Paradoxical insomnia, or insomnia without objective findings, means that a person perceives themselves as being awake even when asleep. As a result, they may believe they have insomnia, even though they sleep naturally.

Paradoxical insomnia can be emotionally distressing. It may cause conflict with loved ones or caregivers. It can also lead to the inappropriate use of or addiction to sleep medication.

If a person feels tired, they may misattribute their fatigue to their insomnia rather than exploring whether another medical condition could be responsible. This can delay care and treatment.

Researchers do not understand what causes paradoxical insomnia, but some research suggests a link between the condition and mental health issues, such as anxiety or depression.

This article will explain paradoxical insomnia, its causes, and its treatment.

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Paradoxical insomnia is a poorly understood condition that causes people to believe they have insomnia when they do not. They may perceive themselves as being awake when they are sleeping or misremember themselves as being awake when they are actually asleep.

However, objective measures show that people with paradoxical insomnia are sleeping naturally. Additionally, they do not typically have other insomnia symptoms, such as intense daily fatigue.

Estimating how common paradoxical insomnia is can be difficult. This is because people with this condition usually do not realize they have it. A 2019 systematic review found prevalence rates ranging from 8 to 66%, depending on the criteria researchers used to define paradoxical insomnia.

Paradoxical insomnia vs. paradoxical sleep

Paradoxical sleep refers to rapid eye movement (REM) sleep. During REM sleep, the eyes rapidly move back and forth. This is the phase of sleep during which vivid dreams often occur.

Paradoxical insomnia means that a person believes they are awake when they are asleep or believes they have insomnia when they do not. It has no relationship to REM sleep or REM sleep disorders.

Read more about REM sleep.

People with paradoxical insomnia believe they have insomnia. Therefore, the main symptom is a belief that the person is not getting enough sleep.

A roommate, partner, or family member familiar with the individual’s sleep habits may disagree — this is a warning sign of paradoxical insomnia. A sleep study may provide objective evidence that a person is getting adequate sleep.

Some other symptoms may include:

  • anxiety, especially at bedtime
  • conflict with others over sleep
  • a subjective experience of insomnia, but not feeling tired during the day

Doctors do not have a good understanding of what causes paradoxical insomnia.

Emerging research points to differences in the brains of people with paradoxical insomnia while sleeping. They have higher alpha, beta, and gamma wave activity and lower activity in the electroencephalography studies. This may cause them to misperceive themselves as being awake.

A 2021 study found that people with paradoxical insomnia had differences in certain brain structures that play a role in sleep and dreaming, including:

  • the nucleus accumbens
  • caudate
  • posterior putamen
  • hippocampus
  • thalamus
  • amygdala

Relation to other disorders

Some research suggests that a state of hyperarousal at bedtime may contribute to the false belief that a person did not sleep.

People who experience anxiety tend to be hyperarousal. Hyperarousal often sometimes occurs in individuals who ruminate on anxious or upsetting thoughts.

Other mental health conditions, such as bipolar, schizophrenia, and alcoholism, may co-occur with paradoxical insomnia.

Diagnosis of paradoxical insomnia compares objective evidence with the person’s subjective insomnia experience.

A sleep study may prove that someone is getting adequate sleep. A doctor will diagnose paradoxical insomnia when there is proof that an individual gets enough sleep, but they continue to believe they have insomnia. A sleep study can also rule out other sleep disorders, such as sleep apnea.

Explaining the diagnosis to a person may be helpful, especially if a doctor explains that their brain may behave differently during sleep.

No specific medication can treat paradoxical insomnia. Therapy, particularly cognitive behavioral therapy, may help ease symptoms and support someone in developing coping skills.

While paradoxical insomnia is not dangerous, it may be emotionally challenging. A person may feel frustrated by their perceived insomnia.

The condition can also cause conflicts with others, such as family and friends who observe the person is sleeping naturally or doctors who review the results of a sleep study. If the individual does not accept their diagnosis, they may continue seeking treatment for a condition they do not have.

Sometimes, paradoxical insomnia can lead to the use of sleeping medication. However, because the person does not have insomnia, the medication is unnecessary. But because the insomnia they do not have cannot improve, the individual may continue using the medication in a fruitless attempt to “cure” the condition. This could lead to addiction or medication side effects.

A person can contact a doctor if their sleep causes distress and self-care strategies have not worked. Insomnia that does not get better after a few weeks requires medical care.

If a person’s loved ones say they appear to be sleeping, this may be a warning sign that the individual has paradoxical insomnia.

Paradoxical insomnia is not a type of insomnia or a sleep disorder. It is a misperception of sleeping and time spent sleeping. It can cause immense distress, especially when a person finds that treating their “insomnia” does not work. It may also co-occur in people with other mental health conditions, exacerbating their distress.

Treatment may help reduce distress and conflict over paradoxical insomnia. However, it is important to know that people with this condition may not know they have it. Anyone with chronic insomnia that does not improve with self-care or home treatment should consult a healthcare professional to address the problem.