What Is the Definition of Paradoxical Sleep?

How does paradoxical insomnia affect sleep?

Woman sleeping in her bed. Credit: Astronaut Images / Getty Images

Paradoxical sleep is one of the two basic states of sleep and is notable for the presence of rapid eye movement (REM). Get the facts on this stage of sleep and the sleep disorder known as paradoxical insomnia. Also learn how paradoxical intention works to treat insomnia.

What Defines Paradoxical Sleep?

Also known as REM sleep or dreaming sleep, paradoxical sleep is a deep stage of sleep with intense brain activity in the forebrain and midbrain.

It is characterized by dreaming and the absence of motor function with the exception of the eye muscles and the diaphragm. It occurs cyclically several times during sleep, but it comprises the smallest portion of the sleep cycle.

During paradoxical sleep, our muscles are relaxed so that we don't act out our dreams.

What Is Insomnia?

Insomnia is defined as difficulty falling asleep and it is often exacerbated by sleep-related effort. Paradoxical insomnia is a rare condition in which people misjudge how long it takes for them to fall asleep as well as how long they've actually slept. They may think they've only been asleep for a couple of hours, even if they've slept for seven or eight. People with this disorder are extremely aware of their surroundings while sleeping.

The next day they feel sleep deprived. Melatonin, Tylenol PM and prescription-strength sleep drugs can counter the symptoms of paradoxical insomnia.

Paradoxical insomnia is considered to be rare because while insomnia affects roughly 35 percent of the population, fewer than five percent of these cases are deemed paradoxical.  

In typical cases of insomnia, if you try to fall asleep, it won't happen. But what if you try to stay awake? The use of paradoxical intention sleep therapy may help.

Behavioral Changes Can Improve Insomnia

There are a variety of behavioral interventions that can be effective in treating chronic insomnia. These are collectively employed as part of a structured program called cognitive-behavioral therapy for insomnia (CBTI). Some of these changes rely on altering how you think about or perceive a situation, the component known as cognitive therapy. One such option is paradoxical intention.

What Is Paradoxical Intention?

A paradox is defined as a statement that may seem superficially absurd or self-contradictory, but when it is investigated or explained may prove to be well founded or true. One such paradox in insomnia is that by staying up later, you might actually fall asleep faster and sleep better. It is possible to use effort surrounding your sleep, which often perpetuates insomnia, paradoxically to your advantage.

Paradoxical intention is a form or cognitive therapy in which you learn to confront the fear of staying awake and the potential adverse effects.

It may be learned from a psychologist, psychiatrist, or a physician trained in sleep medicine. Paradoxical intention helps to relieve the "performance anxiety" of falling asleep.

As part of this, you might objectively evaluate the consequences of a poor night of sleep on daytime function. This cognitive restructuring may relieve some of the anxiety about getting to sleep promptly at night. In addition, you can actually try to stay awake in order to fall asleep faster.

How Does Paradoxical Intention Treat Insomnia?

Rather than attempting to force yourself to sleep - in a sense, to perform on demand - you instead remain passively awake without any effort to fall asleep. With training, you stop "trying" to sleep (which never works). Quiet wakefulness becomes an acceptable alternative. Distraction, including breathing techniques, progressive muscle relaxation, and guided imagery, may also prove to be helpful.

Paradoxical intention can be achieved by staying awake until you feel sleepy and then going to bed. Retire to the bedroom and turn out the lights and preserve the sleep environment as a place conducive to rest and sleep (without activities such as reading, watching TV, or excessive light or noise). Lie quietly with your eyes closed. Instead of focusing on getting to sleep, try to stay awake. Surprisingly, you may find that you fall asleep faster in these conditions.

The anxiety of not being able to sleep is thus gradually relieved as you learn to accept quiet wakefulness as an acceptable alternative when you are in bed.

Paradoxical intention may be particularly helpful in people who have insomnia that is characterized by a difficulty falling asleep at the start of the night. It has been demonstrated to be effective and has no risks of side effects.

If you need additional assistance with your insomnia, find a CBTI specialist in your area and finally put an end to your insomnia.

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