Sleep-wake misperception. A comprehensive analysis of a large sleep lab cohort

Valko, Philipp O.; Hunziker, Schirin; Graf, K.; Werth, Esther; Baumann, Christian R.

doi:10.1016/j.sleep.2021.10.023

Cited by 21 publications

(18 citation statements)

References 29 publications

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“…Although the first study showed the impact of Parkinson's disease on the awareness of sleep onset (89), the second showed that misperception of sleep onset during the test was related to the risk of sleepiness-related road accidents (90). Finally, a recent study (91) investigating the relationship between PSG-measured sleep times and their self-reports found a significant influence of the type of sleep-wake disorder on the type of misperception (i.e. under-or over-perception) of total sleep time.…”

Section: New Sleepiness Assessment Tools and Path Dependencementioning

confidence: 99%

Sleepiness in adults: An umbrella review of a complex construct

Martin¹,

Lopez²,

Dauvilliers³

et al. 2023

Sleep Medicine Reviews

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Section: New Sleepiness Assessment Tools and Path Dependencementioning

confidence: 99%

Sleepiness in adults: An umbrella review of a complex construct

Martin¹,

Lopez²,

Dauvilliers³

et al. 2023

Sleep Medicine Reviews

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“…A large sleep lab cohort study revealed that a most patients with sleep-wake disorders tended to overestimate their SOL and to underestimate WASO. 55 Objective, but not self-reported, measures are associated with prominent pathophysiological effects, such as an increased risk of hypertension. 56 A prior work revealed that subjective WASO was significantly greater than objective WASO and that subjective and objective measures of sleep-maintenance disturbances were positively correlated.…”

Section: Discussionmentioning

confidence: 99%

Effect of low-frequency repetitive transcranial magnetic stimulation as adjunctive treatment for insomnia patients under hypnotics: A randomized, double-blind, sham-controlled study

Lin

Chen

Liou

et al. 2023

Journal of the Chinese Medical Association

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Background: Pharmacotherapy of insomnia is prescribed often but may be complicated by drug dependence. Cognitivebehavioral therapy for insomnia is effective, but requires time to take effect. Repetitive transcranial magnetic stimulation (rTMS) is effective for depression but of uncertain benefit for insomnia. We studied low-frequency rTMS of the left dorsal medial prefrontal cortex (DMPFC) as an adjunctive therapy of insomnia. Methods: We recruited 60 patients with insomnia, of whom 49 completed the study. We applied 1 Hz rTMS to the DMPFC in the experimental group (n = 36) and sham coil for the placebo group (n = 13). Outcome measures included objective polysomnography (PSG) and subjective Pittsburgh Sleep Quality Index (PSQI). All participants were requested to continue prescribed pharmacotherapy.Results: After 10 sessions of low-frequency DMPFC-rTMS, the experimental group demonstrated a reduction of duration of wake after sleep onset (WASO) from 75.4 (±53.3) to 51.2 (±75.1) min (p = 0.011). Sleep efficiency (SE) increased from 74.6% (±15.6) to 80.8% (±13.8) (p = 0.004). The sham group experienced improved SE from 79.4% (±30.7) to 88.9% (±5.6) (p = 0.039). After controlling for baseline PSG parameters and hypnotic dosage, the sham group exhibited better effects of sleep onset latency and SE than the rTMS group but no difference on PSQI. Conclusion: Although the effects of rTMS and sham coil on insomnia were similar (which implied significant placebo effect), low-frequency DMPFC-rTMS might offer a safe, non-invasive, and useful adjunctive therapy of insomnia by reducing WASO. The DMPFC may represent a new target for future rTMS insomnia studies.

