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other researchers applied spectral analysis algorithms to the EEGs of their sleeping insomniacs, they found different patterns, fast waves known as beta and gamma (Sleep, vol 24, p 110). Normally, these are indicators of consciousness, alertness and even anxiety Like alpha waves, Perlis calls these beta and gamma waves "intrusions" into normal sleep: "It's as if somebody is playing with the switch – boop, boop – flipping at a mad rate between wake and sleep".
164:
260:
objective normal sleep duration is characterized by depressive, anxious-ruminative traits and poor coping resources. Thus, it appears that not all chronic insomniacs underestimate their sleep duration, and that sleep misperception is a clinical characteristic of chronic insomniacs with objective normal sleep duration. Furthermore,
291:
in Durham, North
Carolina, used spectral analysis to quantify just how much they were intruding. Krystal's non-sleepers not only had a greater proportion of these alpha disturbances, but the alpha waves were bigger and the delta waves were correspondingly smaller. That wasn't all. When Perlis and
234:
Finally, on the opposite end of the spectrum, other patients may report feeling that they have slept much longer than is observed. It has been proposed that this experience be subclassified under sleep state misperception as "positive sleep state misperception", "reverse sleep state misperception",
74:
as wakefulness, though it has been proposed that it be applied to those who severely overestimate their sleep time as well ("positive" sleep state misperception). While most sleepers with this condition will report not having slept in the previous night at all or having slept very little, clinical
885:
Fernandez-Mendoza J, Calhoun S, Bixler E, Karataraki M, Liao D, Vela-Bueno A, Ramos-Platon M, Sauder K, Basta M, Vgontzas A. "Sleep
Misperception and Chronic Insomnia in the General Population: The Role of Objective Sleep Duration and Psychological Profiles." Psychosomatic Medicine, 2011; 73(1):
243:
The patient has a complaint of insomnia while sleep quality and duration are normal. Polysomnographic monitoring demonstrates normal sleep latency, a normal number of arousals and awakenings, and normal sleep duration with or without a multiple sleep latency test that demonstrates a mean sleep
259:
A 2011 study published in the journal
Psychosomatic Medicine has shown that sleep misperception (i.e., underestimation of sleep duration) is prevalent among chronic insomniacs who sleep objectively more than 6 hours in the sleep lab. The psychological profile of these chronic insomniacs with
309:
through clinical testing, such as by polysomnogram. Those who experience SSM may believe that they have not slept for extended periods of time, when they in fact do sleep but without perceiving it. For example, while patients who claim little or no sleep may usually acknowledge impaired job
713:
Edinger, JD; Wyatt, JK; Stepanski, EJ; Olsen, MK; Stechuchak, KM; Carney, CE; Chiang, A; Crisostomo, MI; Lineberger, MD; Means, MK; Radtke, RA; Wohlgemuth, WK; Krystal, AD (October 2011). "Testing the reliability and validity of DSM-IV-TR and ICSD-2 insomnia diagnoses. Results of a
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recordings generally show normal sleep patterns. Though the sleep patterns found in those with SSM have long been considered indistinguishable from those without, some preliminary research suggest there may be subtle differences (see
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it uncovered subtle differences in the EEGs of sleeping insomniacs: alpha waves – signatures of wakefulness that are supposed to show up only in early sleep – were intruding into deep sleep. Perlis. But Andrew
Krystal of
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Coleman, R. M.; Roffwarg, HP; Kennedy, SJ; Guilleminault, C; Cinque, J; Cohn, MA; Karacan, I; Kupfer, DJ; et al. (1982). "Sleep-wake disorders based on a polysomnographic diagnosis. A national cooperative study".
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latency of greater than 10 minutes. No medical or mental disorder produces the complaint. Other sleep disorders producing insomnia are not present to a degree that would explain the patient's complaint.
379:. It has also been noted that patients with this condition may sometimes opt to take medications over other treatments "for the wrong reasons (e.g. because of euphoriant properties)."
216:(EEG), which may record normal sleep. Observing such discrepancy between subjective and objective reports, clinicians may conclude that the perception of poor sleep is primarily
155:
The validity and reliability of the sleep state misperception as a pertinent medical entity was questioned. A study found poor empirical support for this diagnostic item.
