Skip to main content

Paradoxical Insomnia

  • Chapter
  • First Online:
Clinical Handbook of Insomnia

Part of the book series: Current Clinical Neurology ((CCNEU))

  • 1966 Accesses

Abstract

A fascinating yet poorly understood disorder, paradoxical insomnia refers to a condition of gross discrepancy between objective sleep quantity per night and the subjective perception of sleep. Generally, people suffering from this condition complain bitterly, and sincerely, of not being able to sleep at all, yet when studied show sleep of normal duration and quality. Pathophysiology of paradoxical insomnia remains largely poorly understood. Increase in faster EEG activity during sleep and increase in physiological arousal seem to be prevalent in these patients, but whether they have direct causative impact remains to be seen. Management starts with education and other than psychotherapy no other techniques have been shown helpful.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 89.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 119.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 169.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Buysse DJ et al (1994) Clinical diagnoses in 216 insomnia patients using the International Classification of Sleep Disorders (ICSD), DSM-IV and ICD-10 categories: a report from the APA/NIMH DSM-IV Field Trial. Sleep 17(7):630–637

    CAS  PubMed  Google Scholar 

  2. Borkovec T (1979) Pseudo (experiential)-insomnia and idiopathic(objective) insomnia: theoretical and therapeutic issues. Adv Behav Res Ther 2:27–55

    Article  Google Scholar 

  3. Kuisk LA, Bertelson AD, Walsh JK (1989) Presleep cognitive hyperarousal and affect as factors in objective and subjective insomnia. Percept Mot Skills 69(3 Pt 2):1219–1225

    Article  CAS  PubMed  Google Scholar 

  4. Edinger JD, Fins AI (1995) The distribution and clinical significance of sleep time misperceptions among insomniacs. Sleep 18(4):232–239

    CAS  PubMed  Google Scholar 

  5. Salin-Pascual RJ et al (1992) Long-term study of the sleep of insomnia patients with sleep state misperception and other insomnia patients. Am J Psychiatry 149(7):904–908

    Article  CAS  PubMed  Google Scholar 

  6. Mercer JD, Bootzin RR, Lack LC (2002) Insomniacs’ perception of wake instead of sleep. Sleep 25(5):564–571

    PubMed  Google Scholar 

  7. Reynolds CF 3rd et al (1991) Subtyping DSM-III-R primary insomnia: a literature review by the DSM-IV Work Group on Sleep Disorders. Am J Psychiatry 148(4):432–438

    Article  PubMed  Google Scholar 

  8. Perlis ML et al (2001) The mesograde amnesia of sleep may be attenuated in subjects with primary insomnia. Physiol Behav 74(1–2):71–76

    Article  CAS  PubMed  Google Scholar 

  9. Vanable PA et al (2000) Sleep latency and duration estimates among sleep disorder patients: variability as a function of sleep disorder diagnosis, sleep history, and psychological characteristics. Sleep 23(1):71–79

    CAS  PubMed  Google Scholar 

  10. Hauri PJ (1998) Insomnia. Clin Chest Med 19(1):157–168

    Article  CAS  PubMed  Google Scholar 

  11. Haynes SN et al (1985) Responses of psychophysiologic and subjective insomniacs to auditory stimuli during sleep: a replication and extension. J Abnorm Psychol 94(3):338–345

    Article  CAS  PubMed  Google Scholar 

  12. Mendelson WB et al (1986) A psychophysiological study of insomnia. Psychiatry Res 19(4):267–284

    Article  CAS  PubMed  Google Scholar 

  13. Martin SE et al (1997) The effect of nonvisible sleep fragmentation on daytime function. Am J Respir Crit Care Med 155(5):1596–1601

    Article  CAS  PubMed  Google Scholar 

  14. Hauri PJ, Wisbey J (1992) Wrist actigraphy in insomnia. Sleep 15(4):293–301

    CAS  PubMed  Google Scholar 

  15. Chervin RD, Guilleminault C (1996) Overestimation of sleep latency by patients with suspected hypersomnolence. Sleep 19(2):94–100

