Effects of Cognitive Behavioral Therapy for Insomnia on Subjective–Objective Sleep Discrepancy in Patients with Primary Insomnia: a Small-Scale Cohort Pilot Study

Feb 25, 2021International journal of behavioral medicine

Cognitive Behavioral Therapy for Insomnia and its impact on differences between perceived and measured sleep in people with primary insomnia

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Abstract

Subjective and objective discrepancies in sleep measures decreased by 36 minutes in total sleep time after cognitive behavioral therapy for insomnia (CBT-I).

Discrepancies in sleep-onset latency and wake time after sleep onset decreased by 25 and 37 minutes, respectively.
Sleep efficiency improved by 7% following CBT-I.
Seven patients changed from underestimating to overestimating sleep efficiency after treatment.
Improvements in insomnia severity were correlated with changes in sleep-onset latency discrepancy.
CBT-I may help align subjective and objective sleep measures in primary insomnia patients.

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BACKGROUND: Cognitive behavioral therapy for insomnia (CBT-I) is a first-line therapy for insomnia disorders. We assessed changes in discrepancies between subjective and objective sleep measures and correlations between discrepancy changes and clinical insomnia severity for CBT-I in patients with primary insomnia METHODS: Fifty-two outpatients (mean age, 60.3 years; 26 women) with primary insomnia were treated by individual CBT-I (50 min, maximum six sessions, once every 1-2 weeks). One week before and after CBT-I, patients recorded a sleep log and wore an actigraphy device. Subjective and objective time in bed (TIB), total sleep time (TST), sleep-onset latency (SOL), wake time after sleep onset (WASO), and sleep efficiency (SE) were evaluated by averaging 1-week records. Relative values of sleep discrepancy in TIB, TST, SOL, WASO, and SE were calculated for estimating effects of CBT-I. The therapeutic effects were also evaluated using psychological scales before and after CBT-I.

RESULTS: Subjective and objective discrepancies in sleep measures decreased by 36, 25, and 37 min in TST, SOL, and WASO, respectively, and 7% in SE (all P < 0.001) after CBT-I. Seven patients transitioned from underestimating SE before CBT-I to overestimating SE after CBT-I. Although CBT-I improved relative values of discrepancy in WASO and SE, alongside ISI, the improvement in insomnia severity only correlated with SOL discrepancy.

CONCLUSIONS: CBT-I may reduce the discrepancy between subjective and objective sleep measures in patients with primary insomnia. However, a greater therapeutic effect of CBT-I was observed in reducing the ISI, which was slightly influenced by improvements in sleep discrepancies.

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Effects of Cognitive Behavioral Therapy for Insomnia on Subjective–Objective Sleep Discrepancy in Patients with Primary Insomnia: a Small-Scale Cohort Pilot Study

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