The subjective–objective mismatch in sleep perception among those with insomnia and sleep apnea

MedicalResearch.com Interview with
Matt T. Bianchi MD PhD MMSc Assistant Professor Department of Neurology Director, Sleep Division Massachusetts General Hospital Matt T. Bianchi MD PhD MMSc
Assistant Professor
Department of Neurology
Director, Sleep Division
Massachusetts General Hospital

MedicalResearch.com: What are the main findings of the study?

Dr. Bianchi: We showed that patients reporting symptoms of insomnia tend to under-estimate the amount of time they slept during overnight sleep testing in our clinical sleep laboratory.

MedicalResearch.com: Were any of the findings unexpected?

Dr. Bianchi: It has been known for decades that many patients with insomnia exhibit so-called “misperception” of sleep: that is, they feel awake despite objective evidence by electro-encephalogram that they are in fact asleep. What was surprising in our study was that this tendency was not related to the quality of sleep. We expected that patients with very light or interrupted sleep would tend to show this misperception, but this was not the case.

MedicalResearch.com: What should clinicians and patients take away from your report?

Dr. Bianchi: There is much to be learned about sleep misperception. Knowing whether we are awake or asleep during the night seems so natural and obvious that few patients (or clinicians) might question the reliability of that subjective sense.

However, misperception turns out to be common, and difficult to predict (there were in fact no predictors found in our study, despite extensive efforts). Where a patient with insomnia stands on the spectrum of (mis)perception of their own sleep is an important component of assessing the risk-benefit balance when it comes to insomnia drug therapy for example. Some patients may be reassured to know they are sleeping better than they think.

MedicalResearch.com: What recommendations do you have for future research as a result of this study?

Dr. Bianchi: There is an urgent need to understand misperception, and how this common finding impacts individual medical decisions (for example, about the need for medication for sleep). Also, much of what is written in the epidemiology literature is based on self-reported sleep durations – our study adds to the growing evidence that self-reported sleep durations may not match with objective data. Currently, in an epidemiology study linking short sleep durations to adverse health outcomes, the group who reports sleeping less than, say, 6 hours per night consists of individuals who have objectively short sleep, and those who have longer sleep but perceive it to be less. These subgroups should be teased apart in future studies, to improve our understanding of sleep-duration correlations in the literature.

Citation:

The subjective–objective mismatch in sleep perception among those with insomnia and sleep apnea

Bianchi MT, Williams KL, McKinney S, Ellenbogen JM.

Sleep Division, Neurology Department, Massachusetts General Hospital, Boston, MA, USA; Division of Sleep Medicine, Harvard Medical School, Boston, MA, USA.

J Sleep Res. 2013 Mar 25. doi: 10.1111/jsr.12046.