There is nothing in the realm of sleep medicine that creates more confusion (both among patients and providers) than paradoxical insomnia. Known by many terms over the years, paradoxical insomnia (or sleep state misperception) is at once common and rare, This is unfortunate because more awareness could improve the overall recognition and diagnosis or insomnia as well as improve treatment outcomes. In this episode we will:Review the definition and incidence of insomnia disorderExplore the inherent problems that result from patient sleep reporting (sleep latency, sleep duration, etc.)Describe the origins of sleep state misperception and how it was a natural outgrowth of the more widespread use and formalization  of the polysomnogramDefine paradoxical insomnia and detail the shortcomings of the definitionDifferentiate between a formal diagnosis of paradoxical insomnia and a patient who underestimated their sleep amount/overestimates sleep latencyLook at historical studies that first quantified the number of insomnia patients that underestimated their sleep amount and to what degreeDefine the Misperception Index (MI) and how it can be used to create a spectrum and diagnostic structure for paradoxical insomnia. List the risk factors and causes of paradoxical insomniaBriefly touch upon potential treatmentsProduced by: Maeve WinterMore Twitter: @drchriswinter IG: @drchriwinter Threads: @drchriswinter Bluesky: @drchriswinter The Sleep Solution and The Rested Child Thanks for listening and sleep well!