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What Defines Paradoxical Sleep?
During paradoxical sleep, our muscles are relaxed so that we don’t act out our dreams. If this fails,REM sleep behavior disordercan develop.
The paradox is that even though the brain is quite active during REM sleep, consuming large amounts of energy, the body remains completely inactive.
What Is Paradoxical Insomnia?
Paradoxical insomnia is considered to be rare because while insomnia affects roughly 10 to 30 percent of the global population, 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 a behavioral technique called paradoxical intention sleep therapy may help.
Behavioral Changes Can Improve Insomnia
There are a variety of behavioral interventions that can be effective in treating chronicinsomnia. These are collectively employed as part of a structured program calledcognitive 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?
Paradoxical intention is a form of 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 insleep 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. Cognitive distraction, including breathing techniques, progressive muscle relaxation, and guided imagery, may also be helpful.
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.
The Use of Paradoxical in Sleep Medicine
A Word From Verywell
13 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Luppi PH, Chancel A, Malcey J, Cabrera S, Fort P, Maciel RM.Which structure generates paradoxical (REM) sleep: the brainstem, the hypothalamus, the amygdala or the cortex?Sleep Med Rev. 2024;74:101907. doi:10.1016/j.smrv.2024.101907Blumberg MS, Lesku JA, Libourel PA, Schmidt MH, Rattenborg NC.What Is REM sleep?Curr Biol. 2020;30(1):R38-R49. doi:10.1016/j.cub.2019.11.045Eunice Kennedy Shriver National Institute of Child Health and Human Development.What happens during sleep?Roguski A, Rayment D, Whone AL, Jones MW, Rolinski M.A neurologist’s guide to REM sleep behavior disorder.Front Neurol. 2020;11:610. doi.org/10.3389/fneur.2020.00610U.S. National Library of Medicine.Insomnia.Rezaie L, Fobian AD, McCall WV, Khazaie H.Paradoxical insomnia and subjective-objective sleep discrepancy: a review.Sleep Med Rev. 2018;40:196-202. doi: 10.1016/j.smrv.2018.01.002Wasey W, Saleh S, Abernathy K, Sapra A, Bhandari P.Paradoxical insomnia in a frustrated patient treated with hypnotics for ten years.Cureus,2021;13(7):e16234.doi:10.7759/cureus.16234Sharma M, Andrade C.Behavioral interventions for insomnia: Theory and practice.Indian J Psychiatry. 2012;54(4):359. doi: 10.4103/0019-5545.104825Trauer JM, Qian MY, Doyle JS, Rajaratnam SMW, Cunnington D.Cognitive behavioral therapy for chronic insomnia: a systematic review and meta-analysis.Ann Intern Med. 2015;163(3):191-204. doi:10.7326/M14-2841Jansson‐Fröjmark M, Alfonsson S, Bohman B, Rozental A, Norell‐Clarke A.Paradoxical intention for insomnia: a systematic review and meta‐analysis.J Sleep Res. 2022;31(2). doi:10.1111/jsr.13464Liu K, Chen Y, Wu D, Lin R, Wang Z, Pan L.Effects of progressive muscle relaxation on anxiety and sleep quality in patients with COVID-19.Complement Ther Clin Pract. 2020;39:101132. doi:10.1016/j.ctcp.2020.101132Jerath R, Beveridge C, Jensen M, Paladiya R.The therapeutic role of guided mental imagery in treating stress and insomnia: a neuropsychological perspective.Open J Med Psychol. 2020;09(01):21-39. doi:10.4236/ojmp.2020.91003Jerath R, Beveridge C, Barnes VA.Self-regulation of breathing as an adjunctive treatment of insomnia.Front Psychiatry. 2019;9:780. doi:10.3389/fpsyt.2018.00780Additional ReadingKryger, MHet al. “Principles and Practice of Sleep Medicine.“Elsevier, 6th edition, 2017.
