Sleep State Misperception: When Insomnia Isn’t Really Insomnia

Many people in New York and elsewhere suffer from insomnia, the inability to fall asleep and to stay asleep that can severely affect the person’s ability to function during the day. However, there are some cases where a person may be convinced that they have insomnia, even though in reality the duration and quality of their sleep is absolutely fine. This is called sleep state misperception or paradoxical insomnia, and is recognized by the American Academy of Sleep Medicine as a legitimate sleep-related disorder. Although people with sleep state misperception are sleeping just fine, the idea that they are losing sleep can cause considerable anxiety and stress.

Signs and Symptoms

People with sleep state misperception underestimate the time they spend sleeping, and are often mistakenly under the impression that they were awake at times when they had actually been asleep. They often report to their healthcare providers that they are not sleeping much at all, requesting treatment for insomnia. However, when they are given a polysomnograph test—a clinical test incorporating EEG, EMG, and other measurements to evaluate for sleep disorders—it is revealed that there is nothing wrong with the quality or duration of their sleep. Although they sometimes do report excessive daytime sleepiness, which is typical of insomnia, evidence suggests that this effect is more likely to be “in their heads” or due to a cause other than lack of sleep.

Sleep State Misperception, Anxiety, and Stress

Even when polysomnographic studies indicate that they’re actually fine, a person with sleep state misperception may remain convinced that there is something wrong with their sleeping patterns. Often this causes considerable anxiety and stress. Sometimes doctors will prescribe the patient a sleep medication anyway, such as Lunesta or Ambien, but this can be dangerous because these drugs can be habit-forming and can also cause unwanted side effects. Chronic sleep state misperception is associated with increased risk of depression, anxiety, and substance abuse, which are often exacerbated by stress over the fact that doctors “can’t figure out what’s wrong” with the patient.

How Can Sleep State Misperception Be Treated?

Since people with sleep state misperception are not actually having trouble sleeping, treatment should theoretically differ from the typical treatments for actual insomnia. Some psychologists suggest that a major component of treatment for paradoxical insomnia should be cognitive restructuring. A person with sleep state misperception is not “malingering,”, or deliberately lying to deceive healthcare professionals; they are legitimately concerned that they are suffering from insomnia, and are generally surprised when sleep studies indicate that they are not. Although they are sleeping, some evidence also suggests that over arousal could be compromising the depth and quality of their sleep, contributing to the misperception that they have only slept for a few hours. Sleep state misperception may be best treated with cognitive behavioral approaches, including addressing underlying anxiety or depression that may contribute to the person’s worries about possible insomnia. Although research has yet to be conducted into using neurofeedback therapy for sleep state misperception, this may theoretically prove a fruitful field of research.