When sleep reports diverge from physiology: correlates of sleep discrepancy in a health population
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Study Objectives
Sleep characteristics are often estimated using self-reports, which may differ from objective measurements, a phenomenon known as sleep discrepancy. However, the factors associated with the degree of sleep discrepancy remain poorly understood.
Methods
In the current study, a large healthy participant sample of the Budapest Sleep, Experiences and Traits Study (total N=267, 1899 nights) completed a 7-day protocol including mobile EEG recordings and sleep diaries, and also provided questionnaire-based reports of habitual sleep. We compared analogous sleep metrics from these three modalities, and used cross-validated LASSO regression to investigate demographic, psychological and lifestyle-related factors associated with increased sleep discrepancy across all three modalities, at both between- and within-participant levels.
Results
Daily diaries estimated EEG-based sleep timing accurately (mean r=0.83), but were less accurate for sleep onset latency and quality. In contrast, questionnaire reports of habitual sleep provided inaccurate measures of even sleep timing (mean r=0.49) and considerably misestimated sleep timing and duration. Insomnia and depressive symptoms, napping, co-sleeping and personality traits were associated with increased sleep discrepancy.
Conclusion
In healthy adults, questionnaires about habitual sleep provide only moderately accurate and biased estimates of actual sleep. Daily diaries provide considerably more accurate estimates, but sleep onset latency and physiological sleep quality is estimated by all self-reports less accurately than sleep timing. Sleep discrepancy is also present in healthy participants, it is particularly and its degree is affected by non-pathological characteristics. Long-term monitoring by daily diaries or wearables should be preferred to self-report questionnaires to measure sleep.
Statement of significance
This study provides a comprehensive evaluation of how closely two types of subjective reports (habitual sleep questionnaires and daily sleep diaries) track EEG-based objective sleep in a large community sample. We show that while diaries estimate sleep timing accurately, questionnaires about habitual sleep are both inaccurate and biased. The degree of objective-subjective sleep discrepancy varies both across and within-individuals as a function of depressive and insomnia symptoms, sleep habits, and personality traits. The findings show that self-reports of habitual sleep provide inaccurate and distorted estimates of sleep behavior, especially in participants with subclinical psychiatric symptoms. Longitudinal diary- or wearable-based assessments are increasingly viable and more valid alternatives.