13 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Luppi PH, Chancel A, Malcey J, Cabrera S, Fort P, Maciel RM.Which structure generates paradoxical (REM) sleep: the brainstem, the hypothalamus, the amygdala or the cortex?Sleep Med Rev. 2024;74:101907. doi:10.1016/j.smrv.2024.101907Blumberg MS, Lesku JA, Libourel PA, Schmidt MH, Rattenborg NC.What Is REM sleep?Curr Biol. 2020;30(1):R38-R49. doi:10.1016/j.cub.2019.11.045Eunice Kennedy Shriver National Institute of Child Health and Human Development.What happens during sleep?Roguski A, Rayment D, Whone AL, Jones MW, Rolinski M.A neurologist’s guide to REM sleep behavior disorder.Front Neurol. 2020;11:610. doi.org/10.3389/fneur.2020.00610U.S. National Library of Medicine.Insomnia.Rezaie L, Fobian AD, McCall WV, Khazaie H.Paradoxical insomnia and subjective-objective sleep discrepancy: a review.Sleep Med Rev. 2018;40:196-202. doi: 10.1016/j.smrv.2018.01.002Wasey W, Saleh S, Abernathy K, Sapra A, Bhandari P.Paradoxical insomnia in a frustrated patient treated with hypnotics for ten years.Cureus,2021;13(7):e16234.doi:10.7759/cureus.16234Sharma M, Andrade C.Behavioral interventions for insomnia: Theory and practice.Indian J Psychiatry. 2012;54(4):359. doi: 10.4103/0019-5545.104825Trauer JM, Qian MY, Doyle JS, Rajaratnam SMW, Cunnington D.Cognitive behavioral therapy for chronic insomnia: a systematic review and meta-analysis.Ann Intern Med. 2015;163(3):191-204. doi:10.7326/M14-2841Jansson‐Fröjmark M, Alfonsson S, Bohman B, Rozental A, Norell‐Clarke A.Paradoxical intention for insomnia: a systematic review and meta‐analysis.J Sleep Res. 2022;31(2). doi:10.1111/jsr.13464Liu K, Chen Y, Wu D, Lin R, Wang Z, Pan L.Effects of progressive muscle relaxation on anxiety and sleep quality in patients with COVID-19.Complement Ther Clin Pract. 2020;39:101132. doi:10.1016/j.ctcp.2020.101132Jerath R, Beveridge C, Jensen M, Paladiya R.The therapeutic role of guided mental imagery in treating stress and insomnia: a neuropsychological perspective.Open J Med Psychol. 2020;09(01):21-39. doi:10.4236/ojmp.2020.91003Jerath R, Beveridge C, Barnes VA.Self-regulation of breathing as an adjunctive treatment of insomnia.Front Psychiatry. 2019;9:780. doi:10.3389/fpsyt.2018.00780Additional ReadingKryger, MHet al. “Principles and Practice of Sleep Medicine.“Elsevier, 6th edition, 2017.
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Luppi PH, Chancel A, Malcey J, Cabrera S, Fort P, Maciel RM.Which structure generates paradoxical (REM) sleep: the brainstem, the hypothalamus, the amygdala or the cortex?Sleep Med Rev. 2024;74:101907. doi:10.1016/j.smrv.2024.101907Blumberg MS, Lesku JA, Libourel PA, Schmidt MH, Rattenborg NC.What Is REM sleep?Curr Biol. 2020;30(1):R38-R49. doi:10.1016/j.cub.2019.11.045Eunice Kennedy Shriver National Institute of Child Health and Human Development.What happens during sleep?Roguski A, Rayment D, Whone AL, Jones MW, Rolinski M.A neurologist’s guide to REM sleep behavior disorder.Front Neurol. 2020;11:610. doi.org/10.3389/fneur.2020.00610U.S. National Library of Medicine.Insomnia.Rezaie L, Fobian AD, McCall WV, Khazaie H.Paradoxical insomnia and subjective-objective sleep discrepancy: a review.Sleep Med Rev. 2018;40:196-202. doi: 10.1016/j.smrv.2018.01.002Wasey W, Saleh S, Abernathy K, Sapra A, Bhandari P.Paradoxical insomnia in a frustrated patient treated with hypnotics for ten years.Cureus,2021;13(7):e16234.doi:10.7759/cureus.16234Sharma M, Andrade C.Behavioral interventions for insomnia: Theory and practice.Indian J Psychiatry. 