Your partner says that you sleep soundly, but you feel like you’re awake for the entire night. Could it be paradoxical insomnia?
If you’ve ever been tired but unable to fall asleep, then you’re probably familiar with insomnia. But paradoxical insomnia is something different.
Also called subjective insomnia or sleep state misperception, paradoxical insomnia occurs when you feel like you didn’t fall asleep or get enough sleep despite having actually slept.
Despite it being a frustrating and distressing experience, there are treatments that can help you recover from paradoxical insomnia.
Paradoxical insomnia is considered a subtype of chronic insomnia. In paradoxical insomnia, you feel as if you aren’t able to fall asleep or aren’t obtaining adequate sleep, and it may persist for months or years.
However, what you feel conflicts with what’s observed during a sleep study. These studies typically use a device to measure how well and for how long you slept. In paradoxical insomnia, the device usually shows that you slept for most of the night and did indeed sleep soundly.
In chronic insomnia, the same test would show that you didn’t sleep soundly. Fatigue and excessive daytime sleepiness are also typically more pronounced in insomnia, which is considered a true sleep deficit.
Symptoms that you may experience in paradoxical insomnia include the following:
- unrefreshed sleep
- feeling like you were awake most of the night
- constant thoughts or rumination while attempting to sleep
- daytime sleepiness
- constant awareness of your surroundings while attempting to sleep
- trouble functioning at work or socially
Consequences of paradoxical insomnia
Paradoxical insomnia can be quite frustrating and is described by some to be tormenting. It can be months or years of time that you feel you aren’t sleeping, with little to no relief.
The consequences of paradoxical insomnia can also add to your overall mental health burden, especially if you’re living with an anxiety disorder. Increasing anxiety about your perceived lack of sleep each night can ultimately create a true sleep deficit.
The subjective nature of paradoxical insomnia may even complicate your relationships. Your partner may invalidate your experience, stating that you appear to be sleeping soundly, though you know this isn’t true.
You might find a lack of comfort in your colleagues and friends, who state that you don’t look tired or remain skeptical of your claims.
Visits to healthcare professionals can also be trying, as prescribed medications may be ineffective or only work for a little while.
The cause of paradoxical insomnia is currently unknown. Some studies have associated it with psychiatric conditions and demonstrated changes in brain function, which may help to shed light on what may be influencing the disorder.
A small 2021 study examined several brain structures for those with paradoxical insomnia. Changes were noted in key areas of the brain involved in the perception of sleep and the regulation of the sleep-wake cycle.
Its onset is also theorized to be related to so-called psychological or personality profiles, according to a
Further, a separate
Whatever the cause may truly be, it seems that paradoxical insomnia has a strong psychological component.
Currently, there are no accepted treatment guidelines for paradoxical insomnia. However, it’s theorized that a combination of the following may be effective:
- sleep education
Medications for insomnia typically include sedative and hypnotic agents, which aim to help you either fall asleep or stay asleep. They can, however, be addictive, which is one reason why therapy is typically recommended first.
Common medications for insomnia include:
- eszopiclone (Lunesta)
- zaleplon (Sonata)
- zolpidem (Ambien)
- ramelteon (Rozerem)
- mirtazapine (Remeron)
Cognitive behavioral therapy is a type of psychotherapy sometimes recommended for paradoxical insomnia. There isn’t much research to support its effectiveness. However, it’s a reasonable recommendation given that it can help restore healthier beliefs and perspectives around sleep.
Sleep education may also be helpful for some people. This can include education about sleep hygiene and a discussion of the findings recorded during sleep studies. Together, these topics can help you create better nighttime routines and understand the true impact of your sleep quality.
While it’s still a disorder that’s largely understudied, paradoxical insomnia is a true and bothersome sleep disorder. It does resemble chronic insomnia but rather involves inconsistencies in your perception of sleep.
If you resonate with paradoxical insomnia, know that there are treatments that may help. It may be worthwhile to visit a mental health professional who can provide cognitive behavioral therapy.
Otherwise, sleep hygiene is an important part of overall health. Building healthy nighttime habits can positively impact your sleep quality and can be a great place to start.