Changes in Subjective-Objective Sleep Discrepancy Following Inpatient Cognitive Behavior Therapy for Insomnia

Investigating the subjective and objective efficacy of a cognitive behavioural therapy for insomnia (CBT-I)-based smartphone app on sleep: A randomised controlled trial

Due to insufficient treatment options for insomnia, effective solutions are urgently needed. We evaluated the effects of a CBT-I-based app combining sleep training with subjective and objective sleep monitoring on (i) sleep and (ii) subjective-objective sleep discrepancies (SOSD). Fifty-seven volunteers (20-76 years; MAge = 45.67 ± 16.38; 39 female) suffering from sleep problems were randomly assigned to an experimental group (EG, n = 28) or a waitlist control group (CG, n = 29). During the 6-week app phase, the EG used the CBT-I-based programme and a heart rate sensor for daily sleep monitoring and -feedback, while the CG used sleep monitoring only. Sleep was measured (i) subjectively via questionnaires (Insomnia Severity Index, ISI; Pittsburgh Sleep Quality Index, PSQI), (ii) objectively via ambulatory polysomnography (PSG), and (iii) continuously via heart-rate sensor and sleep diaries. Data revealed interactions for ISI (p = 0.003, ƞ2 part = 0.11) and PSQI (p = 0.050, ƞ2 part = 0.05), indicating training-specific improvements in EG, yet not in CG. While PSG-derived outcomes appear to be less training-specific, a tendential reduction in wake after sleep onset (WASO) was found in EG (p = 0.061, d = 0.55). Regarding changes in SOSD, the results indicate improvements during the app phase (EG) for sleep efficiency, sleep onset latency, and WASO (p ≤ 0.022, d ≥ 0.46); for total sleep time both groups showed a SOSD reduction. The findings indicate beneficial effects of a novel smartphone app on sleep and SOSD. More scientific evaluation of such digital programmes is needed to ultimately help in reducing the gap in non-pharmacological insomnia treatment.

First-night effect in insomnia disorder: a systematic review and meta-analysis of polysomnographic findings

Polysomnographic studies have been performed to investigate the first-night effect in insomnia disorder. However, these studies have revealed discrepant findings. This meta-analysis aimed to summarise and quantify the characteristics of the first-night effect in insomnia disorder. We performed a systematic search of the PubMed, Medline, EMBASE, Web of Science and PsycINFO databases to identify studies published through October 2019. A total of 11,862 articles were identified, and seven studies with eight independent populations were included in the meta-analysis. A total of 639 patients with insomnia disorder and 171 healthy controls underwent more than 2 consecutive nights of in-laboratory polysomnography. Pooled results demonstrated that both variables of sleep continuity and sleep architecture, other than slow-wave sleep were significantly altered in the first-night effect in insomnia disorder. Furthermore, the results indicated that patients with insomnia disorder had a disruption of sleep continuity in the first-night effect, including increased sleep onset latency and reduced total sleep time, compared to healthy controls. Overall, the findings show that patients with insomnia disorder experience the first-night effect, rather than reverse first-night effect, and the profiles of the first-night effect in patients with insomnia are different from healthy controls. These indicate that an adaptation night is necessary when sleep continuity and sleep architecture is to be studied in patients with insomnia disorder. More well-designed studies with large samples are needed to confirm the results.

Sleep-wake state discrepancy does not impair the efficacy of cognitive behavioural therapy for insomnia: Findings from a large clinic sample

