Insomnia Severity and Degree of Dysfunction: What Is to Be Learned When These Domains are Discordant?

Abstract

ABSTRACT Objective/Background Illness severity and resultant dysfunction are often linearly related and tightly coupled (concordant). Some percentage of individuals, however, exhibit discordant associations (high illness severity and low dysfunction [HL] or low illness severity and high dysfunction [LH]). In the present study, a sample of subjects with insomnia complaints were evaluated to determine what percentage of subjects exhibited discordant associations. Participants Archival data were drawn from a community-based sample (n = 4,680; 61.8% female; Ages 18–105). Methods Median splits were calculated for illness severity and daytime dysfunction and each individual was typed as High (H) or Low (L) for the concordant (HH and LL) and discordant domains (HL and LH). Results Given this typology, 61% were classified as concordant and 39% were classified as discordant. Of these, 38% were sub-typed as HH, 23% as LL, 26% as LH, and 13% as HL. Conclusions We propose that some of the discordance may be ascribable to a mismatch between sleep need and sleep ability. Those “who need a lot, may suffer a lot, in the face of only a little (LH)”, whereas those “who need a little, may suffer only a little, in the face of a lot (HL)”.