Subjective–objective sleep discrepancy among older adults: associations with insomnia diagnosis and insomnia treatment

Abstract

SUMMARY Discrepancy between subjective and objective measures of sleep is associated with insomnia and increasing age. Cognitive behavioral therapy for insomnia improves sleep quality and decreases subjective-objective sleep discrepancy. This study describes differences between older adults with insomnia and controls in sleep discrepancy, and tests the hypothesis that reduced sleep discrepancy following cognitive behavioral therapy for insomnia correlates with the magnitude of symptom improvement reported by older adults with insomnia. Participants were 63 adults >60 years of age with insomnia, and 51 controls. At baseline, participants completed sleep diaries for 7 days while wearing wrist actigraphs. After receiving cognitive behavioral therapy for insomnia, insomnia patients repeated this sleep assessment. Sleep discrepancy variables were calculated by subtracting actigraphic sleep onset latency and wake after sleep onset from respective self-reported estimates, pre- and post-treatment. Mean level and night-to-night variability in sleep discrepancy were investigated. Baseline sleep discrepancies were compared between groups. Pre- to post-treatment changes in Insomnia Severity Index score and sleep discrepancy variables were investigated within older adults with insomnia. Sleep discrepancy was significantly greater and more variable across nights in older adults with insomnia than controls, p ≤.001 for all. Treatment with cognitive behavioral therapy for insomnia was associated with significant reduction in Insomnia Severity Index score that correlated with changes in mean level and night-to-night variability in wake after sleep onset discrepancy, p <.001 for all. Study of sleep discrepancy patterns may guide more targeted treatments for late-life insomnia.

Subjective insomnia is associated with low sleep efficiency and fatigue in middle-aged women

“…In line with previous studies that documented the discrepancy between subjective insomnia and objective sleep state assessments 28,29 , our results similarly revealed that objective sleep states including total sleep time, day-to-day variation in sleep time, episodes of nocturnal awakening, and sleep latency were not associated with subjective insomnia in middle-aged women. However, in the present study, we found that low sleep efficiency was one of the two factors that independently affect subjective insomnia.…”

“…Polysomnography provides information on body and brain functions during sleep based on electroencephalography, electromyography, and electrocardiography. Due to the documented discrepancy between subjective and objective sleep parameters 28,29 , it is preferable to assess both subjective and objective sleep measures to study sleep disturbances in detail.…”

Hyperarousal and Beyond: New Insights to the Pathophysiology of Insomnia Disorder through Functional Neuroimaging Studies

“…Because both approaches result in decreased total sleep time, they appear to primarily promote sleep drive in these patients. In terms of conscious awareness, there is evidence that CBTI reduces subjective-objective sleep discrepancy following treatment [109]. It is possible that CBTI works to suppress conscious awareness during sleep by enhancing sleep drive, thereby reducing sleep discrepancy.…”

Predictors of Nightly Subjective-Objective Sleep Discrepancy in Poor Sleepers over a Seven-Day Period

“…The discrepancy between subjective reports and objective estimates has been demonstrated in a variety of indices of sleep, including total sleep time (TST) [12,13,14,26], sleep onset latency (SOL) [13,24,27,28,29], wake-time after sleep onset (WASO) [24,28,29], and sleep efficiency (SE) [26,30]. Discrepancy occurs in primary insomnia and also in patient groups where insomnia is comorbid with other health or psychiatric conditions [31,32,33,34,35,36].…”

“…The tendency for people with insomnia to underestimate objective sleep has been conceptualised in several ways; (i) as an exaggeration of sleep difficulties, perhaps due to more general psychological characteristics and personality traits [19,27]; (ii) as a meaningful phenomenon which reflects a localised sleep disturbance with candidate physiological markers [20,28]; and (iii) as a cognitive distortion which contributes to the maintenance and escalation of insomnia [37]. According to Harvey’s Cognitive Model (2002), those who underestimate their sleep may be more at risk of developing objective sleep deficits due to increased preoccupation with sleep and increased sleep related anxiety and arousal, which is antithetical to optimal sleep onset and maintenance [37].…”