Sleep education for paradoxical insomnia

Abstract

This case study series investigated a new treatment for paradoxical insomnia patients as there is no standard treatment for this patient group at this time. Four paradoxical insomnia patients had a polysomnography (PSG) sleep study, an unsuccessful brief course of behavioral treatment for insomnia, and then a novel sleep education treatment comprising review of their PSG with video and exploration of the discrepancy between their reported and observed sleep experience. Two patients responded well to sleep education, mainly with improved self-reported sleep onset latency, total sleep time, and Insomnia Severity Index scores; and the other two, who exhibited sleep architecture anomalies, were unresponsive. These findings suggest that sleep education holds promise for some paradoxical insomnia patients. Suggestions for future studies are given.

FIGURE 1

Correspondence between Non-REM Stage 1% (N1%) and sleep education self-reported sleep onset latency (SOL) treatment response. Note. N1% is derived from the diagnostic polysomnography. The N1% dark bar is the average N1% of Patients 1 and 3 (the 2 weak responders), and the light bar is the average N1% of Patients 2 and 4 (the 2 good responders). SOL% captures the decrease after sleep education (Assessment 3) compared to the behavioral treatment post assessment (Assessment 2): SOL Assessment 3 ÷ SOL Assessment 2 × 100. The SOL% dark bar indicates Patients’ 1 and 3 average SOL post-sleep education was equal to nearly 100% of behavioral treatment post SOL (no change). The SOL% light bar shows Patients 2 and 4 averaged about 30% of behavioral treatment post SOL (about a 70% SOL reduction following sleep education).