Fast Five Quiz: Insomnia

Stephen Soreff, MD


June 05, 2020

Paradoxical insomnia is a condition describing people who, despite sleep study evidence indicating achievement of a normal amount of sleep, persist in their belief and complaint that they sleep much less.

In paradoxical insomnia, one or more of the following criteria apply:

  • The patient reports a chronic pattern of little or no sleep most nights, with rare nights during which relatively normal amounts of sleep are obtained

  • Sleep log data from one or more weeks of monitoring often show no sleep at all for several nights each week; typically, daytime naps are absent following such nights

  • There is typically a mismatch between objective findings from polysomnography or actigraphy and subjective sleep estimates from a self-reported sleep diary

At least one of the following is observed:

  • The patient reports constant or near-constant awareness of environmental stimuli throughout most nights

  • The patient reports a pattern of conscious thoughts or rumination throughout most nights while maintaining a recumbent posture

The daytime impairment reported is consistent with that reported by other insomnia subtypes, but is much less severe than expected, given the extreme level of sleep deprivation reported. The sleep disturbance is not better explained by another sleep disorder, medical or neurologic disorder, medication use, or substance abuse disorder.

Read more about paradoxical insomnia.


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