Sleep State Misperception - Paradoxical Insomnia
It’s actually really common to come across people who say they just don’t sleep. They feel like they never fall asleep. They insist they get zero sleep, and that they haven’t gotten any sleep in weeks.
Because people remember the ‘worst’ or most ‘extreme’ episodes rather than the day in and day out, it’s hard to rely on memory like this when assessing someone’s sleep.
That’s why sleep specialists use daily sleep diaires prospectively (going forward) to gather sleep information from someone.
Very often people are surprised that they actually get more sleep than they remember. But – in some people with insomnia, especially those who insist they never sleep, those diaries will show just that. In that person’s experience, they got zero sleep. Maybe for nights in a row.
Some of those people would have actually slept the entire night.
If you put someone like this in a sleep lab for many nights in a row, you would find that they actually got much more sleep than they experienced subjectively. Some of these people have partners who swear they were sleeping and snoring all night long. But both would have felt like they got zero sleep – and they aren’t faking it!
Sleep state misperception, or paradoxical insomnia, is common. I’d argue everyone has a little of it, but in people with insomnia and high levels of arousal, it’s much more common. One of my own bouts of insomnia was a period of sleep state misperception.
My experience was that I would lay down, lay awake all night, and then get up for the day. Rinse and repeat the next night. And the next. My other half would say I slept solidly and hardly moved all night.
Initially, a person with this kind of insomnia may have a hard time believing that they slept – but it’s important to know they are not ‘faking’ it.
People with paradoxical insomnia have a high level of hyperarousal – they have heightened alertness and awareness of their environment. Having a mind on ‘alert’ all the time, including at night, is a main contributor to insomnia but when it is this extreme, a part of the brain is literally ‘on and watching’ all of the time. As a sleep coach, I see it during daytime sleep-related thinking and behaviours, manifesting as sleep anxiety and ‘trying’ behaviours, and ‘watching for sleep’ attitudes toward sleep.
People will often spend more time in lighter stages of sleep; however, the sleep of those with paradoxical insomnia could be viewed as having a ‘jumping’ tendency. Their sleep will show them to ‘jump’ from deep sleep to light sleep very quickly. It is like their ‘radar’ is on and they are on high alert, particularly about sleep. They also have more cognitive activity’ during their light sleep, so they can perceive themselves as awake and thinking even though they often can’t recall what they were thinking about.
That is why, even though they are sleeping, they feel like they are awake.
So what can we do about this?
Two main approaches can be helpful. The first is sleep education. Sleep education alone has been shown to improve sleep state perception when measured in a sleep lab. Just educating a person that this is a possibility, and teaching them about it, can be reassuring enough to reduce that hyperarousal so that people can begin to perceive their sleep more accurately.
The second approach is CBTi to help improve sleep state perception, and to improve sleep quality through consolidating it and making it deeper. It can also help with the perception of ‘never falling asleep’ by reducing the time it takes to fall asleep into those deeper stages of sleep, rather than staying in the lighter ‘thinking’ stages of sleep that some people experience.
If you struggle with chronic insomnia, please reach out for help.