You Didn’t Sleep At All Last Night?
by Dr. Robert Rosenberg, DO
Actually, Maybe You Did: Insomnia, Reconsidered
|"Alarm Clock." Public Domain Image.|
This type of insomnia, called Paradoxical Insomnia, is also referred to as Sleep State Misperception. Previously it was considered a rare condition, present–or so we thought–in no more than five percent of insomnia sufferers. We now know this estimate to be incorrect. Furthermore, in several recent studies, the incidence is closer to 50% when defined as misperceiving-sleep-as-wake-time by at least one hour or more per night.
As a result, we are now coming to realize there are two basic types of insomniacs:
1) Those who sleep greater than six hours a night but perceive they sleep less;
2) Those who actually sleep fewer than six hours, but accurately estimate their sleep time.
Why is it important to differentiate between the two groups of insomniacs? Because those who actually sleep fewer than six hours a night are much more likely to develop hypertension, diabetes, and suffer earlier death than those who misperceive their sleep time. These findings are potentially revolutionary when it comes to our understanding of the diagnosis and treatment of insomnia. Consequently, we need objective data in order to differentiate these two types, since effective treatment approaches are different.
What I find fascinating is that those with the misperception of their sleep cycles are more likely to respond to CBT (Cognitive Behavioral Therapy), while those who actually sleep fewer than six hours–the short sleeper type–are more likely to require pharmacological therapies. Why? It appears that the short sleepers have an underlying level of physiological hyperarousal. They have elevated levels of stress hormones such as cortisol and adrenaline, while the misperception group seems to demonstrate more of a psychological basis for their insomnia.
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Due to our new understanding of insomnia and these technological advances, we can offer our patients evidenced-based therapies. As with many other things in medicine, we are learning that in the treatment of insomnia, one size does not fit all.
--This article originally appeared in Everyday Health, 2.18.2014
|Dr. Robert Rosenberg, DO|
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