Misperception of sleep can adversely affect daytime functioning in insomnia

This experiment was designed to investigate the relationship between subjective perception of sleep and daytime processes in primary insomnia. Twenty-two individuals with primary insomnia received positive or negative feedback about their sleep, immediately on waking, on three consecutive mornings. The positive feedback was that last night's sleep was good quality. The negative feedback was that last night's sleep was poor quality. Objective sleep on each of the three nights was estimated by actigraphy and did not differ across the three nights or the two feedback conditions. Negative feedback (based on 32 nights of data) was associated with more negative thoughts, sleepiness, monitoring for sleep-related threat, and safety behaviours during the day, relative to positive feedback (based on 34 nights of data). These results indicate that the impaired daytime functioning reported by insomnia patients is maintained, at least in part, by subjective perception of sleep.