Dealing with combintation of middle insomnia and paradoxical insomnia

Sleep Health Insomnia Help
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I suffer from middle insomnia. Although I haven’t had a sleep study done and for practical reasons cannot have one done, I have very concrete reasons to believe that I also have paradocial insomnia. I keep reading conflicting advice on whether CBT-I is even appropriate for middle insomnia. Is there any concensus on this? Some challenges I see with applying CBT-I are as follows:

  1. It’s hard to keep a meaningful sleep diary that would allow for adjusting SRT hours becuase it’s not clear how many hours I’ve actually slept.
  2. Stimulus control is a problem becuase I could be forcing myself out of bed thinking I’m awake when I’d actually be sleeping if I stay in bed.

Is there any literature on this topic?

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Hi John, Thanks so much for your question. I hear you—it sounds really challenging to deal with middle insomnia, especially when you suspect paradoxical insomnia on top of it. The good news is that CBT‑I is still considered a safe and effective approach for sleep maintenance difficulties, and it can even be adapted for paradoxical insomnia. It’s completely understandable that keeping a precise sleep diary is tough when you’re unsure how much you’re actually sleeping, and that stimulus control can feel tricky if you risk getting out of bed while you’re still asleep. Many people in similar situations find it helpful to use objective sleep trackers alongside their diary, start sleep restriction conservatively, and apply flexible stimulus control rules. CBT‑I also focuses on reducing the anxiety and hyperarousal around sleep, which can help close the gap between perceived and actual sleep. Research shows that these behavioral strategies can improve both the quality of sleep and how rested you feel (see Sleep Foundation: https://www.sleepfoundation.org/insomnia/treatment/cognitive-behavioral-therapy-insomnia; and PMC article: https://pmc.ncbi.nlm.nih.gov/articles/PMC8808745/?utm_source=chatgpt.com).

It may take some patience and adjustment, but with tailored guidance, CBT‑I can still be a helpful tool for managing middle or paradoxical insomnia. Wishing you all the best :light_blue_heart: