Predictors of Nightly Subjective-Objective Sleep Discrepancy in Poor Sleepers over a Seven-Day Period

This study sought to examine predictors of subjective/objective sleep discrepancy in poor sleepers. Forty-two individuals with insomnia symptoms (mean age = 36.2 years, 81% female) were recruited to take part in a prospective study which combined seven days of actigraphy with daily assessment of sleep perceptions, self-reported arousal, sleep effort, and mood upon awakening. A high level of intra-individual variability in measures of sleep discrepancy was observed. Multilevel modelling revealed that higher levels of pre-sleep cognitive activity and lower mood upon awakening were significantly and independently predictive of the underestimation of total sleep time. Greater levels of sleep effort predicted overestimation of sleep onset latency. These results indicate that psychophysiological variables are related to subjective/objective sleep discrepancy and may be important therapeutic targets in the management of insomnia.

[1]  M. Bianchi,et al.  Sleep misperception in healthy adults: implications for insomnia diagnosis. , 2012, Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine.

[2]  Daniel J. Taylor,et al.  Insomnia as a Health Risk Factor , 2003, Behavioral sleep medicine.

[3]  C. Espie,et al.  The attention-intention-effort pathway in the development of psychophysiologic insomnia: a theoretical review. , 2006, Sleep medicine reviews.

[4]  S. Mazza,et al.  Psychological functioning measures in patients with primary insomnia and sleep state misperception , 2013, Acta neurologica Scandinavica.

[5]  F. Ho,et al.  Cross-cultural and comparative epidemiology of insomnia: the Diagnostic and statistical manual (DSM), International classification of diseases (ICD) and International classification of sleep disorders (ICSD). , 2015, Sleep medicine.

[6]  A. Sadeh,et al.  Validation of actigraphy with continuous video-electroencephalography in children with epilepsy. , 2014, Sleep medicine.

[7]  J. Wyatt,et al.  Moving beyond average values: assessing the night-to-night instability of sleep and arousal in DSM-IV-TR insomnia subtypes. , 2011, Sleep.

[8]  R. Larsen Neuroticism and selective encoding and recall of symptoms: evidence from a combined concurrent-retrospective study. , 1992, Journal of personality and social psychology.

[9]  Adam N. Sanborn,et al.  Deciphering the temporal link between pain and sleep in a heterogeneous chronic pain patient sample: a multilevel daily process study. , 2012, Sleep.

[10]  N. Douglas,et al.  Randomized clinical effectiveness trial of nurse-administered small-group cognitive behavior therapy for persistent insomnia in general practice. , 2007, Sleep.

[11]  C. McCrae,et al.  Beyond mean values: Quantifying intraindividual variability in pre-sleep arousal and sleep in younger and older community-dwelling adults , 2015, Sleep science.

[12]  Hans Ivers,et al.  Dysfunctional beliefs and attitudes about sleep (DBAS): validation of a brief version (DBAS-16). , 2007, Sleep.

[13]  A. Harvey,et al.  Correcting distorted perception of sleep in insomnia: a novel behavioural experiment? , 2004, Behaviour research and therapy.

[14]  L. Creti,et al.  A COGNITIVE MODEL OF INSOMNIA , 2022 .

[15]  A. Okifuji,et al.  Nightly Analyses of Subjective and Objective (Actigraphy) Measures of Sleep in Fibromyalgia Syndrome: What Accounts for the Discrepancy? , 2011, The Clinical journal of pain.

[16]  A. Krystal,et al.  Subtyping primary insomnia: is sleep state misperception a distinct clinical entity? , 2003, Sleep medicine reviews.

[17]  G. Arbanas Diagnostic and Statistical Manual of Mental Disorders (DSM-5) , 2015 .

[18]  W C Dement,et al.  Self-reports versus sleep laboratory findings in 122 drug-free subjects with complaints of chronic insomnia. , 1976, The American journal of psychiatry.