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of not having slept. Generally, they may describe experiencing several years of no sleep, short sleep, or non-restorative sleep. Otherwise, patients appear healthy, both
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Cases of objective total insomnia are extremely rare. The few that have been recorded have predominantly been ascribed to a rare incurable genetic disorder called
356:
The condition may worsen as a result of persistent attempts to treat the symptoms through conventional methods of dealing with insomnia. The prescription of
394:
Distribution among the general population and by gender is unknown. About 5% of the clinical population may be affected, though that figure is subject to
116:. Nonetheless, the value of distinguishing this type of insomnia from other types is debatable due to the relatively low frequency of SSM being reported.
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The validity and reliability of sleep state misperception as a pertinent diagnosis has been questioned, with studies finding poor empirical support.
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A subject who is not being monitored (by a recording or other observer) may not have a way to tell if a treatment is working properly due to the
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Trajanovic, N; Radivojevic, V; Kaushansky, Y; Shapiro, C (2007). "Positive sleep state misperception – A new concept of sleep misperception".
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or chronic disabling sleepiness, while no sleep disorder has been found to exist. Methods of diagnosing sleepiness objectively, such as the
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86:—appear to be more associated with fear of negative consequences of insomnia ("insomnia phobia") than from any actual loss of sleep.
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93:: "subjective insomnia complaint without objective findings" and "subjective sleepiness complaint without objective findings."
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Edinger, J; Krystal, AD (2003). "Subtyping primary insomnia: is sleep state misperception a distinct clinical entity?".
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Littner, M; Hirshkowitz, M; Kramer, M; Kapen, S; Anderson, WM; Bailey, D; Berry, RB; Davila, D; et al. (2003).
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Paradoxical insomnia, pseudo-insomnia, subjective insomnia, subjective sleepiness, sleep hypochondriasis
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McCall, WV; Edinger, JD (1992). "Subjective total insomnia: an example of sleep state misperception".
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hypnotics may also help relieve the symptoms. Additionally, education about normal patterns of the
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in some patients. For patients with severe depression resulting from the fear of having insomnia,
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highlighted above) recorded from those with SSM may appear indistinguishable from those without.
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Sleep state misperception can also be further broken down into several types, by patients who:
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or prevention, though it is believed to be most prevalent among young to middle aged adults.
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633:"A case of extreme paradoxical insomnia responding selectively to electroconvulsive therapy"
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However, upon clinical observation, it is found that patients may severely overestimate
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SSM is poorly understood. As of 2008, there is little to no information regarding
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592:. Healthcommunities.com. Original Publication: 01 Dec 2000. Updated: 01 Dec 2007.
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908:"Practice parameters for using polysomnography to evaluate insomnia: an update"
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and poor coping resources may play a significant role in sleep misperception.
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report short sleep (subjective insomnia complaint without objective findings)
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performance and daytime drowsiness, sleep state misperceivers often do not.
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Patients are otherwise generally in good health, and any illnesses—such as
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may help clinicians find objective evidence for sleep state misperception:
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Sleep state misperception was adopted by the ICSD to replace two previous
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Szuba, Martin P.; Kloss, Jacqueline D.; Dinges, David F. (19 June 2003).
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Case, K; Hurwitz, TD; Kim, SW; Cramer-Bornemann, M; Schenck, CH (2008).
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frequently applies when patients report not feeling tired despite their
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112:, it is also established as a separate sleep-condition, with distinct
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466:. Originally published: September 6, 1995. Updated: October 29, 2008.
208:—often reporting having slept half the amount of time indicated by
70:(ICSD) most commonly used for people who mistakenly perceive their
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Fatal
Familial Insomnia. Part 1: What Is Fatal Familial Insomnia
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139:(subjective sleepiness complaint without objective findings)
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Sleep state misperception is classified as an intrinsic
607:"Awake asleep: Insomniac brains that can't switch off"
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Behavioral treatment can be effective in some cases.
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201:could explain why it is relatively unreported.)
