Paradoxical Insomnia: Misperception of Sleep Can Be a Tormenting Experience.

Paradoxical insomnia, which has previously been called sleep state misperception and subjective insomnia, is the reporting of severe insomnia without corroborative objective evidence of sleep disturbance or significant impairment of daytime function. Patients who have this relatively uncommon form of insomnia have a marked propensity to underestimate sleep duration and overestimate wakefulness relative to polysomnographic measures. Cognitive behavior therapy for insomnia includes sleep hygiene education, stimulus control, sleep restriction, relaxation, and cognitive therapy, and is an effective treatment for paradoxical insomnia. Our patient underestimated her actual sleep time because of irrational beliefs and excessive worry about sleep. She can now correctly estimate her sleep time and only occasionally feels like she is experiencing insomnia. Her relationship with her husband and friends has improved.