Light sleep and sleep time misperception – Relationship to alpha–delta sleep

Martinez, Dênis; Breitenbach, Tiago Cataldo; Lenz, Maria do Carmo Sfreddo

doi:10.1016/j.clinph.2010.01.005

Cited by 33 publications

(27 citation statements)

References 29 publications

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“…29,32 Psychological factors such as personality characteristics and mood disorders have been linked to misperception. 9,33,34 Aspects of sleep physiology have been associated with misperception, including hyperarousal, 35 alpha frequency intrusion into slow wave sleep, 11 and the cyclic alternating pattern 12 (but this has not been seen in other work). 36 In addition, in regards to the hyperarousal theory of insomnia, 35 insomnia patients have increased basal metabolic rate and longer sleep latencies during nap studies, among other physiological changes.…”

Section: Perception Of Total Sleep Timementioning

confidence: 99%

“…For example, misperception has been linked with anxiety and mood, 3,8 personality traits, and sleep physiology measures such as electroencephalogram patterns of alpha-delta sleep or cyclic alternating pattern and high frequency electroencephalography (EEG) content. [9][10][11][12][13] In addition, we previously investigated possible relations between sleep architecture and misperception of TST as a means to test the hypothesis that sleep fragmentation is associated with misperception. Using metrics such as The difficulty in linking sleep metrics to misperception could be due to insensitivity of the metrics for capturing the relevant physiology and/or the manner in which misperception is quantified.…”

Section: -7mentioning

confidence: 99%

See 1 more Smart Citation

Sleep Fragmentation Does Not Explain Misperception of Latency or Total Sleep Time

Saline

Goparaju

Bianchi

2016

Journal of Clinical Sleep Medicine

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Study Objectives: Perception of sleep-wake times may differ from objective measures, although the mechanisms remain elusive. Quantifying the misperception phenotype involves two operational challenges: defining objective sleep latency and treating sleep latency and total sleep time as independent factors. We evaluated a novel approach to address these challenges and test the hypothesis that sleep fragmentation underlies misperception. Methods: We performed a retrospective analysis on patients with or without obstructive sleep apnea during overnight diagnostic polysomnography in our laboratory (n = 391; n = 252). We compared subjective and objective sleep-wake durations to characterize misperception. We introduce a new metric, sleep during subjective latency (SDSL), which captures latency misperception without defining objective sleep latency and allows correction for latency misperception when assessing total sleep time (TST) misperception. Results:The stage content of SDSL is related to latency misperception, but in the opposite manner as our hypothesis: those with > 20 minutes of SDSL had less N1%, more N3%, and lower transition frequency. After adjusting for misperceived sleep during subjective sleep latency, TST misperception was greater in those with longer bouts of REM and N2 stages (OSA patients) as well as N3 (non-OSA patients), which also did not support our hypothesis. Conclusions: Despite the advantages of SDSL as a phenotyping tool to overcome operational issues with quantifying misperception, our results argue against the hypothesis that light or fragmented sleep underlies misperception. Further investigation of sleep physiology utilizing alternative methods than that captured by conventional stages may yield additional mechanistic insights into misperception. I NTRO DUCTI O NAssessment of sleep often includes subjective reports of sleepwake durations, in clinical practice as well as epidemiological studies of sleep duration.1 However, when concurrent objective sleep measurements are available, it is not uncommon to observe that the subjective responses may differ. Underestimation of total sleep time has been previously observed in healthy adults under experimental circumstances, as well as insomnia patients during polysomnography (PSG).2-4 This phenomenon, sometimes termed misperception, may manifest as either overestimating sleep latency (SL) or underestimating total sleep time (TST), or both.4 Some patients with obstructive sleep apnea (OSA) may also exhibit misperception, though perhaps not to the same extent as those with insomnia symptoms. 5-7Several hypotheses have arisen regarding the basis for misperception, although a unified explanation remains elusive. For example, misperception has been linked with anxiety and mood, 3,8 personality traits, and sleep physiology measures such as electroencephalogram patterns of alpha-delta sleep or cyclic alternating pattern and high frequency electroencephalography (EEG) content. [9][10][11][12][13] In addition, we previously investigated possible relat...

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Section: Perception Of Total Sleep Timementioning

confidence: 99%

Section: -7mentioning

confidence: 99%

Sleep Fragmentation Does Not Explain Misperception of Latency or Total Sleep Time

Saline

Goparaju

Bianchi

2016

Journal of Clinical Sleep Medicine

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“…Intrusion of alpha activity in non-REM sleep is frequently present in patients with fibromyalgia, chronic fatigue and non-restorative sleep (Anch et al 1991;Branco et al 1994;Moldofsky et al 1975;Olsen et al 2013), arthritis (Mahowald et al 1989), insomnia (Martinez et al 2010;Riedner et al 2016) and depression (Hauri and Hawkins 1973;Jaimchariyatam et al 2011). Although it may be seen in asymptomatic subjects (Scheuler et al 1983;Horne and Shackell 1991), its prevalence and extent are clearly greater in these disorders such that a clinical association is well established.…”

