Abstract
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.
Highlights
Insomnia disorder is characterised by persistent difficulties with the initiation and/or maintenance of sleep, leading to daytime impairment [1,2]
We focused on discrepancies in total sleep time (TST) and sleep onset latency (SOL) because the subjective/objective discrepancy has been demonstrated more robustly in these indices
With regards to SOLd, the univariate analyses identified sleep effort as the only significant predictor. These findings suggest that cognitive arousal is associated with subjective/objective discrepancy in TST
Summary
Insomnia disorder is characterised by persistent difficulties with the initiation and/or maintenance of sleep, leading to daytime impairment [1,2]. Epidemiological studies have shown that approximately one in ten people meet the criteria for insomnia disorder [3,4]. A diagnosis of insomnia disorder is typically based on self-reported symptoms alone. Numerous studies have demonstrated a mismatch between subjective reports and objective estimates of sleep in people with insomnia [11]. Many individuals with a diagnosis of insomnia disorder do not demonstrate sleep abnormalities according to objective assessments such as Polysomnography (PSG). Where objective measures do corroborate abnormalities in sleep, it is often not to the extent that the subjective report suggests [12,13,14,15,16]. There is debate in the field as to whether the subjective/objective mismatch represents a distinct subtype of insomnia
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