Understanding paradoxical insomnia

Q:  “I haven’t slept in 8 days.  I seem beyond hope.  Is there anything that can help me?”

A:  In all probability, what’s likely going on is a misperception of sleep.  Not to diminish your difficult experience, but unless you have reason to believe you are somehow different than every other mammal that has ever lived, it is highly unlikely you could go 8 days without sleep.  The reality is that as human beings our physiologic need for sleep is so basic, so powerful, that it eventually overwhelms even the most persistent and deep-rooted insomnia.

The reality is we can’t not sleep, even if we tried.

That said, your complaint of not sleeping for days at a time is not all that unusual for some people struggling with insomnia.  What is probably more accurate to say is that you haven’t slept well in 8 days.  This is a key difference in perception to understand, and it may suggest a worthwhile treatment.

Insomniacs consistently underestimate how much sleep they are getting by an hour or more per night, a phenomenon known as sleep state misperception.  Simply put, this results from being unaware of the time spent in bed asleep, because we are, well, asleep.

Taken to an extreme, some people complain of no sleep for days or even weeks at a time, with severe daytime complications.  Yet when these individuals are tested in a sleep lab, they are actually sleeping for hours at a time but completely unaware of it.  This condition is sometimes called paradoxical insomnia.

What many insomniacs tend to focus on is how much time in bed is spent with the intensely negative experience of tossing and turning for seemingly hours at a time, frustrated and even angry at their inability to sleep.  This hopelessness is often the only thing some insomniacs remember from the previous night, and so they tend to dismiss any benefit from whatever sleep they do actually get, as if it somehow doesn’t count.  That persistent negativity can then in turn fuel a vicious self-reinforcing cycle of bad sleep.

Getting a handle on your true sleep situation is therefore helpful in breaking this vicious cycle.  Rest assured if you are spending time in bed with your eyes closed, you are more than likely experiencing at least some beneficial sleep, and it most definitely does count.

The experience of those afflicted with severe obstructive sleep apnea demonstrates how we make it count.  Those with severe untreated OSA can’t sleep for more than a few minutes at a time without waking themselves up, often gasping for air.  To compensate, it’s not unusual for these people to experience dozens if not hundreds of microsleeps throughout the night, and often during the day — which is one reason why OSA can be a very dangerous condition if not treated.

So even if your sleep seems fitful and fragmented, rest assured at some point your mind and body will not be denied sleep no matter what.

The key to making this better is to proactively manage the sleep process for the best possible results.  Fortunately, there are effective and proven ways to do this.

Your first step should be to get a checkup with your doctor.  This will help you either treat or rule out any underlying medical conditions that could be preventing or interfering with your ability to sleep.  But don’t be surprised if there are no identifiable medical problems.  The majority of insomnia is primary, meaning without a true medical basis.

If that’s the case with you, consider looking at nonmedical solutions.  One of the best is CBT — cognitive behavioral therapy, specifically designed for insomnia.  CBT typically involves the use of sleep logs, to help you more accurately track and understand how much sleep you are actually getting.  This is one good way to counter sleep state misperception.

CBT also includes a combination of common sense methods that have been proven to help most people sleep better.  It is a drug-free and permanent solution to insomnia.  You can learn CBT sleep training methods through a number of sources, including counselors and psychologists, or if you are the self-help type, check out online resources which are often very inexpensive.

So be encouraged.  There is hope, and there are effective solutions to help you sleep better.

Explore posts in the same categories: Health, Insomnia, sleep

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