11/9/2023 0 Comments Paradoxical insomnia meaningOne report worth noting documented a pair of identical twins who both experienced dramatic reactions to midazolam. Genetic variability may play a part in some idiosyncratic reactions. The neurobiology of paradoxical reactions is unclear. Risk factors found for developing a paradoxical reaction from benzodiazepines include alcoholism, extremes of age, and psychiatric comorbidity. The rate of paradoxical reactions following benzodiazepine administration is estimated to be 1-2%. ![]() They are most frequent in anxious and aggressive individuals, children, and the elderly. Such reactions are similar to those sometimes provoked by alcohol. Less dramatic increases in irritability and argumentativeness are much more common and are frequently remarked upon by patients or by their families. Unfortunately, there is no uniform definition of a paradoxical reaction.Īttacks of rage and violent behavior, including assault (and even homicide), have been reported, particularly after benzodiazepine intravenous administration but also after oral administration. This may be associated with increased autonomic activity including tachycardia, hypertension, and tachypnea. Tolerance, akathisia and withdrawal can sometimes feel like paradoxical reactions, but this is often not a true paradoxical reaction by definition.Ĭentral features of paradoxical reactions are emotional lability, agitation, excessive movement, and confusion. Benzodiazepine treatment can sometimes result in paradoxical reactions in susceptible individuals causing an increase in anxiety, agitation, hallucinations at the onset of sleep, aggressiveness, hyperactivity, irritability, hyperactive behavior, insomnia and exacerbation of seizures in epileptics. An example of this is pain relief medication causing increased pain. If a patient responds to medication in a contradictory or opposite way to what is expected, it is said to have had a paradoxical effect. Benzodiazepine Withdrawal Syndrome (BWS)Ī paradoxical reaction happens when a person experiences the opposite of what the drug is intended to do.Why Patients Shouldn’t Go To Detox or Rehab.Steps to Reduce Benzodiazepine Overprescribing.Class Actions, Lawsuits and Reporting Harm.Objective insomnia Paradoxical insomnia Quantitative definition Sleep misperception Subjective insomnia.Ĭopyright © 2018 Elsevier Ltd. The overarching goal is to motivate a rigorous discussion involving the main experts of the field, to build a consensus, and develop an evidence-based measure of sleep state misperception and/or of paradoxical insomnia. The current study provides a critical analysis about the strength and the limitations of the available definitions, using both a data-driven and a theory-driven approach. STATEMENT OF SIGNIFICANCE: The current understanding of paradoxical insomnia and, more broadly, of sleep state misperception, is greatly hampered by the lack of agreement on a quantitative and evidence-base measure of the discrepancy between subjective and objective sleep evaluation. ![]() We conclude by advocating continued study of paradoxical insomnia and sleep state misperception and by providing specific directions for future research. Several open questions remain, such as whether there is a minimum number of hours a patient should sleep to fulfill the criteria for a diagnosis of paradoxical insomnia, and whether sleep latency can be used in the definition along with total sleep time. Based on the results garnered, necessary features for a quantitative definition of paradoxical insomnia were identified. Depending on the definition used, the prevalence of paradoxical insomnia ranged from 8 to 66%, while agreement between different definitions ranged from -0.19 to 0.9 (using Cohen's kappa coefficient). For each dataset, available data from the objective sleep parameters and their subjective estimation were imported and analysed in MATLAB. The second consisted of 200 age- and sex-matched healthy persons without insomnia. The first consisted of 200 chronic primary insomnia patients, diagnosed according to the DSM-IV-TR criteria. ![]() These definitions were then applied to two distinct datasets. To help filling some of the existing gaps, a systematic review of the literature was conducted, through which 19 different quantitative definitions were obtained. Much of the debate is fuelled by the lack of a consensus on its precise definition. Despite being recognized for a long time by the international community, it is still unclear whether this entity really exists, which are its features and boundaries. Paradoxical insomnia is one of the most intriguing yet challenging subtypes of insomnia.
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