Sleep misperception and chronic insomnia in the general population: role of objective sleep duration and psychological profiles

Abstract

Objective: To examine the role of objective sleep duration, a novel marker in phenotyping insomnia, and psychological profiles on sleep misperception in a large, general population sample. Sleep misperception is considered by some investigators a common characteristic of chronic insomnia, whereas others propose it as a separate diagnosis. The frequency and the determinants of sleep misperception in general population samples are unknown.

Methods: A total of 142 insomniacs and 724 controls selected from a general random sample of 1,741 individuals (aged ≥20 years) underwent a polysomnographic evaluation, completed the Minnesota Multiphasic Personality Inventory-2, and were split into two groups based on their objective sleep duration: "normal sleep duration" (≥6 hours) and "short sleep duration" (<6 hours).

Results: The discrepancy between subjective and objective sleep duration was determined by two independent factors. Short sleepers reported more sleep than they objectively had, and insomniacs reported less sleep than controls with similar objective sleep duration. The additive effect of these two factors resulted in underestimation only in insomniacs with normal sleep duration. Insomniacs with normal sleep duration showed a Minnesota Multiphasic Personality Inventory-2 profile of high depression and anxiety and low ego strength, whereas insomniacs with short sleep duration showed a profile of a medical disorder.

Conclusions: Underestimation of sleep duration is prevalent among insomniacs with objective normal sleep duration. Anxious-ruminative traits and poor resources for coping with stress seem to mediate the underestimation of sleep duration. These data further support the validity and clinical utility of objective sleep measures in phenotyping insomnia.

Figure 1. Effects of insomnia and objective sleep duration on discrepancy in next-morning sleep duration

Line plot illustrating the absence of a significant interaction effect between insomnia and objective sleep duration on the discrepancy between objective sleep duration and next-morning subjective sleep duration. The additive effect of these two factors resulted in underestimation only in insomniacs with normal sleep duration. All data are adjusted for age, race, sex, education, BMI, SDB, physical health, and mental health. Error bars represent standard error of the mean (SEM).

Figure 2. Effects of insomnia and objective sleep duration on selected MMPI-2 clinical and research scales

Line plot illustrating significant interaction effects between insomnia and objective sleep duration on 7-psychasthenia, anxiety and ego strength scales (left panel), and the absence of interaction effects on the other 3 most elevated clinical scales, i.e., 1-hypochondriasis, 2-depression, and 3-hysteria, (right panel). All data are adjusted for age, race, sex, education, BMI, SDB, physical health, and mental health. Error bars represent standard error of the mean (SEM).