Paradoxical insomnia (previously called sleep state misperception) is characterized by complaints of little or no sleep over long periods of time without the level of impairment expected with such a level of sleep deprivation. Patients often describe heightened awareness of their surroundings when lying down to sleep. Sleep study reveals normal sleep architecture with normal sleep onset latency and sleep efficiency, but with subjective patient reports indicating prolonged sleep onset latency and poor sleep efficiency. Treatment usually involves patient reassurance. Behavioral therapy and sedative-hypnotics have also been tried.
In this article Dr. Deirdre Conroy of the University of Michigan reviews the manifestations, etiology, and diagnosis of paradoxical insomnia.
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