[19]  B. Bradley,et al.  Mood and the self-reference bias in recall. , 1983, Behaviour research and therapy.

[20]  N. Galambos,et al.  Losing Sleep Over It: Daily Variation in Sleep Quantity and Quality in Canadian Students' First Semester of University , 2009 .

[21]  F. Snyder,et al.  Recorded and reported sleep in chronic primary insomnia. , 1976, Archives of general psychiatry.

[22]  S. Kyle,et al.  The Sleep Condition Indicator: a clinical screening tool to evaluate insomnia disorder , 2014, BMJ Open.

[23]  S. Kyle,et al.  “… Not Just a Minor Thing, It Is Something Major, Which Stops You From Functioning Daily”: Quality of Life and Daytime Functioning in Insomnia , 2010, Behavioral sleep medicine.

[24]  A. Krystal,et al.  NREM sleep EEG frequency spectral correlates of sleep complaints in primary insomnia subtypes. , 2002, Sleep.

[25]  R. Daroff,et al.  The International Classification of Sleep Disorders , 1991, Neurology.

[26]  B. Feige,et al.  The exploratory power of sleep effort, dysfunctional beliefs and arousal for insomnia severity and polysomnography‐determined sleep , 2015, Journal of sleep research.

[27]  W. Mendelson,et al.  Insomnia, Health-Related Quality of Life and Healthcare Resource Consumption , 1998, PharmacoEconomics.

[28]  S. Tufik,et al.  Effects of different sleep deprivation protocols on sleep perception in healthy volunteers. , 2014, Sleep medicine.

[29]  S. Kyle,et al.  The Glasgow Sleep Impact Index (GSII): a novel patient-centred measure for assessing sleep-related quality of life impairment in Insomnia Disorder. , 2013, Sleep medicine.

[30]  Philip Scheltens,et al.  Discrepancy between subjective and objective sleep disturbances in early- and moderate-stage Alzheimer disease. , 2012, The American journal of geriatric psychiatry : official journal of the American Association for Geriatric Psychiatry.

[31]  Kai Spiegelhalder,et al.  Sleep changes in the disorder of insomnia: a meta-analysis of polysomnographic studies. , 2014, Sleep medicine reviews.

[32]  F. Raes,et al.  I sleep with my Mind's eye open: Cognitive arousal and overgeneralization underpin the misperception of sleep. , 2016, Journal of behavior therapy and experimental psychiatry.

[33]  A. Harvey,et al.  (Mis)perception of sleep in insomnia: a puzzle and a resolution. , 2012, Psychological bulletin.

[34]  D. Giles,et al.  Beta/Gamma EEG activity in patients with primary and secondary insomnia and good sleeper controls. , 2001, Sleep.

[35]  A. Harvey,et al.  Time Estimation Ability and Distorted Perception of Sleep in Insomnia , 2005, Behavioral sleep medicine.

[36]  J. Ellenbogen,et al.  The subjective–objective mismatch in sleep perception among those with insomnia and sleep apnea , 2013, Journal of sleep research.

[37]  D. Schacter,et al.  The cognitive neuroscience of constructive memory. , 1998, Annual review of psychology.

[38]  K. Sher,et al.  Effects of induced mood on diagnostic interviewing: Evidence for a mood and memory effect , 1993 .

[39]  P. Lovibond,et al.  Manual for the Depression Anxiety Stress Scales. 2 , 1995 .

[40]  B. Feige,et al.  Sleep-related arousal versus general cognitive arousal in primary insomnia. , 2012, Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine.

[41]  E. Huntley,et al.  Subjectively and objectively measured sleep with and without posttraumatic stress disorder and trauma exposure. , 2012, Sleep.

[42]  Daniel J Buysse,et al.  The Pittsburgh sleep quality index: A new instrument for psychiatric practice and research , 1989, Psychiatry Research.

[43]  R. Bootzin,et al.  Psychophysiological insomnia: the behavioural model and a neurocognitive perspective , 1997, Journal of sleep research.

[44]  Rachel Pemberton,et al.  Factors contributing to depressive mood states in everyday life: A systematic review. , 2016, Journal of affective disorders.

[45]  Daniel J Buysse,et al.  The consensus sleep diary: standardizing prospective sleep self-monitoring. , 2012, Sleep.

[46]  A. Sadeh The role and validity of actigraphy in sleep medicine: an update. , 2011, Sleep medicine reviews.

[47]  R. Bootzin,et al.  Subjective and psychophysiologic insomnia: An examination of sleep tendency and personality , 1997, Biological Psychiatry.

[48]  A. Harvey,et al.  Effects of cognitive arousal and physiological arousal on sleep perception. , 2004, Sleep.

[49]  R. J. Sullivan,et al.  Insomnia and the eye of the beholder: are there clinical markers of objective sleep disturbances among adults with and without insomnia complaints? , 2000, Journal of consulting and clinical psychology.

[50]  John Trinder,et al.  Beyond the mean: A systematic review on the correlates of daily intraindividual variability of sleep/wake patterns. , 2016, Sleep medicine reviews.

[51]  Daniel J Buysse,et al.  Subjective–objective sleep discrepancy among older adults: associations with insomnia diagnosis and insomnia treatment , 2015, Journal of sleep research.

[52]  D. Kay,et al.  Sleep discrepancy, sleep complaint, and poor sleep among older adults. , 2013, The journals of gerontology. Series B, Psychological sciences and social sciences.

[53]  T. Coates,et al.  Estimating sleep parameters: a multitrait--multimethod analysis. , 1982, Journal of consulting and clinical psychology.

[54]  J. Edinger,et al.  The distribution and clinical significance of sleep time misperceptions among insomniacs. , 1995, Sleep.

[55]  D. Kay,et al.  Greater Night-to-Night Variability in Sleep Discrepancy Among Older Adults with a Sleep Complaint Compared to Noncomplaining Older Adults , 2013, Behavioral sleep medicine.

[56]  D. Dijk,et al.  British Association for Psychopharmacology consensus statement on evidence-based treatment of insomnia, parasomnias and circadian rhythm disorders , 2010, Journal of psychopharmacology.

[57]  Bonnet Mh,et al.  Physiological activation in patients with Sleep State Misperception. , 1997 .

[58]  M. Lévesque Perception , 1986, The Yale Journal of Biology and Medicine.

[59]  D. Schacter,et al.  The cognitive neuroscience of constructive memory: remembering the past and imagining the future , 2007, Philosophical Transactions of the Royal Society B: Biological Sciences.

[60]  C. Coffman,et al.  Dose-response effects of cognitive-behavioral insomnia therapy: a randomized clinical trial. , 2007, Sleep.

[61]  C. Espie,et al.  Initial Insomnia And Paradoxical Intention: An Experimental Investigation Of Putative Mechanisms Using Subjective And Actigraphic Measurement Of Sleep , 2002, Behavioural and Cognitive Psychotherapy.

[62]  Pan Zhi-zhong The distribution and clinical significance of lymph node demonstrated by colorectal carcinoma with solitary lymph node metastasis , 2005 .

[63]  K. Stechuchak,et al.  Cognitive behavioral therapy for patients with primary insomnia or insomnia associated predominantly with mixed psychiatric disorders: a randomized clinical trial. , 2009, Sleep.

[64]  Catherine S. Fichten,et al.  Time Estimation in Good and Poor Sleepers , 2005, Journal of Behavioral Medicine.

[65]  S. Linton,et al.  The course of insomnia over one year: a longitudinal study in the general population in Sweden. , 2008, Sleep.

[66]  T. Suppes,et al.  Comparison of objective and subjective assessments of sleep time in subjects with bipolar disorder. , 2013, Journal of affective disorders.

[67]  L. Ferini-Strambi,et al.  Measuring the error in sleep estimation in normal subjects and in patients with insomnia , 2010, Journal of sleep research.

