The Discrepancy between Subjective and Objective Measures of Sleep in Older Adults Receiving CBT for Comorbid Insomnia

Abstract

This is the first CBT-I outcome study to analyze discrepancy changes and demonstrate that these changes account for a significant portion of self-report outcome. In addition, improved sleep quality as measured by a decrease in percentage of stage N1 sleep following treatment may be one mechanism that explains why sleep estimation is more accurate following CBT-I.

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

“…In the total sample, transformations did not normalize distributions for STAI, MMSE, and all SOL and WASO variables. Extreme values in SOL and WASO variables were visually determined to be within the range of natural fluctuations relative to previous studies in older adults (Lund et al 2012; Kay et al, 2013). Where appropriate, non-parametric tests were used.…”

“…One study in a small sample of older adults with insomnia reported that behavioral interventions improved both actigraphy and sleep diary WASO but these changes (subjective and objective) did not correlate within individuals (e.g., Brooks et al 1993). A more recent study in older adults with insomnia (OAI) showed CBTI significantly decreased negative sleep discrepancy (PSG vs. sleep diary) in SOL but not WASO or TST (Lund et al 2012). More importantly, pre- to post-treatment changes in sleep discrepancy mediated the association between stage N1 sleep changes and sleep efficiency (SE=percent of time in bed spent sleeping) improvements (Lund et al 2012).…”

“…A more recent study in older adults with insomnia (OAI) showed CBTI significantly decreased negative sleep discrepancy (PSG vs. sleep diary) in SOL but not WASO or TST (Lund et al 2012). More importantly, pre- to post-treatment changes in sleep discrepancy mediated the association between stage N1 sleep changes and sleep efficiency (SE=percent of time in bed spent sleeping) improvements (Lund et al 2012). These studies suggest negative sleep discrepancy may be modifiable via CBTI and may be related to improvement in insomnia severity.…”

Effects of the Integrative Mind-Body Intervention on Depression, Sleep Disturbances and Plasma IL-6

“…Moreover, insomnia symptoms were collected mainly via subjective reports. Future studies may supplement subjective reports with objective measures, including actigraphy and polysomnography [10]. Currently, there is not sufficient empirical support for the causal direction of the relationships among sleep, mood, and IL-6 [2,3].…”

The Prevalence of Sleep Disturbance in Alcoholics Admitted for Treatment

“…2 Health promotion strategies in an addiction recovery model should address quality-of-life enhancements for individuals and their families including optimizing sleep through sustained recovery. Examples of such strategies include cognitive-behavioral therapy for insomnia (CBT-I), which targets behaviors, cognitions, and associations that negatively affect sleep, 3 and is the most common and well-accepted nonpharmacologic treatment of insomnia. CBT-I has been tested on alcohol-dependent populations and has demonstrated improvements in general sleep quality, 4 sleep efficiency, 5–9 wake after sleep onset (WASO), 7,8 and general fatigue.…”