The current study determined the extent to which sleep-wake state discrepancy impairs the efficacy of cognitive behavioural therapy for insomnia in a real-world clinical sample. Sleep-wake state discrepancy occurs when there is an inconsistency between a person's subjective and objective sleep, and is a common phenomenon amongst patients with insomnia. Limited information is available on the effectiveness of cognitive behavioural therapy for insomnia in treating patients who experience significant sleep-wake state discrepancy in "real-world" samples. In the present study, all patients with insomnia received cognitive behavioural therapy for insomnia through an outpatient insomnia program (N = 386; mean age = 51.96 years, SD = 15.62; 65.97% [N = 254] female). Prior to treatment, participants completed a polysomnography sleep study and sleep diary, which was used to calculate sleep-wake state discrepancy. At pre-treatment, post-treatment and 3-month follow-up, participants completed the Insomnia Severity Index and other questionnaires, and 1 week of sleep diaries from which sleep-onset latency, wake after sleep onset and other sleep variables were calculated. There were no differences in self-reported sleep-onset latency, wake after sleep onset or Insomnia Severity Index scores at post-treatment or 3-month follow-up between quintiles of sleep-wake state discrepancy. These results indicate that sleep-wake state discrepancy at pre-treatment does not predict treatment response to cognitive behavioural therapy for insomnia. Future research could examine multi-night assessments of sleep-wake state discrepancy to determine whether variations in discrepancy may relate to pre-treatment insomnia severity and cognitive behavioural therapy for insomnia outcomes.

Reconsidering sleep perception in insomnia: from misperception to mismeasurement

So-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.

Tailoring cognitive behavioural therapy for insomnia across contexts, conditions, and individuals: What do we know, where do we go?

Cognitive behavioural therapy for insomnia (CBT-I) is considered the front-line treatment for insomnia. Despite the demonstrated effectiveness of CBT-I, it is necessary to consider how CBT-I may be tailored to different individuals. The purpose of the present review is to provide a summary of literature on tailoring CBT-I to different individuals and provide directions for future research. This review focused on the following domains of adaptation: (i) tailoring CBT-I components to individuals with comorbid mental or physical health conditions such as comorbid depression and pain; (ii) adapting CBT-I delivery for different contexts in which individuals exist, such as inpatient, educational, and different social/cultural settings, (iii) adapting CBT-I to specific individuals via case-formulation in clinical settings. We highlight current gaps in the exploration of tailored CBT-I, including a lack of research methodology to evaluate tailored interventions, a need for the integration of ongoing individualised assessment to inform treatment, and the necessary involvement of consumers and stakeholders throughout the research and treatment development process. Together, this review showed abundant adaptations in CBT-I already exist in the literature. Future research is needed in understanding when and how to apply adaptations in CBT-I and evaluate the benefits of these adaptations.

The importance and limitations of polysomnography in insomnia disorder-a critical appraisal

The importance polysomnography (PSG) in the diagnosis and treatment process of insomnia disorder (ID) remains highly disputed. This review summarises the state of the science regarding PSG indications and findings in ID, and the indications to conduct PSG in ID as stated by relevant guidelines. It then highlights the most relevant questions regarding the topic, including the relevance of ID subtyping, to allow an individualised pharmacological or psychotherapeutic treatment approach.

Non-pharmacological interventions for improving sleep in people living with HIV: a systematic narrative review

Background

Sleep disturbances are common in people living with Human Immunodeficiency Virus (HIV) and may lead to poor adherence to antiretroviral therapy and worsen HIV symptom severity. Due to the side effects of pharmacotherapy for sleep disturbances, there is more room for non-pharmacological interventions, but knowledge of how these non-pharmacological interventions have been used to improve sleep in people living with HIV (PLWH) is still missing.

Objective

To investigate the content of non-pharmacological interventions, sleep measurements, and the impact of these interventions on improving sleep in PLWH.

Methods

Following PRISMA guidelines, we conducted a systematic search on PubMed, EMBASE, Cochrane Central Registry of Controlled Trials, Cumulative Index to Nursing and Allied Health Literature, Web of Science, China National Knowledge Infrastructure, Wanfang Data, and China Biology Medicine disc. Non-pharmacological interventions for improving sleep in PLWH were included, and study quality was assessed using the Joanna Briggs Institute (JBI) critical appraisal checklists. We performed a narrative approach to synthesize the data to better understand the details and complexity of the interventions.

Results

Fifteen experimental studies in three categories for improving sleep in PLWH were included finally, including psychological interventions (components of cognitive-behavioral therapy for insomnia or mindfulness-based cognitive therapy, n = 6), physical interventions (auricular plaster therapy, acupuncture, and exercise, n = 8), and elemental interventions (speed of processing training with transcranial direct current stimulation, n = 1). Wrist actigraphy, sleep diary, and self-reported scales were used to measure sleep. Psychological interventions and physical interventions were found to have short-term effects on HIV-related sleep disturbances.

Conclusions

Psychological and physical interventions of non-pharmacological interventions can potentially improve sleep in PLWH, and the combination of patient-reported outcomes and actigraphy devices can help measure sleep comprehensively. Future non-pharmacological interventions need to follow protocols with evidence-based dosing, contents, and measures to ensure their sustainable and significant effects.

On the Efficacy of a CBT-I-Based Online Program for Sleep Problems: A Randomized Controlled Trial

There is an urgent need for easily accessible treatment options for sleep problems to reduce the current treatment gap in receiving cognitive behavioral therapy for insomnia (CBT-I). Using a randomized controlled trial, we evaluated the efficacy of a CBT-I-based online program on sleep. Fifty-three volunteers (21-71 years; MAge = 44.6 ± 12.5; 27 female) suffering from impaired sleep were randomly allocated either to the experimental group (EG, n = 27) or to an active control group (CG, n = 26). The EG participated in a 6-week CBT-I-based online program, while the CG received psychoeducation and sleep hygiene instructions. Sleep was assessed both objectively via ambulatory polysomnography (PSG) as well as subjectively via questionnaires at three time points (baseline, pre- and post-intervention). A one-month follow-up assessment was performed using questionnaires. The EG showed small but reliable improvements from pre- to post-intervention in PSG-derived wake after sleep onset (from 58.6 min to 42.5 min; p < 0.05) and sleep efficiency (from 86.0% to 89.2%; p < 0.05). Furthermore, subjective sleep quality (assessed via Pittsburgh Sleep Quality Index) improved significantly during intervention (p = 0.011) and follow-up (p = 0.015) in the EG alone. The Insomnia Severity Index decreased from pre- to post-intervention in both groups (EG: p = 0.003, CG: p = 0.008), while it further improved during follow-up (p = 0.035) in the EG alone. We show that a CBT-I-based online program can improve sleep not only subjectively but also objectively and can be a viable alternative when face-to-face interventions are not available.

Comparative efficacy of onsite, digital, and other settings for cognitive behavioral therapy for insomnia: a systematic review and network meta-analysis

Given the limited availability and accessibility of onsite cognitive behavioral therapy for insomnia (CBT-I), other CBT-I settings, such as internet-delivered CBT-I (iCBT-I), have been proposed. The primary aim of the study was to compare the efficacy of available CBT-I settings on insomnia severity. A systematic review and frequentist network meta-analysis of available CBT-I settings was performed. PsycINFO, PsycARTICLES, MEDLINE, PubMed, and CINAHL were searched for randomized controlled trials (RCTs) investigating any CBT-I settings in adults with insomnia disorder. The systematic literature search (3851 references) resulted in 52 RCTs. For the primary outcome insomnia severity, all examined CBT-I settings except smartphone-delivered CBT-I yielded significant effects when compared to WL. Large standardized mean differences were found for individual onsite CBT-I (- 1.27;95%CI - 1.70, - 0.84), group-delivered CBT-I (- 1.00;95%CI - 1.42. - 0.59), telehealth (- 1.28;95%CI - 2.06, - 0.50), and guided bibliotherapy (- 0.99;95%CI - 1.67, - 0.32). Both guided iCBT-I (- 0.71;95%CI - 1.18, - 0.24) and unguided iCBT-I (- 0.78;95%CI - 1.18, - 0.38) yielded medium effect sizes. The results underline that health care systems should intensify their efforts to provide synchronously-delivered CBT-I (individual onsite, group-delivered, and telehealth), and particularly individual onsite CBT-I, given its solid evidence base. Medium to large effect sizes for iCBT-I and guided bibliotherapy indicate that self-help settings may be a viable alternative when synchronously-delivered CBT-I is not available.