    CAS  PubMed  Google Scholar 

  16. McCall WV, Edinger JD (1992) Subjective total insomnia: an example of sleep state misperception. Sleep 15(1):71–73

    CAS  PubMed  Google Scholar 

  17. Neu D et al (2007) Sleep quality perception in the chronic fatigue syndrome: correlations with sleep efficiency, affective symptoms and intensity of fatigue. Neuropsychobiology 56(1):40–46

    Article  PubMed  Google Scholar 

  18. Weigand D, Michael L, Schulz H (2007) When sleep is perceived as wakefulness: an experimental study on state perception during physiological sleep. J Sleep Res 16(4):346–353

    Article  PubMed  Google Scholar 

  19. Attarian HP, Duntley S, Brown KM (2004) Reverse sleep state misperception. Sleep Med 5(3):269–272

    Article  PubMed  Google Scholar 

  20. Schneider-Helmert D (2007) Asymptomatic insomnia. Sleep Med 8(2):107–110

    Article  PubMed  Google Scholar 

  21. Trajanovic NN et al (2007) Positive sleep state misperception - a new concept of sleep misperception. Sleep Med 8(2):111–118

    Article  PubMed  Google Scholar 

  22. Attarian H (2007) Disturbed perception of wakefulness within sleep: a new sleep disorder or the extreme end of a spectrum. Sleep Med 8(2):103–104

    Article  PubMed  Google Scholar 

  23. Laposky A, Anch M, Duntley S (2001) The association between EEG and sleep perception during MSLT naps on subjects with excessive daytime sleepiness. Sleep and Hypnosis 3(2):84–92

    Google Scholar 

  24. Schneider-Helmert D, Kumar A (1995) Sleep, its subjective perception, and daytime performance in insomniacs with a pattern of alpha sleep. Biol Psychiatry 37(2):99–105

    Article  CAS  PubMed  Google Scholar 

  25. Krystal AD et al (2002) NREM sleep EEG frequency spectral correlates of sleep complaints in primary insomnia subtypes. Sleep 25(6):630–640

    PubMed  Google Scholar 

  26. Perlis ML et al (2001) Beta EEG activity and insomnia. Sleep Med Rev 5(5):363–374

    Article  PubMed  Google Scholar 

  27. Perlis ML et al (2001) Beta/Gamma EEG activity in patients with primary and secondary insomnia and good sleeper controls. Sleep 24(1):110–117

    CAS  PubMed  Google Scholar 

  28. Bonnet MH, Arand DL (1997) Physiological activation in patients with sleep state misperception. Psychosom Med 59(5):533–540

    Article  CAS  PubMed  Google Scholar 

  29. Edinger JD et al (2004) Derivation of research diagnostic criteria for insomnia: report of an American Academy of Sleep Medicine Work Group. Sleep 27(8):1567–1596

    PubMed  Google Scholar 

  30. Trinder J (1988) Subjective insomnia without objective findings: a pseudo diagnostic classification? Psychol Bull 103(1):87–94

    Article  CAS  PubMed  Google Scholar 

  31. Mendelson WB (1995) Effects of flurazepam and zolpidem on the perception of sleep in insomniacs. Sleep 18(2):92–96

    CAS  PubMed  Google Scholar 

  32. Mendelson WB (1995) Effects of flurazepam and zolpidem on the perception of sleep in normal volunteers. Sleep 18(2):88–91

    CAS  PubMed  Google Scholar 

  33. Case K et al (2008) A case of extreme paradoxical insomnia responding selectively to electroconvulsive therapy. J Clin Sleep Med 4(1):62–63

    PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2010 Springer Science+Business Media, LLC

About this chapter

Cite this chapter

Attarian, H. (2010). Paradoxical Insomnia. In: Attarian, H., Schuman, C. (eds) Clinical Handbook of Insomnia. Current Clinical Neurology. Humana Press, Totowa, NJ. https://doi.org/10.1007/978-1-60327-042-7_13

Download citation

  • DOI: https://doi.org/10.1007/978-1-60327-042-7_13

  • Published:

  • Publisher Name: Humana Press, Totowa, NJ

  • Print ISBN: 978-1-60327-033-5

  • Online ISBN: 978-1-60327-042-7

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics