Accuracy of sleep perceptions among insomnia sufferers and normal sleepers

Duke University, Durham, North Carolina, United States
Sleep Medicine (Impact Factor: 3.15). 08/2003; 4(4):285-96. DOI: 10.1016/S1389-9457(03)00057-1
Source: PubMed


To examine the distribution, consistency, and correlates of sleep time perceptions in primary insomnia sufferers and normal sleepers across settings (laboratory and home).
Fifty-two middle-aged and older insomnia sufferers and 49 matched normal sleepers underwent multiple nights of laboratory and home polysomnography (PSG) and provided concurrent subjective estimates of their sleep. Descriptive statistics, cluster analyses, and inferential tests were used to examine the nature of sleep time perceptions, identify subgroups with distinctive patterns such as perceptions, and explore factors that may contribute to these subgroups' distinctive sleep perceptions.
Consistent with previous studies, the insomnia sufferers, as a group, showed a greater tendency to underestimate the time they slept than did the normal sleepers, but the accuracy of sleep time perceptions varied widely within each sample. Correlational analyses showed that study participants in each sample showed a moderate level of consistency in how accurately they estimated sleep time across nights. Subsequent cluster analyses conducted to identify subgroups with distinctive patterns of sleep time perceptions yielded four subgroups within the insomnia sample and three subgroups within the normal sleeper sample. Although the sleep setting significantly affected sleep perceptions for one insomnia subgroup, both laboratory and home objective-subjective sleep comparisons provided similar impressions regarding the relative accuracy of each subgroup's nocturnal sleep/wake perceptions. Finally, varying patterns of subgroup differences were noted across several common psychometric measures.
The underestimation of sleep time is not a generic characteristic that separates all insomnia sufferers from normal sleepers. Sleep setting, personality traits, and perhaps constitutional factors appear to influence perceptions of sleep and wake time duration.

10 Reads
    • "Compared with previous older cohorts, some factors could have resulted in less napping in contemporary seniors, such as later retirement age, more physically and socially active lifestyles, and greater rates of residence in senior living facilities. Nonetheless, the present review is the first to explore historical patterns of objective sleep duration, which has long been regarded as the gold standard for defining sleep duration [18]. Further, the findings have several implications. "
    [Show abstract] [Hide abstract]
    ABSTRACT: The common assumption that population sleep duration has declined in the past few decades has not been supported by recent reviews, which have been limited to self-reported data. The aim of this review was to assess whether there has been a reduction in objectively recorded sleep duration over the last 50+ years. The literature was searched for studies published from 1960 to 2013, which assessed objective sleep duration (total sleep time (TST)) in healthy normal-sleeping adults. The search found 168 studies that met inclusion criteria, with 257 data points representing 6052 individuals ages 18-88 y. Data were assessed by comparing the regression lines of age vs. TST in studies conducted between 1960 and 1989 vs. 1990-2013. Weighted regression analyses assessed the association of year of study with age-adjusted TST across all data points. Regression analyses also assessed the association of year of study with TST separately for 10-y age categories (e.g., ages 18-27 y), and separately for polysomnographic and actigraphic data, and for studies involving a fixed sleep schedule and participants' customary sleep schedules. Analyses revealed no significant association of sleep duration with study year. The results are consistent with recent reviews of subjective data, which have challenged the notion of a modern epidemic of insufficient sleep.
    No preview · Article · Aug 2015 · Sleep Medicine Reviews
  • Source
    • "A recent meta-analysis of PSG studies has demonstrated that primary insomnia (PI) is characterized by a pattern of mildly to moderately increased sleep onset latency (SOL), reduced total sleep time (TST), an increased number of awakenings and time awake and a reduced proportion of slow wave sleep (SWS) and rapid eye movement (REM) sleep (Baglioni et al., 2014a,b). However, patients with PI have been found to overestimate their SOL and wake after sleep onset (WASO) and underestimate their TST (Feige et al., 2008; Manconi et al., 2010; Means et al., 2003; Nofzinger et al., 2006), indicating that subjective sleep complaints and PSG-determined sleep are partially independent measures. To date, it is not sufficiently understood why subjective complaints are associated with marked disruptions of PSG-determined sleep in some patients, whereas PSG parameters are normal in others with comparable subjective complaints (Bianchi et al., 2012; Edinger and Krystal, 2003; Vgontzas et al., 2013). "
    [Show abstract] [Hide abstract]
    ABSTRACT: Differences between subjective sleep perception and sleep determined by polysomnography (PSG) are prevalent, particularly in patients with primary insomnia, indicating that the two measures are partially independent. To identify individualized treatment strategies, it is important to understand the potentially different mechanisms influencing subjective and PSG-determined sleep. The aim of this study was to investigate to what extent three major components of insomnia models, i.e. sleep effort, dysfunctional beliefs and attitudes about sleep, and presleep arousal, are associated with subjective insomnia severity and PSG- determined sleep. A sample of 47 patients with primary insomnia according to DSM-IV criteria and 52 good sleeper controls underwent 2 nights of PSG and completed the Glasgow Sleep Effort Scale, the Dysfunctional Beliefs and Attitudes about Sleep Scale, the Pre-Sleep Arousal Scale and the Insomnia Severity Index. Regression analyses were conducted to investigate the impact of the three predictors on subjective insomnia severity and PSG- determined total sleep time. All analyses were adjusted for age, gender, depressive symptoms and group status. The results showed that subjective insomnia severity was associated positively with sleep effort. PSG-determined total sleep time was associated negatively with somatic presleep arousal and dysfunctional beliefs and attitudes about sleep. This pattern of results provides testable hypotheses for prospective studies on the impact of distinct cognitive and somatic variables on subjective insomnia severity and PSG-determined total sleep time. © 2015 European Sleep Research Society.
    Full-text · Article · Mar 2015 · Journal of Sleep Research
  • Source
    • "Although participants reported worse subjective sleep quality in association with higher stress and somatic arousal on the interindividual level and with higher stress and cognitive arousal on the intraindividual level, this relationship does not seem to apply for actigraphy-assessed sleep data. Still this finding is not necessarily contradictory, as it is well-known that the subjective perception of impaired sleep is not always objectively measurable in actigraphic or PSG sleep data [63] [64] [65] [66]. Further, it might be possible that higher levels of stress and arousal might not yet influence actigraphic sleep measures in a young and healthy sample, but it could still constitute a factor preceding the development of subsequent sleep disturbances [35] [36] [37]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Objective Our study aimed to further elucidate the mediating role of presleep arousal in the relationship between daily stress and sleep by investigating subjective sleep quality and actigraphy-assessed sleep efficiency (SE) on both within- and between-participant levels in a sample of healthy young women. Methods Multilevel modelling was applied on electronically assessed data comprising 14 consecutive nights in 145 healthy young women to assess the relationship between daily stress; presleep (somatic and cognitive) arousal; and sleep on both levels, between participants and within participants across days. Results Higher levels of daily stress were consistently and significantly associated with higher levels of somatic and cognitive arousal. Somatic arousal mediated the relationship between daily stress and worsened subjective sleep quality on the between-participant level, while cognitive arousal mediated the relationship between daily stress and worsened subjective sleep quality on the within-participants level. Unexpectedly, healthy young women showed higher SE following days with above average stress with somatic arousal mediating this relationship. Conclusions Our data corroborate the role of presleep arousal mediating the relationship between daily stress and subjective sleep quality. Interestingly this effect was restricted to somatic arousal being relevant on interindividual levels and cognitive arousal on intraindividual levels. For young and healthy individuals who experience high stress and arousal, well-established cognitive-behavioral techniques could be useful to regulate arousal and prevent worse subjective sleep quality.
    Full-text · Article · Mar 2014 · Sleep Medicine
Show more