A low-threshold sleep intervention for improving sleep quality and well-being

BACKGROUND

Approximately one-third of the healthy population suffer from sleep problems, but only a small proportion of those affected receive professional help. Therefore, there is an urgent need for easily accessible, affordable, and efficacious sleep interventions.

OBJECTIVE

A randomized controlled study was conducted to investigate the efficacy of a low-threshold sleep intervention consisting of either (i) sleep data feedback plus sleep education or (ii) sleep data feedback alone in comparison with (iii) no intervention.

MATERIAL AND METHODS

A total of 100 employees of the University of Salzburg (age: 39.51 ± 11.43 years, range: 22-62 years) were randomly assigned to one of the three groups. During the 2-week study period, objective sleep parameters were assessed via actigraphy. In addition, an online questionnaire and a daily digital diary were used to record subjective sleep parameters, work-related factors, as well as mood and well-being. After 1 week, a personal appointment was conducted with participants of both experimental group 1 (EG1) and experimental group 2 (EG2). While the EG2 only received feedback about their sleep data from week 1, the EG1 additionally received a 45-min sleep education intervention containing sleep hygiene rules and recommendations regarding stimulus control. A waiting-list control group (CG) did not receive any feedback until the end of the study.

RESULTS

Results indicate positive effects on sleep and well-being following sleep monitoring over the course of 2 weeks and minimal intervention with a single in-person appointment including sleep data feedback. Improvements are seen in sleep quality, mood, vitality, and actigraphy-measured sleep efficiency (SE; EG1), as well as in well-being and sleep onset latency (SOL) in EG2. The inactive CG did not improve in any parameter.

CONCLUSION

Results suggest small and beneficial effects on sleep and well-being in people being continuously monitored and receiving (actigraphy-based) sleep feedback when paired with a single-time personal intervention.

Insomnia

Insomnia is highly prevalent in clinical practice, occurring in up to 50% of primary care patients. Insomnia can present independently or alongside other medical conditions or mental health disorders and is a risk factor for the development and exacerbation of these other disorders if not treated. In 2016, the American College of Physicians recommended that insomnia be specifically targeted for treatment. The recommended first-line treatment for insomnia, whether the underlying cause has been identified or not, is cognitive behavioural therapy for insomnia (CBT-I). Currently, there is no global consensus regarding which pharmacological treatment has the best efficacy or risk-benefit ratio. Both CBT-I and pharmacological intervention are thought to have similar acute effects, but only CBT-I has shown durable long-term effects after treatment discontinuation. Administering a combined treatment of CBT-I and medication could decrease the latency to treatment response, but might diminish the durability of the positive treatment effects of CBT-I.

The Effect of Cognitive Behavioural Therapy for Insomnia (CBT-I) on Subjective–Objective Sleep Discrepancy in Individuals with Co-Morbid Insomnia and Sleep Apnoea: A Randomised Controlled Trial

People with insomnia frequently underestimate the duration of their sleep compared to objective polysomnography-measured sleep duration. Cognitive behavioural therapy for insomnia (CBT-I) is the most effective treatment for insomnia and also reduces the degree of sleep underestimation. Obstructive sleep apnoea (OSA) is a highly prevalent sleep disorder characterised by frequent narrowing (hypopnoea) and closure (apnoea) of the upper airway during sleep. Comorbid insomnia and sleep apnoea (COMISA) is a prevalent and debilitating disorder. No study has investigated subjectively (sleep diary) versus objectively (polysomnography) measured sleep discrepancies (SOSD) in individuals with COMISA before or following CBT-I. This randomised waitlist-controlled trial investigated SOSD in 145 participants with COMISA before and 6-weeks after CBT-I (n = 72) versus control (n = 73). All participants were studied prior to continuous positive airway pressure treatment for sleep apnoea. At baseline, participants underestimated their total sleep time (mean ± SD −51.9 ± 94.1 min) and sleep efficiency (−9.6 ± 18.3%), and overestimated sleep onset latency (34.5 ± 86.1 min; all p = < 0.001). Mixed models indicated a main effect of time on reduction of SOSD in both groups, but no between-group difference in the reduction of any SOSD parameters. These findings may indicate that untreated OSA contributes to a discrepancy between perceived and objective sleep parameters in people with COMISA that is not amenable to CBT-I alone (ACTRN12613001178730).

