13 years of age and excessive nightmares.
While they can be distressing for parents, most parasomnias are not harmful, and it’s generally best to gently comfort a child back to sleep without awakening them. Children very rarely recall the episodes, and they usually occur only sporadically and eventually stop on their own. If parasomnias begin to interrupt sleep, are frequent, or put a child at risk of harm (such as during sleepwalking episodes), then they may require treatment.
When children have daytime impairments like excessive sleepiness, irritability, or affected thinking and attention, the issue should be discussed with a doctor. These symptoms can be related to pediatric obstructive sleep apnea, especially if restless sleep is accompanied by loud or persistent snoring. Daytime impairments from restless sleep can also be tied to Restless Leg Syndrome as well as conditions like attention-deficit/hyperactivity disorder (ADHD) and Autism Spectrum Disorder (ASD).
A contributing factor to restless sleep in teens is a natural, biological shift in their sleep timing. During adolescence, the body moves toward a later, “night owl” sleep schedule, so teens may appear restless when trying to go to bed early.
Sleep challenges from this changing biology can be exacerbated by stress and anxiety related to school or social life as well as poor sleep habits, such as the use of mobile phones and other electronic devices in bed.
As with younger children, teens can be affected by conditions like OSA, RLS, and ADHD that can cause restless or low-quality sleep.
Restless and insufficient sleep in teens is a concern for many reasons. It can affect critical mental and physical development as well as decision-making and the likelihood of engaging in high-risk behaviors. For this reason, persistent restless sleep and daytime symptoms of poor sleep in teens should be discussed with a doctor.
A significant number of adults struggle with restless sleep, and in this age group, a higher percentage of cases may be tied to insomnia, obstructive sleep apnea, and other sleep disorders.
Adults frequently have more co-occurring health problems that cause pain or other disruptions to sleep. Stress, anxiety, and depression can take a toll on sleep in adults. Work, family, and social obligations can decrease time allotted for sleep, and these issues may be worsened by inadequate sleep hygiene.
Like in other age groups, adults should talk with their health professional if they frequently experience restless sleep, if they have loud snoring or breathing disruptions, or if they suffer from daytime effects including drowsiness, fatigue, or difficulty thinking clearly.
Many of the factors that cause restless sleep in adults apply to the elderly who face additional challenges as well. Older adults spend more time in lighter stages of sleep, making it easier for them to be disrupted and making their sleep feel less restorative.
The circadian rhythm of seniors often shifts forward and may lead to waking up earlier than desired in the morning. This can occur naturally and because of greater difficulty in getting sufficient daylight exposure, especially for people in managed care facilities.
Many older people have multiple physical and mental health issues and take a greater number of prescription medications, all of which may contribute to restless sleep.
The confluence of these issues make sleeping problems widespread among older adults, but steps to address underlying conditions and improve sleep hygiene can enable better sleep. Precautions to prevent falls are another component of caring for older adults with restless sleep who may be groggy or disoriented when getting out of bed during the night or in the morning.
Addressing restless sleep depends on its underlying cause. Practicing strategies to fall asleep easily can help prevent tossing and turning, but other steps, including talking to a doctor, may be necessary to stop restless sleep and keep it from becoming a growing problem.
If restless sleep is frequent, persistent, or worsening, it may be a sign of a bigger issue and should be discussed with your doctor. Similarly, signs of excessive daytime sleepiness or other daytime impairment should always be raised with your doctor who can help to identify the most likely cause and most appropriate steps for treatment.
In every age group, sleep hygiene can play a critical role in sleep quality. Healthy sleep tips like finding consistency in your sleep schedule, bedtime routines, diet, and exercise are a good starting point. Making your bedroom comfortable with as few distractions as possible can reduce the chances of having restless sleep.
One way to learn more about your sleep situation is to keep a journal with notes about how well and how long you sleep each night. In the journal, you can make notes about restless sleep and any issues that you feel might be causing it. Tracking your sleep in this way not only provides insight into your sleep patterns but also casts light on potential trends about what is causing restless sleep.