Paradoxical insomnia and subjective-objective sleep discrepancy: a review
Abstract
Paradoxical insomnia is characterized by discrepancy between subjective and objective assessments of sleep and is challenging to diagnosis and treat. Typically, polysomnographic (PSG) findings show significantly longer total sleep time than patients' report of sleep, and the difference between subjective and PSG sleep is greater than that seen in other insomnia subtypes. Subjective-objective sleep discrepancy may also present in different clinical pictures, as marked discrepancies between patients' perception of sleep and objective findings are common in a variety of medical, sleep and psychiatric disorders. However, there is a paucity of literature about the etiology and treatment of sleep discrepancy and paradoxical insomnia. Therefore, the underlying neurophysiological mechanisms of sleep discrepancy and paradoxical insomnia should be further investigated. Additionally, well-controlled clinical trials are needed to establish an evidence based intervention for treatment.
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Available research suggests that individuals with paradoxical insomnia appear to have increased brain activity during sleep, making them more aware of their environment and leading them to believe that they are awake when they are actually asleep.
“The available research suggests that individuals with this insomnia subtype appear to have increased brain activity during sleep, making them more aware of their environment and leading them to believe that they are awake when they are actually asleep (117).”
From Interventions for insomnia in cancer patients and survivors-a comprehensive systematic review and meta-analysis (2024) · cites this paper as [117]
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“The available research suggests that individuals with this insomnia subtype appear to have increased brain activity during sleep, making them more aware of their environment and leading them to believe that they are awake when they are actually asleep (117).”
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- Authors
- Rezaie, L., Fobian, A. D., McCall, W. V., & Khazaie, H.
- Affiliations
- Kermanshah University of Medical Sciences (IR)
- University of Alabama at Birmingham (US)
- Augusta University (US)
- Corresponding author
- Khazaie, Habibolah
- Venue
- Sleep Medicine Reviews
- Publisher
- Elsevier BV
- Published
- 2018-08
- Volume
- 40
- Pages
- 196-202
- ISSN
- 1087-0792 (ISSN-L)
- OpenAlex
- W2782114289
- Cited by
- 236
- References
- 84
- Citations by year
- 2026: 38 · 2025: 33 · 2024: 41 · 2023: 35 · 2022: 29 · 2021: 30 · 2020: 16 · 2019: 11 · 2018: 3
- FWCI
- 2.39
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Sleep Medicine Reviews (publishedVersion)
- PubMed (publishedVersion)
- Funders
- NIH (MH095776)
- American Foundation for Suicide Prevention (DIG-0-087-13)
- National Institute of Diabetes and Digestive and Kidney Diseases (1K23DK106570-01A1)
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
- Health Sciences › Medicine › Physiology › Obstructive Sleep Apnea Research
- Life Sciences › Neuroscience › Cognitive Neuroscience › Sleep and Wakefulness Research
- Keywords
- paradoxical insomnia, subjective-objective sleep discrepancy, total sleep time, polysomnography, insomnia subtypes, sleep perception, neurophysiological mechanisms, insomnia treatment
- MeSH terms
- Humans, Sleep Initiation and Maintenance Disorders, Perception, Sleep, Polysomnography, Self Report
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