Abstract:

Paradoxical insomnia (Para-I), also known as pseudoinsomnia or sleep state misperception, is a condition in which the patient complains of severe insomnia but has no objective evidence of sleep disorder, and daytime functioning may be disrupted disproportionately to the degree of patient-reported sleep loss. Para-I is characterized by overestimation of sleep latency (SL) and underestimation of total sleep time (TST). Incorrect assessment of sleep quality hinders the diagnosis, evaluation of severity, and assessment of clinical efficacy of sleep disorders. The pathogenesis of Para-I remains unclear, but may be related to factors such as depression, anxiety, personality traits, social relationships and specific changes in brain structure and function. Studies on the polysomnography (PSG) of the patients with insomnia have found that changes in non-rapid eye movement (NREM) and rapid eye movement (REM) sleep may be related to the degree of subjective-objective sleep discrepancy. PSG is a valuable diagnostic tool for sleep disorders. It allows for the analysis of sleep structure and related physiological and behavioral changes by monitoring various parameters, including electroencephalogram (EEG), electromyogram (EMG), electrooculogram (EOG), oro-nasal airflow, thoracic and abdominal respiratory motions, oxygen saturation, electrocardiogram (ECG) and snoring. In recent years, studies have increasingly explored the sleep EEG and treatment of Para-I with PSG, resulting in significant progress. This article reviews the latest advances in the electroencephalographic characteristics and treatment of Para-I, providing new ideas for precise treatment.

Key words: paradoxical insomnia (Para-I), subjective-objective sleep discrepancy, polysomnography (PSG), cognitive behavioral therapy for insomnia