Perfectionism Contributes to Sleep-Wake State Discrepancy: The Mediating Role of Pre-Sleep Arousal

Objectives: Sleep-wake state discrepancy, the discrepancy between self-reported and objective sleep measures, is commonly experienced in poor sleep and insomnia. While perfectionism is implicated in insomnia, its relationship to sleep-wake state discrepancy has not been investigated. This study aimed to assess the association between sleep-wake state discrepancy and perfectionism and explore whether dysfunctional sleep beliefs and pre-sleep arousal mediate that relationship. Methods: Sixty adult participants from community and clinical populations were conveniently sampled (85% females, mean age 30.28 ± 11.13 years, 38% with insomnia symptoms). Sleep-wake state discrepancy measures were calculated using data from actigraphy and sleep diary collected over 14 days. The Frost Multidimensional Perfectionism Scale (FMPS), Hewitt-Flett Multidimensional Perfectionism Scale (HFMPS), Dysfunctional Beliefs about Sleep (DBAS), and Pre-sleep Arousal Scale (PSAS) were also collected. Results: High perfectionism levels were associated with high levels of sleep-wake state discrepancy. Concern over Mistakes and Doubts about Actions correlated with sleep onset latency discrepancy with small effects (r = 0.26 and 0.29, respectively). Doubts about Actions was associated with sleep onset latency discrepancy. Furthermore, pre-sleep arousal and cognitive pre-sleep arousal mediated relationships between sleep onset latency discrepancy and Concern over Mistakes and Doubts about Actions. Conclusions: Concern over Mistakes and Doubts about Actions relate to a poorer perception of sleep relative to objective sleep measures. During sleep onset, cognitive pre-sleep arousal appears to mediate relationships between perfectionism and sleep-wake state discrepancy. Therefore, perfectionism may be an important cognitive-emotional factor to consider when assessing and treating sleep-wake state discrepancy that commonly accompanies insomnia.