Paradoxical Insomnia in a Frustrated Patient Treated With Hypnotics for Ten Years

Wasey, Waiz; Saleh, Sharefi; Abernathy, Kristia; Sapra, Amit; Bhandari, Priyanka

doi:10.7759/cureus.16234

Cited by 4 publications

(2 citation statements)

References 7 publications

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“…Worldwide cytomegalovirus (CMV) seroprevalence is estimated between 60% and 100%,1 in Australia it is reported to be 57% 2. CMV is a double-stranded DNA virus, from the herpes group, found in human and monkey hosts with oral, sexual and transplacental transmission 3 4. Primary CMV infection starts with a viraemic phase, with multiorgan and haematological dissemination and shedding 5.…”

Section: Introductionmentioning

confidence: 99%

Acute primary CMV infection complicated by pneumonitis and ITP in young immunocompetent woman in a regional Queensland Hospital

Roberts,

Ng,

Sanjeewa

et al. 2024

BMJ Case Rep

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We present the first published case of simultaneous pneumonitis and immune thrombocytopenic purpura secondary to primary cytomegalovirus (CMV) infection in an immunocompetent patient. Treatment with oral valganciclovir for 2 weeks successfully led to complete clinical recovery. CMV is traditionally associated with infection in immunocompromised patients and neonates; however, evidence of severe CMV infections in immunocompetent hosts is emerging. It is important to highlight the broad range of clinical presentations of CMV infections to prevent diagnostic delay and associated morbidity and expense.

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Section: Introductionmentioning

confidence: 99%

Acute primary CMV infection complicated by pneumonitis and ITP in young immunocompetent woman in a regional Queensland Hospital

Roberts,

Ng,

Sanjeewa

et al. 2024

BMJ Case Rep

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“…Paradoxical Insomniacs often report near-constant awareness of the environment (e.g., actively hearing every noise in the house while sleeping in the bedroom) [6], and daytime function impairment reported is often consistent with objective insomnia but is much less severe than expected given the severe level of sleep deprivation reported [7].…”

Section: Introductionmentioning

confidence: 99%

Sleep Instability in Paradoxical Insomnia is Associated with Perception of Sleep

Lo¹,

Tsai

Yang

2022

Preprint

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Objective: The main clinical characteristics that diversify paradoxical insomniacs from objective insomnia patients remain unclear. The current study systematically examined the difference in sleep-related, subjective-and objective parameters between insomnia patients with or without misperception. Methods: Patients who reported having poor sleep quality (subjective sleep efficiency; SE ≤ 85%) on both weekends and weekdays and difficulty falling asleep in the Sleep Heart Health Study were examined in this study. Patients with objective SE ≤ 85% and > 85% were then classified as objective insomnia (n = 58) and paradoxical insomnia (n = 61), respectively. The differences in demographic data, subjective sleep quality, daytime function, and objective sleep architecture measured by polysomnography, were assessed between the groups. Results: Though there were no significant group differences in the demographics between objective insomniacs and paradoxical insomniacs, paradoxical insomniacs reported significantly poorer daytime function than patients with objective insomnia. Moreover, subjective sleep evaluation on recording day of paradoxical insomniacs was significantly higher than habitual reports. The main finding from this research was that the transition indices from stage N3 to stage N2 or N1 was significantly different between the two groups, which could indicate that sleep instability may be a factor in leading paradoxical insomnia patients to underestimate their sleep efficiency. Conclusions: Our findings indicated a possible link between sleep misperception and the microstructure of sleep, specifically the sleep-state instability. The interplay between the neurobiology of sleep instability and perception of sleep needs further investigation.

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Proportion and Associated Clinical Factors of Paradoxical Insomnia in Patients With Chronic Insomnia: A Retrospective and Observational Study

No¹,

Kim²,

Lee³

et al. 2023

J Sleep Med

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Objectives: Paradoxical insomnia, a type of sleep disorder, is characterized by misperception and underestimation of an individual’s sleep time. In this study, we investigated the percentage and clinical factors associated with paradoxical insomnia in patients with chronic insomnia, who underwent polysomnography.Methods: The study included 148 patients with chronic insomnia. The study population was categorized into paradoxical and non-paradoxical insomnia groups. The following criteria were used to define paradoxical insomnia: 1) total sleep time >390 min and sleep efficiency ≥85.0%, and 2) significant discrepancy of >1 hour between subjective and objective sleep measurements. We analyzed demographic data, polysomnographic parameters, and perceived sleep time in all patients.Results: Among 148 patients with chronic insomnia, 33 (22.6%) had paradoxical insomnia. We observed significant intergroup differences in age, sex, and the Insomnia Severity Index (ISI). Sleep architecture patterns were relatively better in the paradoxical than in the non-paradoxical insomnia group. Logistic regression analysis was performed to determine clinical factors associated with paradoxical insomnia. Female sex (odds ratio [OR] 2.96, 95% confidence interval [CI] 1.19–7.37), age (OR 0.97, 95% CI 0.94–0.99), and ISI (OR 1.18, 95% CI 1.05–1.31) were significantly associated with paradoxical insomnia.Conclusions: Approximately 20.0% of patients with chronic insomnia were classified into the paradoxical insomnia group, and female sex, age, and ISI were identified as clinical factors associated with this type of sleep disorder.

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Paradoxical Insomnia in a Frustrated Patient Treated With Hypnotics for Ten Years

Cited by 4 publications

References 7 publications

Acute primary CMV infection complicated by pneumonitis and ITP in young immunocompetent woman in a regional Queensland Hospital

Acute primary CMV infection complicated by pneumonitis and ITP in young immunocompetent woman in a regional Queensland Hospital

Sleep Instability in Paradoxical Insomnia is Associated with Perception of Sleep

Proportion and Associated Clinical Factors of Paradoxical Insomnia in Patients With Chronic Insomnia: A Retrospective and Observational Study

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