460:http://www.medlink.com/web_content/MLT0003S.asp
371:Nonetheless, chronic SSM may increase risk for
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68:International Classification of Sleep Disorders
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341:appears to be a safe and effective treatment.
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871:Conroy, Deirdre A; Culebras, Antonio (2013).
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272:According to a May 2014 article published in
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975:Principles and practice of sleep medicine.
689:. Cambridge University Press. p. 11.
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235:and "negative sleep state misperception".
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77:Symptoms and diagnosis: Spectral analysis
977:2nd ed. Philadelphia: WB Saunders, 1994.
760:. Icantgetnosleep.info. November 4, 2009
458:Minecan, Daniela, and Antonio Culebras.
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252:Detecting sleep state misperception by
305:, unlike SSM, can easily be confirmed
223:Alternatively, some people may report
108:. While SSM is regarded a sub-type of
76:
142:report sleeping too much (subjective
7:
858:Sleepnet.com - Insomnia Information
686:Insomnia: Principles and Management
714:multitrait-multimethod analysis".
637:Journal of Clinical Sleep Medicine
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728:10.1001/archgenpsychiatry.2011.64
206:the time they took to fall asleep
1289:Obesity hypoventilation syndrome
1284:Central hypoventilation syndrome
197:. (That this condition is often
1444:Periodic limb movement disorder
1411:Non-24-hour sleep–wake disorder
126:or no sleep at all (subjective
973:Hauri PJ. "Primary insomnia."
716:Archives of General Psychiatry
1:
1716:Biphasic and polyphasic sleep
1524:Nocturnal clitoral tumescence
1386:Advanced sleep phase disorder
462:"Sleep state misperception."
301:What is considered objective
1396:Delayed sleep phase disorder
1324:Excessive daytime sleepiness
892:10.1097/PSY.0b013e3181fe365a
225:excessive daytime sleepiness
137:excessive daytime sleepiness
1529:Nocturnal penile tumescence
1401:Irregular sleep–wake rhythm
566:10.1016/j.sleep.2006.08.013
523:Informa Health Care, 2008.
519:Handbook of Sleep Disorders
229:Multiple Sleep Latency Test
146:without objective findings)
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1391:Cyclic alternating pattern
613:(2969): 34, archived from
248:Detection and difficulties
1607:Behavioral sleep medicine
1416:Shift work sleep disorder
1364:Sleep state misperception
339:electroconvulsive therapy
297:Distinction from insomnia
60:Sleep state misperception
33:Sleep state misperception
1164:Rapid eye movement (REM)
605:Finkbeiner, Ann (2014),
256:means has been elusive.
91:diagnostic terminologies
1485:Exploding head syndrome
1294:Obstructive sleep apnea
315:fatal familial insomnia
1800:Sleeping while on duty
1349:Idiopathic hypersomnia
925:10.1093/sleep/26.6.754
873:"Paradoxical insomnia"
835:10.1001/jama.247.7.997
799:10.1053/smrv.2002.0253
787:Sleep Medicine Reviews
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214:electroencephalography
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159:Symptoms and diagnosis
1622:Neuroscience of sleep
1354:Night eating syndrome
1339:Kleine–Levin syndrome
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1776:Sleep and creativity
947:Paradoxical Insomnia
856:Insomnia Information
18:Paradoxical insomnia
1771:Sleep and breathing
1227:Sensorimotor rhythm
408:Second wind (sleep)
368:as a complication.
239:Diagnostic criteria
66:) is a term in the
1781:Sleep and learning
1534:Nocturnal emission
1434:Nightmare disorder
1299:Periodic breathing
1086:External resources
775:Holisticonline.com
755:2011-07-21 at the
649:10.5664/jcsm.27081
516:Kushida, Clete A.
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1791:Sleep deprivation
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957:Schenkein, Joyce
696:978-0-521-01076-4
537:978-0-8493-7319-0
464:MedLink Neurology
280:spectral analysis
268:Spectral analysis
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27:Medical condition
16:(Redirected from
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1786:Sleep and memory
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1232:Sleep spindle
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961:
954:
951:
948:
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940:
935:
931:
926:
921:
918:(6): 754–60.
