Have you found that you fall asleep quickly at night, but then wake up multiple times?  Typically these waking periods are short, but many times it’s a struggle to get back to a restful deep sleep.   If this sounds familiar, you may be experiencing fragmented sleep (frequent awakenings during the normal sleep-wake cycle).  People that suffer from fragmented sleep often report waking up tired and never feeling fully refreshed in the morning.

We all know the impacts that occur from sleep deprivation by now.  It impacts more than just how tired you feel, but there is a huge influence on your overall physical and emotional health.

man laying awake at night unable to sleepAm I Getting Enough Sleep?

According to the CDC, approximately 1/3 of adults do not get the recommended 7-8 hours of sleep per night.  Many people don’t get enough sleep or sleep poorly because of their jobs, packed schedules, long shifts at night or they have to rush to get their kids ready in the morning before work.  Also included in this grouping are the 50-70 million people who already suffer from insomnia, OSA or other sleep disorders.

Fragmented sleep can be short-term, stemming from an obvious cause such as being a new parent and waking to care for an infant, or experiencing trouble sleeping due to illness.  Then there are more subtle awakenings, which can be caused by sleep disorders such as PLMD (periodic limb movement disorder), RLS (restless leg syndrome), OSA or snoring.  Although 80% of patients who have RLS have PLMD, RLS commonly presents with insomnia rather than sleep fragmentation.  Medications that can cause sleep fragmentation include SSRIs.  There are also lifestyle triggers that cause poor sleep, such as caffeine and alcohol consumption, excessive ingestion of chocolate which contains theophylline, caffeine & nicotine which constrict the peripheral blood vessels causing muscle pain and sleep disturbance, exercise too close to bedtime, and having an irregular sleep schedule. 

Can Fragmented Sleep Lead to Health Problems?

Fragmented sleep has been linked to a higher risk of chronic health issues.  Common symptoms of fragmented sleep include:

Long-term issues associated with fragmented sleep can include:

  • High Blood Pressure
  • Cardiovascular Problems
  • Diabetes

Sleep performs a range of vital functions, including restoring damaged tissues, boosting learning and memory, and flushing toxins from the brain.  Inadequate amounts of sleep can have serious long-term health consequences, increasing the risk of obesity, diabetes and cardiovascular disease.

Getting insufficient sleep repeatedly (less than six hours a night for adults) can trigger the release of various proteins that cause inflammation in the blood and in the body, leading to sleep problems.  In 2014, adults in the United States who reported sleeping less than 7 hours a night were also more likely to report having health problems, compared to those getting the recommended amount of sleep.

Secondary to the amount of sleep you’re getting is the amount of restorative sleep, or more commonly called “deep sleep”.  In one of our deepest stages of sleep, slow-wave sleep, there is a drop in the level of hormones that raise blood pressure, such as adrenaline.  As one progresses into a deeper sleep, parasympathetic nervous system tone increases while sympathetic nervous system activity, along with heart rate, blood pressure, and systemic vascular resistance decreases.  As a result, workload on the heart is reduced.  People with sleep disorders experience arousals, or very brief periods of awakening.  When you have fragmented sleep, high levels of these hormones can prevent blood pressure from going down.

Studies show that poor sleep quality is an independent risk factor for the development of chronic pain conditions, especially those characterized by musculoskeletal pain (particularly back, neck and head/facial pain).  Sleep fragmentation during the period when musculoskeletal sensitization develops will exacerbate the effects of musculoskeletal sensitization.

At Michigan Head & Neck Institute, we treat patients with a variety of sleep disorders, who have symptoms similar to those described above.   Our focus is on restoring patients’ quality of life with an oral appliance for those who cannot use a CPAP, and by pain reduction of the mouth, eye, ear, jaw, face & neck caused by TMD.

Some preventative measures that you can take to deal with conditions such as fragmented sleep include:

  • Establish a stable sleep schedule
  • Limit alcohol and caffeine intake
  • Avoid exercise before bed
  • Avoid blue light-emitting devices before bed
  • Try to read or listen to music rather than watch TV before bed
  • Make sure your bedroom is uncluttered
  • Maintain a cool temperature for maximum sleep quality
  • Make sure your mattress is adequate

If you would like additional information on fragmented sleep or other sleep disorders, please contact our office at (586) 573-0438.

References:

Bonnet MH, Arand DL. Clinical effects of sleep fragmentation versus sleep deprivation. Sleep Med Rev. 2003;7(4):297-310.

doi:10.1053/smrv.2001.0245

Kaneshwaran K, Olah M, Tasaki S, et al. Sleep fragmentation, microglial aging, and cognitive impairment in

adults with and without Alzheimer’s dementia. Sci Adv. 2019;5(12):eaax7331. Published 2019 Dec 11. doi:10.1126/sciadv.aax7331

Stepanski E, Lamphere J, Badia P, Zorick F, Roth T. Sleep fragmentation and daytime sleepiness. Sleep. 1984;7(1):18-26.

doi:10.1093/sleep/7.1.18

Sutton BC, Opp MR. Sleep fragmentation exacerbates mechanical hypersensitivity and alters subsequent

sleep-wake behavior in a mouse model of musculoskeletal sensitization. Sleep. 2014;37(3):515-524. Published 2014 Mar 1.

doi:10.5665/sleep.3488

Ting L, Malhotra A. Disorders of sleep: an overview. Prim Care. 2005;32(2):305-v.

doi:10.1016/j.pop.2005.02.004

Klein, Richard E. The Evolution of Obstructive Sleep Apnea (OSA) Treatment and Monitoring. Journal of the Macomb Dental Society. 11-12. Published 2016 Summer.