Effects of subjective-objective sleep discrepancy on the response to cognitive behavior therapy for insomnia

OBJECTIVE

This study aimed to evaluate the clinical correlates of sleep discrepancy and how subjective-objective sleep discrepancy (SD) affects the results of cognitive behavioral therapy for insomnia (CBT-I) in patients with insomnia disorder.

METHODS

A total of 33 patients aged >55 years with insomnia disorders participated in this prospective cohort study. Sleep discrepancy (SD) was defined as the difference between the sleep duration derived from the PSG and self-report questionnaires. SD > 2 h was classified as high SD. Self-report questionnaires, and polysomnography (PSG) were performed before 4 weeks of group CBT-I. Statistical analyses were performed to investigate the association of SD with baseline characteristics and CBT-I results, and compare intergroup difference of pre and post-treatment of high SD and low SD.

RESULTS

Patients in the high SD group reported poor subjective sleep, such as lower sleep quality, shorter sleep duration, longer sleep latency, and lower sleep efficiency. However, they had longer sleep duration, higher sleep efficiency in the PSG. There were 35% males in low SD group, but no males in high SD group. After 4 weeks of group CBT-I, SD was positively associated with the effect of CBT-I on subjective total sleep time (r = 0.499, p < 0.006) and sleep efficiency (r = 0.463, p = 0.01) after adjusting age, sex and apnea-hypopnea index.

CONCLUSION

The results of this study suggest that patients in the high SD group may respond better to CBT-I than those in lower SD group. Evaluation of SD may help clinicians to decide tailored treatment strategies for treating insomnia disorders.

The Assessment of Sleep Quality in Patients Following Valve Repair and Valve Replacement for Infective Endocarditis: A Retrospective Study at a Single Center

Background

The aim of this study was to measure sleep quality among patients who underwent infective endocarditis (IE) surgery and identify the risk factors involved in sleep disorders.

Material/Methods

In this study, we used actigraphy, the Pittsburgh Sleep Quality Index (PSQI), and Epworth Sleep Scale (ESS) to determine the clinical characteristics of sleep disorders in 116 patients with IE who were in rehabilitation after surgery.

Results

Our results showed that 46 (39.7%) patients had sleep efficiency over 85%, while 70 (60.3%) patients had sleep efficiency below 85%. The correlation analysis showed that sleep efficiency was related to the duration of the disease, with a longer duration leading to lower sleep efficiency (P=0.031). The sleep efficiency of patients with IE following surgery was also affected by alcohol consumption; however, surprisingly, patients with “heavy” alcohol consumption had higher sleep efficiency (P=0.030). We found a significant correlation between sleep efficiency and postoperative interleukin-6 (IL) levels, C-reactive protein (CRP) levels, and preoperative erythrocyte sedimentation rate (P<0.05). No significant correlation was found between brain natriuretic peptide levels and sleep efficiency, PSQI score, or ESS score. Postoperative hemoglobin (Hb) level was associated with sleep efficiency (R=0.194, P=0.036), but there was no statistically significant correlation between the PSQI and ESS scores. Postoperative alanine transaminase (ALT) showed a significant negative correlation with sleep efficiency (R=−0.27, P=0.003).

Conclusions

We found a high prevalence of sleep disorders in patients with IE along with an increase in inflammatory factors, including postoperative IL-6, CRP, ALT, and Hb levels.

Evaluation of the Consensus Sleep Diary in a community sample: comparison with single-channel electroencephalography, actigraphy, and retrospective questionnaire

STUDY OBJECTIVES

The Consensus Sleep Diary (CSD) was developed by experts to promote standardization of sleep diary data across the field, but studies comparing the CSD with other assessments of sleep parameters are scarce. This study compared the CSD with 3 other methods to assess sleep duration, efficiency, and timing.