Section: Assessment Of Alpha Intrusion (Alpha-delta Sleep)mentioning

confidence: 99%

The case for using digital EEG analysis in clinical sleep medicine

Younes

2017

Sleep Science Practice

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Evaluation of sleep in clinical polysomnograms continues to rely almost exclusively on visual scoring that implements rules proposed by Rechtschaffen and Kales nearly 50 years ago. Apart from its cost and timeconsuming nature, visual scoring has limitations including: A) Sleep depth, which is a continuous variable, is treated as if it changes in a stepwise fashion from light (stage 1), to intermediate (stage 2) to deep (stage 3). B) Even with this limited scale, there is considerable inter-scorer variability, particularly in scoring stages 1 and 3 of non-REM sleep, thereby adding uncertainty to %time spent in these stages as a reliable metric for evaluating sleep depth. C) Limitation in scoring some of EEG features, including 1) arousal intensity, 2) extent of Alpha intrusion and 3) frequency, and characteristics of sleep spindles and K complexes. Digital analysis can solve these problems but producing a reliable system has been a challenge. In this review I begin with recent advances in digital scoring of sleep according to the Rechtschaffen and Kales rules and conclude that this technology has progressed enough to make it possible to obtain reliable, reproducible scoring, comparable in accuracy to scoring by highly experienced technologists, with minimal editing. This is followed by description of several new metrics that can be obtained if digital scoring systems were to be used routinely in clinical studies. The scientific evidence supporting the potential of these metrics to positively impact sleep medicine practice and the wide range of such metrics in patients studied in the sleep laboratory are highlighted.

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“…For insomnia in general, a number of possible factors have been proposed to account for this difference, including misperception of sleep as wake, worry, brief awakenings, and alpha-delta sleep. 34,36 These explanations likely also apply to individuals with comorbid fibromyalgia, in whom patterns of frequent NREM alpha intrusions and greater sleep fragmentation have been noted.…”

Section: Comparison To Non-fibromyalgia Samplesmentioning

confidence: 99%

Measuring Treatment Outcomes in Comorbid Insomnia and Fibromyalgia: Concordance of Subjective and Objective Assessments

Mundt

Crew

Krietsch

et al. 2016

Journal of Clinical Sleep Medicine

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Study Objectives: In insomnia, actigraphy tends to underestimate wake time compared to diaries and PSG. When chronic pain co-occurs with insomnia, sleep may be more fragmented, including more movement and arousals. However, individuals may not be consciously aware of these arousals. We examined the baseline concordance of diaries, actigraphy, and PSG as well as the ability of each assessment method to detect changes in sleep following cognitive behavioral therapy for insomnia (CBT-I). Methods: Adults with insomnia and fibromyalgia (n = 113) were randomized to CBT-I, CBT for pain, or waitlist control. At baseline and posttreatment, participants completed one night of PSG and two weeks of diaries/actigraphy. Results: At baseline, objective measures estimated lower SOL, higher TST, and higher SE than diaries (ps < 0.05). Compared to PSG, actigraphic estimates were higher for SOL and lower for WASO (ps < 0.05). Repeated measures ANOVAs were conducted for the CBT-I group (n = 15), and significant method by time interactions indicated that the assessment methods differed in their sensitivity to detect treatment-related changes. PSG values did not change significantly for any sleep parameters. However, diaries showed improvements in SOL, WASO, and SE, and actigraphy also detected the WASO and SE improvements (ps < 0.05). Conclusions: Actigraphy was generally more concordant with PSG than with diaries, which are the recommended assessment for diagnosing insomnia. However, actigraphy showed greater sensitivity to treatment-related changes than PSG; PSG failed to detect any improvements, but actigraphy demonstrated changes in WASO and SE, which were also found with diaries. In comorbid insomnia/fibromyalgia, actigraphy may therefore have utility in measuring treatment outcomes. Keywords: insomnia, fibromyalgia, chronic pain, assessment, actigraphy, polysomnography, cognitive behavioral therapy, clinical trial Citation: Mundt JM, Crew EC, Krietsch K, Roth AJ, Vatthauer K, Robinson ME, Staud R, Berry RB, McCrae CS. Measuring treatment outcomes in comorbid insomnia and fibromyalgia: concordance of subjective and objective assessments. J Clin Sleep Med 2016;12(2):215-223. I NTRO DUCTI O NChronic insomnia is a primarily subjective disorder that is defined by self-reported difficulty falling asleep, staying asleep, awakening too early, or experiencing sleep that is routinely non-restorative and accompanied by at least one of many possible daytime impairments (e.g., mood disturbance, daytime sleepiness, fatigue or malaise).1 The high prevalence of chronic insomnia among patients with chronic pain has been well-established, with reported rates of insomnia as high as 88% in this population.2,3 Independently, sleep and pain are known to be associated with a host of negative consequences including decreased quality of life, mood disturbance, impaired quality of social interactions, dependence on medication, and cognitive dysfunction. However, these consequences are often exacerbated in chronic pain patients with comorbid insomnia. [...

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Light sleep and sleep time misperception – Relationship to alpha–delta sleep

Cited by 33 publications

References 29 publications

Sleep Fragmentation Does Not Explain Misperception of Latency or Total Sleep Time

Sleep Fragmentation Does Not Explain Misperception of Latency or Total Sleep Time

The case for using digital EEG analysis in clinical sleep medicine

Measuring Treatment Outcomes in Comorbid Insomnia and Fibromyalgia: Concordance of Subjective and Objective Assessments

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