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Sleep Misperception and Chronic Insomnia in the General Population: Role of Objective Sleep Duration and Psychological Profiles

Fernandez-Mendoza, Julio PhD; Calhoun, Susan L. PhD; Bixler, Edward O. PhD; Karataraki, Maria PsyD; Liao, Duanping MD; Vela-Bueno, Antonio MD; Jose Ramos-Platon, María PhD; Sauder, Katherine A. BA; Basta, Maria MD; Vgontzas, Alexandros N. MD

doi: 10.1097/PSY.0b013e3181fe365a
Original Article

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.

BMI = body mass index; DSM-IV = Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition; MANCOVA = multivariate analysis of covariance; MMPI-2 = Minnesota Multiphasic Personality Inventory-2; PLMS = periodic limb movements; SDB = sleep disordered breathing.

From the Sleep Research and Treatment Center (J.F.-M., S.L.C., E.O.B., M.K., K.A.S., M.B., A.N.V.), Departments of Psychiatry and Public Health Sciences (D.L.), Pennsylvania State University College of Medicine, Hershey, Pennsylvania; Department of Psychobiology (J.F.-M., M.J.R.-P.), Complutense University, Madrid, Spain; and the Department of Psychiatry (J.F.-M., A.V.-B.), Autonomous University, Madrid, Spain.

Address correspondence and reprint requests to Alexandros N. Vgontzas, MD, Department of Psychiatry H073, Penn State University College of Medicine, 500 University Drive, Hershey, PA 17033. E-mail:

Received for publication April 21, 2010; revision received September 1, 2010.

The work was performed at the Sleep Research and Treatment Center at the Penn State University Milton Hershey Hospital.

This research was funded, in part, by grants RO1 51931 (E.O.B.), RO1 40916 (E.O.B.), and RO1 64415 (A.N.V.) from the National Institutes of Health.

The authors have not disclosed any potential conflicts of interest.

Copyright © 2011 by American Psychosomatic Society
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