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849:
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840:
836:
832:
828:
824:
816:
813:
808:
804:
800:
796:
793:(3): 203–14.
792:
788:
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772:
766:
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617:on 2014-09-09
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611:New Scientist
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345:Complications
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19:
1677:Sleeping bag
1454:Sleepwalking
1439:Night terror
1363:
1156:sleep cycles
1093:
1069:
1058:
1047:
1024:
1005:
974:
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942:
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911:
881:
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826:
822:
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790:
786:
780:
769:
765:
748:
744:
719:
715:
685:
640:
636:
615:the original
610:
560:(2): 111–8.
557:
553:
517:
484:
480:
463:
393:
389:risk factors
386:
383:Epidemiology
370:
364:may lead to
355:
348:
324:
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285:
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233:
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199:asymptomatic
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127:
118:
103:
95:
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63:
59:
58:
1761:Second wind
1736:Dream diary
1612:Sleep study
1552:Sleep diary
1504:Hypnopompia
1499:Sleep onset
1490:Hypnic jerk
1329:Hypersomnia
1279:Catathrenia
1274:Sleep apnea
1184:Brain waves
1154:Stages of
643:(1): 62–3.
539:. (Page 32)
487:(1): 71–3.
413:Somniphobia
307:empirically
218:illusionary
168:Sleep waves
144:hypersomnia
38:Other names
1820:Categories
1795:Sleep debt
1741:Microsleep
1721:Chronotype
1635:Daily life
1519:Somnolence
1495:Hypnagogia
1426:Parasomnia
1344:Narcolepsy
1256:Anatomical
1237:Theta wave
1207:Gamma wave
1202:Delta wave
1192:Alpha wave
1060:DiseasesDB
419:References
373:depression
362:stimulants
262:rumination
187:perception
184:subjective
84:depression
1805:Sleepover
1756:Power nap
1751:Nightwear
1617:Melatonin
1579:Somnology
1544:Treatment
1377:disorders
1316:Dyssomnia
1222:PGO waves
1217:Mu rhythm
1212:K-complex
1197:Beta wave
1174:Slow-wave
1095:eMedicine
1076:427745001
1071:SNOMED CT
964:Medscape.
358:hypnotics
321:Treatment
254:objective
195:medically
130:insomnia)
106:dyssomnia
47:Specialty
1672:Mattress
1647:Bunk bed
1567:Hypnosis
1359:Nocturia
1334:Insomnia
1100:med/2698
934:14572131
807:12927120
753:Archived
736:21646568
667:18350965
574:17275407
402:See also
327:Sedative
303:insomnia
151:Validity
110:insomnia
1699:Bedtime
1694:Bedroom
1689:Bedding
1684:Bed bug
1667:Hammock
1572:Lullaby
1406:Jet lag
1306:Snoring
1264:Bruxism
1054:D020919
886:88-97.
843:7057593
658:2276826
493:1557596
351:amnesic
335:anxiety
135:report
1766:Siesta
1652:Daybed
1480:Dreams
1043:780.52
1039:307.49
1035:307.42
932:
841:
805:
734:
693:
665:
655:
572:
535:
527:
491:
1836:Dream
1709:Story
1662:Futon
1595:Other
1143:Sleep
1065:26877
1020:G47.0
1016:F51.0
912:Sleep
481:Sleep
178:This
128:total
72:sleep
1145:and
1049:MeSH
1030:9-CM
930:PMID
839:PMID
823:JAMA
803:PMID
732:PMID
691:ISBN
663:PMID
570:PMID
533:ISBN
525:ISBN
489:PMID
193:and
1746:Nap
1642:Bed
1026:ICD
1007:ICD
920:doi
888:doi
831:doi
827:247
795:doi
724:doi
653:PMC
645:doi
562:doi
360:or
212:or
172:EEG
79:).
64:SSM
1822::
1793:/
1497:/
1098::
1074::
1063::
1052::
1041:,
1037:,
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1014::
1011:10
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898:^
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720:68
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651:.
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738:.
726::
699:.
669:.
647::
641:4
576:.
564::
558:8
521:.
495:.
170:(
62:(
20:)
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