METHODS

Participants (n = 80) were community adults (mean age = 32.65 years, 63% female) who completed the time-stamped CSD and used single-channel electroencephalography (EEG) and actigraphy for 7 days at home, then completed a retrospective sleep questionnaire. Total sleep time (TST), sleep efficiency (SE), and sleep midpoint were compared using correlations, Bland-Altman plots, and limits of agreement (adjusted for repeated measures).

RESULTS

Correlations between the CSD and all methods on TST were large (rs = .63-.75). Adjusted CSD average TST was 40 minutes greater than with EEG and 31 minutes greater than with actigraphy. Correlations between CSD, actigraphy, and EEG for SE were small (rs = .18), and there was a medium correlation with questionnaire (r = .42). Adjusted CSD average SE was 7% greater than EEG and 6% greater than actigraphy; both demonstrated heteroscedasticity. Sleep midpoint correlations between CSD and all methods were large (r = .92-.99). Adjusted CSD was, on average, 6 minutes later than EEG and 1 minute later than actigraphy. Questionnaire-derived sleep parameters demonstrated nonconstant bias; lesser values had positive bias and greater values had negative bias.

CONCLUSIONS

The time-stamped CSD led to meaningful overestimations of TST and SE as measured by objective/inferred methods. However, sleep timing was rather accurately assessed with the CSD in comparison to objective/inferred measures. Researchers should carefully consider which sleep assessment methods are best aligned with their research question and parameters of interest, as methods do not demonstrate complete agreement.

Sleep misestimation among older adults suffering from insomnia with short and normal objective sleep duration and the effects of cognitive behavior therapy

STUDY OBJECTIVES

Compare the degree of sleep misestimation in older adults with insomnia presenting with objectively short relative to normal sleep duration, and investigate the differential therapeutic response on sleep misestimation between the proposed sleep duration phenotypes to cognitive-behavior therapy for insomnia (CBTi).

METHODS

Ninety-one adults (male = 43, mean age = 63.34, SD = 6.41) with sleep maintenance insomnia were classified as short sleepers (SS; <6 h total sleep time [TST]) or normal sleepers (NS; ≥6 h TST) based on one night of home-based polysomnography. Participants were randomly allocated to CBTi (N = 30 SS, N = 33 NS) or to a wait-list control condition (N = 9 SS, N = 19 NS). Sleep misestimation was calculated as the difference scores of subjective (sleep diary reported) and objective (derived from actigraphy) sleep onset latency (SOL), wake after sleep onset (WASO), and TST at pre- and post-treatment, and 3-month follow-up.

RESULTS

Prior to treatment, perception of SOL, WASO, and TST did not differ between patients with objectively short sleep duration relative to those with objectively normal sleep duration. Patients' perception of WASO and TST, improved immediately following treatment and at 3-month follow-up relative to the waitlist group. These improvements did not differ significantly between those with short or normal objective sleep duration prior to treatment.

CONCLUSIONS

The degree of sleep misestimation is similar for older adults suffering from chronic insomnia with short or normal objective sleep duration. Irrespective of objective sleep duration prior to treatment, CBTi produces significant improvements in sleep perception.

CLINICAL TRIAL REGISTRATION NUMBER

ACTRN12620000883910.

The (mis)perception of sleep: factors influencing the discrepancy between self-reported and objective sleep parameters

STUDY OBJECTIVES

Self-reported perception of sleep often differs from objective sleep study measures, but factors predicting the discrepancy between self-reported and objective sleep parameters are controversial, and a comparison of laboratory vs ambulatory polysomnography (PSG) is lacking.

METHODS

We retrospectively analyzed PSGs conducted between 2012 and 2016. Linear regression was applied to predict the discrepancy between self-reported and objective sleep parameters (total sleep time, sleep efficiency, sleep latency, using age, sex, arousal index, type of sleep disorder, and PSG type [laboratory vs ambulatory] as regressors).