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“…Among the studies that have directly compared SOSD in patients with insomnia to good sleepers, most have shown a greater underestimation of TST in the patients with insomnia compared to good sleepers (Fernandez‐Mendoza et al, 2011; Lecci et al, 2020; Li et al, 2022; Manconi et al, 2010); while one publication has shown a comparable absence of underestimation in both populations (Ma et al, 2021). Across studies, patients with insomnia overestimated the time it took them to fall asleep between 7 and 95 min (Kay et al, 2015; Kay et al, 2017; Lee et al, 2021; Lovato et al, 2021; Ma et al, 2021; Valko et al, 2021), exceeding their objective SOL by 163% on average (Valko et al, 2021) and representing up to 416% of their objective SOL (Lecci et al, 2020). This overestimation of SOL was greater in patients with insomnia than in good sleepers in two studies (Kay et al, 2015; Kay et al, 2017) and comparable to good sleepers in two others (Lecci et al, 2020; Ma et al, 2021).…”

Section: Methodsmentioning

confidence: 99%

“…This overestimation of SOL was greater in patients with insomnia than in good sleepers in two studies (Kay et al, 2015; Kay et al, 2017) and comparable to good sleepers in two others (Lecci et al, 2020; Ma et al, 2021). Perceived WASO in insomnia has been reported to exceed objective WASO by up to +95 min (Kay et al, 2015; Lovato et al, 2021; Valko et al, 2021) or +38% (Valko et al, 2021) and to represent ~362% of their objective WASO (Lecci et al, 2020). In the only two publications comparing them to a control group, overestimation of WASO was greater in patients with insomnia (Kay et al, 2015; Lecci et al, 2020).…”

Section: Methodsmentioning

confidence: 99%

“…Studies using serial awakening paradigms (Bianchi et al, 2013; Bonnet & Moore, 1982; Lecci et al, 2020; Valko et al, 2021) showed that both the ‘delayed’ perception of sleep onset and the propensity to feel awake during the rest of the night seen in good sleepers was accentuated in patients with insomnia (Borkovec et al, 1981; Rechtschaffen & Monroe, 1969). When awakened 5 min after N2 onset, between 88% and 96% of patients with insomnia felt awake during the night and 68% during a nap; all proportions were significantly greater than in the good sleeper control group (Borkovec et al, 1981; Yang et al, 2010).…”

Section: Methodsmentioning

confidence: 99%

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Reconsidering sleep perception in insomnia: from misperception to mismeasurement

Stephan,

Siclari

2023

Journal of Sleep Research

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SummarySo‐called ‘sleep misperception’ refers to a phenomenon in which individuals have the impression of sleeping little or not at all despite normal objective measures of sleep. It is unknown whether this subjective–objective mismatch truly reflects an abnormal perception of sleep, or whether it results from the inability of standard sleep recording techniques to capture ‘wake‐like’ brain activity patterns that could account for feeling awake during sleep. Here, we systematically reviewed studies reporting sleep macro‐ and microstructural, metabolic, and mental correlates of sleep (mis)perception. Our findings suggest that most individuals tend to accurately estimate their sleep duration measured with polysomnography (PSG). In good sleepers, feeling awake during sleep is the rule at sleep onset, remains frequent in the first non‐rapid eye movement sleep cycle and almost never occurs in rapid eye movement (REM) sleep. In contrast, there are patients with insomnia who consistently underestimate their sleep duration, regardless of how long they sleep. Unlike good sleepers, they continue to feel awake after the first sleep cycle and importantly, during REM sleep. Their mental activity during sleep is also more thought‐like. Initial studies based on standard PSG parameters largely failed to show consistent differences in sleep macrostructure between these patients and controls. However, recent studies assessing sleep with more refined techniques have revealed that these patients show metabolic and microstructural electroencephalography changes that likely reflect a shift towards greater cortical activation during sleep and correlate with feeling awake. We discuss the significance of these correlates and conclude with open questions and possible ways to address them.

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Sleep-wake misperception. A comprehensive analysis of a large sleep lab cohort

Cited by 21 publications

References 29 publications

Sleepiness in adults: An umbrella review of a complex construct

Sleepiness in adults: An umbrella review of a complex construct

Effect of low-frequency repetitive transcranial magnetic stimulation as adjunctive treatment for insomnia patients under hypnotics: A randomized, double-blind, sham-controlled study

Reconsidering sleep perception in insomnia: from misperception to mismeasurement

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