Paradoxical Insomnia

What is paradoxical insomnia?

Paradoxical insomnia happens when you feel like you have insomnia symptoms even though you’re getting a healthy amount of sleep. Healthcare providers sometimes call it sleep state misperception.

If you have paradoxical insomnia, you may feel aware of your surroundings and like you only slept a few hours at night (or not at all). But you’re actually getting an adequate amount of sleep. It can feel like your senses are playing a mean trick on you.

People with typical insomnia usually feel tired, groggy or fatigued during the day because they’re not getting enough sleep at night. If you have paradoxical insomnia, you won’t experience these kinds of symptoms during the day.

That’s because with paradoxical insomnia, you’re getting enough sleep (even if you don’t feel like it). That means, physically, your body will be well-rested in the morning, even if, mentally and emotionally, it may not feel like it.

It can be hard or impossible for you to tell if you’re getting the right amount of sleep without testing. Visit a healthcare provider if you feel like you can’t sleep and it’s affecting your day-to-day quality of life.

What are paradoxical insomnia symptoms?

The main symptom of paradoxical insomnia is thinking you’re not getting enough sleep. You might feel like you:

• Are always aware of your surroundings while you’re trying to sleep
• Can’t fall asleep, no matter how hard you try
• Have constant, racing thoughts while you’re trying to sleep
• Were awake most of the night

The feeling of not sleeping through the night can be vivid and clear. But if you have paradoxical insomnia, your brain and body are getting the right amount of rest each night. This can be very frustrating and make you doubt yourself. You might experience sleep anxiety.

Your feelings are real, even if your body isn’t actually experiencing insomnia symptoms. You’re not faking it or making up what you’re experiencing.

What causes paradoxical insomnia?

Experts aren’t sure what causes paradoxical insomnia. It’s hard to study because it doesn’t cause any physical changes that researchers can examine. One thing experts agree on: it’s a real condition that can affect your mental and emotional health.

Researchers are studying what might trigger paradoxical insomnia. Some causes may include:

• Environmental factors (something about where you live, work or spend lots of time)
• Genetic variations
• Mental health conditions like anxiety and depression
• Post-traumatic stress disorder (PTSD)
• Sleep apnea

How is paradoxical insomnia diagnosed?

A healthcare provider will diagnose paradoxical insomnia by talking to you about your sleep habits and using some tests. Tell your provider how you’re sleeping and if you’ve noticed any changes. They might suggest you visit a sleep specialist.

Your provider will have you try a few tests, including:

• Electroencephalogram (EEG). An EEG checks your brain function. It can help rule out other conditions that may cause similar symptoms.
• Keeping a sleep journal. Your provider will have you record when you fall asleep and wake up. This will help you track how often you actually wake up in the night compared to how often it may feel like you did.
• Wearing an actigraph. This device looks like a smartwatch and will track disruptions in your sleep-wake cycle over several weeks.

If you have paradoxical insomnia, your test results will show that you’re getting a normal, healthy amount of sleep each night. Remember, your provider isn’t trying to trick you or prove that you’re lying. They believe you. They just need to see what’s happening in your brain and body while you’re sleeping.

What are paradoxical insomnia treatments?

Your provider will suggest treatments to help you feel calm and safe when you’re sleeping. Your provider may suggest:

• Cognitive behavioral therapy (CBT or talk therapy). Talking to a mental health provider can help you process stress, anxiety and depression. They can help you manage symptoms of paradoxical insomnia and/or the mental health conditions that may cause it.
• Improving your sleep hygiene. Having a consistent bedtime routine and sleep environment can help you feel comfortable and confident that you’ll get a good night’s rest. Try to avoid alcohol, caffeine and exercising for a few hours before you go to bed.
• Medications. There aren’t any medications that directly treat paradoxical insomnia. But your provider may suggest a sedative to help you tune out the feeling of waking up in the night.

Can you prevent paradoxical insomnia?

Because experts aren’t sure what causes paradoxical insomnia, we don’t know of a way to prevent it. Having good sleep hygiene is the best way to make sure you’re getting the right kind (and amount) of sleep every night. Talk to your provider about your concerns and feelings. Once you know what’s going on, you might feel less anxious at or around bedtime. This may make you less likely to feel like you’re waking up.

Is paradoxical insomnia dangerous?

Paradoxical insomnia can’t physically harm your body. So, it’s not dangerous in the way people usually think.

But the frustration of dealing with it can have a big impact on your mental health. Don’t try to force yourself to process stress, anxiety or other feelings alone. Talk to a mental health provider or your loved ones about what you’re going through.

When should I see my healthcare provider?

Your healthcare provider will tell you how often you should schedule follow-up appointments or tests. They’ll want to check on your sleep and health to make sure you’re feeling better.

Tell your provider if the symptoms are changing or getting worse. They may be able to suggest other treatments or tweaks to your paradoxical insomnia management plan.

Which questions should I ask my doctor?

You may want to ask your provider:

• How do I know if this is paradoxical insomnia or another sleep issue?
• Which tests will I need?
• What’s the best way to use my sleep journal?
• Will I need medications? If so, how do I take them?