Sleep Misperception and Associated Factors in Patients With Anxiety-Related Disorders and Complaint of Insomnia: A Retrospective Study

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.

Patients with cluster headache show signs of insomnia and sleep related stress: results from an actigraphy and self-assessed sleep study

BACKGROUND

Cluster headache (CH) is a primary headache disorder which is characterized by circadian timing of headache attacks, usually at nighttime, in around two thirds of patients. Patients with CH often report sleep difficulties, though it is unknown whether this is a cause or a consequence of nightly headache attacks.

OBJECTIVE

In this case-control study we have assessed sleep quality in study participants with CH in cluster bout respectively in remission, compared to a control group of neurologically healthy individuals to investigate the potential connection between sleep and CH.

METHODS

Fifty study participants with CH and 42 controls were recruited for sleep assessment. Sleep was recorded using MotionWatch 8 actigraphs (CamNTech) for a period of two weeks. Study participants were instructed to wear the unit during rest and sleep and to fill out a sleep diary daily through the two-weeks period.

RESULTS

Results from actigraphy recordings and sleep diaries suggested that patients with CH spend longer time in bed than controls (CH 8.1 hours vs. Controls 7.7 hours, p=0.03), but do not sleep more than controls (CH 6.7 hours vs. controls 6.5 hours, p=0.3). In addition, CH patients reported increased sleep latency (p=0.003), particularly during, but not restricted to, cluster bouts. Study participants with CH further reported higher levels of stress at bedtime (p=0.01), and they felt less well rested than controls (p=0.001).

CONCLUSION

Our analysis suggests that sleep is negatively affected in CH both in cluster bout and in remission, manifesting in symptoms consistent with insomnia such as prolonged sleep latency and increased time in bed.

Actigraphy monitoring in anxiety disorders: A mini-review of the literature

Sleep disturbances and changes of activity patterns are not uncommon in anxiety disorders, but they are rarely the object of attention. Actigraphic monitoring of day and night activity patterns could provide useful data to detect symptom worsening, prevent risk periods, and evaluate treatment efficacy in those disorders. Thus, we have conducted a systematic search of the scientific literature to find any original study using actigraphic monitoring to investigate activity and sleep patterns in patients affected by any type of anxiety disorder according to the definition of the DSM-5. We found only six studies fulfilling these criteria. Three studies report significant findings in patients suffering from anxiety disorders. Overall, the samples and methods are heterogeneous. Although the authors support the interest of actigraphic monitoring in anxiety disorders, the evidence to date is very limited.