RESULTS

A total of 303 PSGs were analyzed (49% women, median age 48 years), comprising patients with insomnia (32%), sleep-related breathing disorders (27%), sleep-related movement disorders (15%), hypersomnia/narcolepsy (14%), and parasomnias (12%). Sleep disorder was the best predictor of discrepancy between self-reported and objective total sleep time, and patients with insomnia showed higher discrepancy values compared to all other patient groups (P < .001), independent of age and PSG type (P > .05). Contributory effects for higher discrepancy values were found for lower arousal index. Patients with insomnia underestimated both total sleep time (median discrepancy: 46 minutes, P < .001) and sleep efficiency (median discrepancy: 11%, P < .001). No significant predictor for discrepancy of sleep latency was found.

CONCLUSIONS

Misperception of sleep duration and efficiency is common in sleep lab patients, but most prominent in insomnia, independent of age, sex, or laboratory vs ambulatory recording setting. This underlines the role of PSG in patients with a clinical diagnosis of insomnia and its use in cognitive behavioral therapy.

Managing Insomnia Using Lucid Dreaming Training: A Pilot Study

Objectives/Background: Despite Cognitive Behavioral Therapy for Insomnia (CBT-I) being considered the first-line treatment for insomnia, it is not without its challenges. As such it is worthwhile to consider, and test, alternative or adjuvant management options. Methods/Participants: The aim of the present study was to examine whether Lucid Dreaming Training for insomnia (LDT-I) impacted on insomnia, depressive and anxious symptomology in an open label trial of 48 adults with Insomnia Disorder. Participants completed the Insomnia Severity Index, General Anxiety Disorder-7 and Patient Health Questionnaire at baseline then one month following LDT-I. Training consisted of four modules delivered over a period of two consecutive weeks. Results: The results suggest, albeit preliminarily, that LDT-I may have a place within the non-pharmacological management of insomnia, as there were significant reductions in insomnia severity (t(46) = 8.16,p <.001), anxious symptomology (t(46) = 4.75,p <.001) and depressive symptomology (t(46) = 5.87,p <.001). Further, the effect size in terms of pre-post reductions on ISI scores was large (d_z 1.17). Conclusions: Whilst the results are promising, further testing of LDT-I is needed to inform its place amongst the non-pharmacological treatments for insomnia.

Misperception of sleep in bipolar disorder: an exploratory study using questionnaire versus actigraphy

Background

The concept of misperception of sleep refers to the estimated discrepancy between subjective and objective measures of sleep. This has been assessed only in a few prior studies in individuals with Bipolar Disorder (BD) as compared to Healthy Controls (HC) and with mixed results.

Methods

We assessed a sample of 133 euthymic individuals with BD and 63 HC for retrospective subjective (Pittsburgh Sleep Quality Index) and objective (21 days of actigraphy recording) measures of total sleep time, sleep latency and sleep efficiency. We first investigated the correlations between these subjective and objective measures in the two groups. We then compared individuals with BD and HC for the absolute values of the differences between subjective and objective sleep parameters, used as a proxy of the magnitude of misperception of sleep. Finally, we undertook regression analyses to assess associations between clinical groups, core demographics, clinical factors and misperception of sleep.

Results

The correlation coefficients between subjective and objective measures of sleep did not differ between groups (total sleep time: rho = .539 in BD and rho = .584 in HC; sleep latency: rho = .190 in BD and rho = .125 in HC; sleep efficiency: rho = .166 in BD and rho = .222 in HC). Individuals with BD did not differ from HC in the magnitude of misperception of total sleep time, sleep latency nor sleep efficiency. Individuals with BD type 1 misperceived their sleep efficiency significantly more than individuals with BD type 2, with no further difference between BD type 1 and BD type 2 regarding sleep latency and sleep duration misperceptions. Three factors (age, symptoms of obstructive sleep apnea, and mild depressive symptoms), were the main contributors to the magnitude of misperception of sleep.

Conclusions

Misperception of sleep was not associated with a diagnosis of BD. In this sample, mild depressive symptoms, older age, or symptoms of obstructive sleep apnea may be related to greater sleep misperception. In that case, the reliability of subjective measures may decrease as the misperception of sleep increases. This study may help guide clinicians in selecting the best approach for assessing sleep (objective versus subjective measures) in individuals with BD.