[68]  C. Espie,et al.  Towards a valid, reliable measure of sleep effort , 2005, Journal of sleep research.

[69]  S. Kyle,et al.  Insomnia and health-related quality of life. , 2010, Sleep medicine reviews.

[70]  Jason G. Craggs,et al.  Sleep and affect in older adults: using multilevel modeling to examine daily associations , 2008, Journal of sleep research.

[71]  Wei Wang,et al.  Comparison of subjective and objective assessments of sleep in healthy older subjects without sleep complaints , 2009, Journal of sleep research.

[72]  B. Feige,et al.  Does REM sleep contribute to subjective wake time in primary insomnia? A comparison of polysomnographic and subjective sleep in 100 patients , 2008, Journal of sleep research.

[73]  M H Bonnet,et al.  Physiological Activation in Patients With Sleep State Misperception , 1997, Psychosomatic medicine.

[74]  C. Espie,et al.  Development and preliminary validation of the Glasgow Content of Thoughts Inventory (GCTI): a new measure for the assessment of pre-sleep cognitive activity. , 2004, The British journal of clinical psychology.

[75]  L. C. Ward,et al.  Sleep Education for Paradoxical Insomnia , 2011, Behavioral sleep medicine.

[76]  Charles M. Morin,et al.  Insomnia: Psychological Assessment and Management , 1993 .

[77]  Daniel J Buysse,et al.  Intra-individual variability in sleep duration and fragmentation: Associations with stress , 2009, Psychoneuroendocrinology.

[78]  S. Kyle,et al.  Subjective but Not Actigraphy-Defined Sleep Predicts Next-Day Fatigue in Chronic Fatigue Syndrome: A Prospective Daily Diary Study. , 2016, Sleep.

[79]  V S Rotenberg,et al.  The relationship between subjective sleep estimation and objective sleep variables in depressed patients. , 2000, International journal of psychophysiology : official journal of the International Organization of Psychophysiology.

[80]  A. Harvey,et al.  Sleeping with the enemy: clock monitoring in the maintenance of insomnia. , 2007, Journal of behavior therapy and experimental psychiatry.

[81]  J. Henry,et al.  The short-form version of the Depression Anxiety Stress Scales (DASS-21): construct validity and normative data in a large non-clinical sample. , 2005, The British journal of clinical psychology.

[82]  C. Morin,et al.  Epidemiology of insomnia: prevalence, self-help treatments, consultations, and determinants of help-seeking behaviors. , 2006, Sleep medicine.

[83]  C. Morin,et al.  Subjective and objective measures of insomnia in the context of traumatic brain injury: a preliminary study. , 2006, Sleep medicine.

[84]  A. Harvey,et al.  Altering misperception of sleep in insomnia: behavioral experiment versus verbal feedback. , 2006, Journal of consulting and clinical psychology.

[85]  J. Trinder,et al.  The effect of arousals during sleep onset on estimates of sleep onset latency , 2000, Journal of sleep research.

[86]  P. Nicassio,et al.  The phenomenology of the pre-sleep state: the development of the pre-sleep arousal scale. , 1985, Behaviour research and therapy.

[87]  C. Vázquez,et al.  Mood-congruent recall of affectively toned stimuli: A meta-analytic review , 1992 .

[88]  B. Rybarczyk,et al.  The discrepancy between subjective and objective measures of sleep in older adults receiving CBT for comorbid insomnia , 2018 .

[89]  Andrea Grassi,et al.  Paradoxical insomnia: the role of CAP and arousals in sleep misperception. , 2009, Sleep medicine.

[90]  J. Edinger,et al.  Accuracy of sleep perceptions among insomnia sufferers and normal sleepers. , 2003, Sleep medicine.

[91]  W. Mendelson,et al.  Sleep latency and duration estimates among sleep disorder patients: variability as a function of sleep disorder diagnosis, sleep history, and psychological characteristics. , 2000, Sleep.