I Haven't Slept at All in Months!
It's not uncommon to hear people say they get ZERO sleep. Or that they haven't slept at all in weeks. People tend to remember the "extremes" of their experiences, which is why sleep specialists like to use daily sleep diaries to gather data rather than relying on memory. People often will be surprised at what their sleep looks like, and it's often more than they realized.
But in some people with insomnia, especially those who claim to never sleep, their diaries will show exactly that. In their experience, they got zero sleep for night after night after night.
It might seem surprising, but a small proportion of them will have slept all night long.
How can this be?
Some will have slept in a sleep lab, showing they got much more sleep than they feel they got. Some will have slept next to a partner who described them as deeply sleep breathing and sometimes even snoring during the night.
Both groups of people will have slept. But the person will feel like they have been awake all night.
What is going on?
Paradoxical insomnia, sometimes referred to as sleep state misperception, is not unusual. One of my bouts of insomnia was paradoxical. My partner, a very light sleeper who wakes when I move, would say that I slept solidly and hardly moved all night -- when my own experience was that I laid down and laid awake all night long.
People with paradoxical insomnia often say they are unable to sleep and often complaining of "never" sleeping. But they don't have the level of daytime problems that would generally be expected with this amount of sleep loss.1
What happens during paradoxical insomnia?
When people with paradoxical insomnia lie down to sleep, they often experience a heightened awareness of their surroundings. They feel they are not sleeping at all and that it takes them a very long time to fall asleep if they do.2
People with paradoxical insomnia often report that their spouses claim that they were asleep when they were certain that they were awake. A sleep study would show that sleep onset time (time to fall asleep) and sleep efficiency (how much sleep they are getting for the time they are in bed) are completely normal.
Initially, the person with insomnia may have a hard time believing that they slept - but it's important to know they are not "faking" it.
Considerations for people with insomnia
Lots of people with insomnia have "hyper-arousal" and hypervigilance, with their minds broadly on "alert" all of the time, including when they are sleeping.2 As a sleep coach, I see this in the daytime sleep-related behaviours and sleep anxieties all the time.
In addition to the effects on the daytime, people with insomnia can often spend more time in lighter stages of sleep, and they more often "skip" to lighter levels of sleep during the night compared to people without insomnia. They will also have more cognitive activity and thoughts in these lighter stages of sleep than others.2
That is why, even though they are sleeping, they feel like they are awake.
The perception of sleep loss can be a target of treatment in and of itself. Sleep education alone can be helpful for those with sleep state misperception.3 Helping someone recognize that they are sleeping can be reassuring in and of itself. Reducing this "arousal" pattern by improving someone's understanding of their sleep could help improve their sleep quality.
Additionally, improving the speed at which a person can fall into a deeper sleep can help reduce a person's complaint of "never" falling asleep.4
Cognitive behavioral therapy for insomnia (CBTi) is a standard treatment for insomnia and has been shown to improve a person's accurate perception of sleep, particularly in older adults, as well as the time it takes to fall asleep.5,6
Do you go to bed at the same time every night?