2012;54(4):359. doi: 10.4103/0019-5545.104825Trauer JM, Qian MY, Doyle JS, Rajaratnam SMW, Cunnington D.Cognitive behavioral therapy for chronic insomnia: a systematic review and meta-analysis.Ann Intern Med. 2015;163(3):191-204. doi:10.7326/M14-2841Jansson‐Fröjmark M, Alfonsson S, Bohman B, Rozental A, Norell‐Clarke A.Paradoxical intention for insomnia: a systematic review and meta‐analysis.J Sleep Res. 2022;31(2). doi:10.1111/jsr.13464Liu K, Chen Y, Wu D, Lin R, Wang Z, Pan L.Effects of progressive muscle relaxation on anxiety and sleep quality in patients with COVID-19.Complement Ther Clin Pract. 2020;39:101132. doi:10.1016/j.ctcp.2020.101132Jerath R, Beveridge C, Jensen M, Paladiya R.The therapeutic role of guided mental imagery in treating stress and insomnia: a neuropsychological perspective.Open J Med Psychol. 2020;09(01):21-39. doi:10.4236/ojmp.2020.91003Jerath R, Beveridge C, Barnes VA.Self-regulation of breathing as an adjunctive treatment of insomnia.Front Psychiatry. 2019;9:780. doi:10.3389/fpsyt.2018.00780
Luppi PH, Chancel A, Malcey J, Cabrera S, Fort P, Maciel RM.Which structure generates paradoxical (REM) sleep: the brainstem, the hypothalamus, the amygdala or the cortex?Sleep Med Rev. 2024;74:101907. doi:10.1016/j.smrv.2024.101907
Blumberg MS, Lesku JA, Libourel PA, Schmidt MH, Rattenborg NC.What Is REM sleep?Curr Biol. 2020;30(1):R38-R49. doi:10.1016/j.cub.2019.11.045
Eunice Kennedy Shriver National Institute of Child Health and Human Development.What happens during sleep?
Roguski A, Rayment D, Whone AL, Jones MW, Rolinski M.A neurologist’s guide to REM sleep behavior disorder.Front Neurol. 2020;11:610. doi.org/10.3389/fneur.2020.00610
U.S. National Library of Medicine.Insomnia.
Rezaie L, Fobian AD, McCall WV, Khazaie H.Paradoxical insomnia and subjective-objective sleep discrepancy: a review.Sleep Med Rev. 2018;40:196-202. doi: 10.1016/j.smrv.2018.01.002
Wasey W, Saleh S, Abernathy K, Sapra A, Bhandari P.Paradoxical insomnia in a frustrated patient treated with hypnotics for ten years.Cureus,2021;13(7):e16234.doi:10.7759/cureus.16234
Sharma M, Andrade C.Behavioral interventions for insomnia: Theory and practice.Indian J Psychiatry. 2012;54(4):359. doi: 10.4103/0019-5545.104825
Trauer JM, Qian MY, Doyle JS, Rajaratnam SMW, Cunnington D.Cognitive behavioral therapy for chronic insomnia: a systematic review and meta-analysis.Ann Intern Med. 2015;163(3):191-204. doi:10.7326/M14-2841
Jansson‐Fröjmark M, Alfonsson S, Bohman B, Rozental A, Norell‐Clarke A.Paradoxical intention for insomnia: a systematic review and meta‐analysis.J Sleep Res. 2022;31(2). doi:10.1111/jsr.13464
Liu K, Chen Y, Wu D, Lin R, Wang Z, Pan L.Effects of progressive muscle relaxation on anxiety and sleep quality in patients with COVID-19.Complement Ther Clin Pract. 2020;39:101132. doi:10.1016/j.ctcp.2020.101132
Jerath R, Beveridge C, Jensen M, Paladiya R.The therapeutic role of guided mental imagery in treating stress and insomnia: a neuropsychological perspective.Open J Med Psychol. 2020;09(01):21-39. doi:10.4236/ojmp.2020.91003
Jerath R, Beveridge C, Barnes VA.Self-regulation of breathing as an adjunctive treatment of insomnia.Front Psychiatry. 2019;9:780. doi:10.3389/fpsyt.2018.00780
Kryger, MHet al. “Principles and Practice of Sleep Medicine.“Elsevier, 6th edition, 2017.
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