Sleep State Misperception

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The patient is suffering from a paradoxical belief, or an incorrect perception, that their sleep is far worse than it actually is. In fact, sometimes those recordings will even indicate that that patient has slept a completely full, quiet, normal night of sleep. But that's not what the patient is telling you in the morning. The patient has a subjective perception of the night of sleep that is very frent to the objective recordings of the actual sleep. It's a mismatch here, hence the term sleep state misperception. And also then the contradictory naming that it's sometimes called, which is paradoxical in omnia.

There is no quick test that can determine insomnia. Instead, the diagnosis of clinical insomnia disorder is based on a set of clinical assessment and interviews. These center on three core features: 1) difficulties falling asleep, 2) difficulty staying asleep, or 3) waking up and not feeling refreshed by your sleep. Furthermore, to receive the diagnosis, you often have to be experiencing these things at least three nights per week; and having these issues for three straight months.

One meta-analysis looked at over twenty studies of people with insomnia or healthy sleep. It found far fewer differences in their sleep recordings than you would imagine. The insomnia patients did spend more time awake, and there were reductions in their deep non-REM and REM sleep. But none of the differences explain the degree of suffering for those with insomnia.

This mismatch can be illustrated by an extreme example. There is a rare variant or subtype of insomnia called sleep state misperception. It is characterized by a mismatch whereby the patient reports their sleep as very bad. But the sleep recordings show a different story. The recordings show that the patient has slept a full, normal night of sleep, but the patient will tell you that they felt as though they never slept a wink!

Such patients used to be dismissed as having nothing wrong with them. Now, science and medicine no longer take this view, and instead, understand that there is a mismatch going on, that the patient has a misperception of their sleep, and they still require clinical consideration.

So, that’s an overview of insomnia classification and diagnosis. Please note that Matt is not a medical doctor, and none of the content in this podcast should be considered medical advice in any way, shape, or form, nor prescriptive in any way.

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