Inaccurate Reporting of Insomnia

Most people are not very good at estimating the amount of time they spend asleep. They may believe they have insomnia or difficulty sleeping, when objective evidence shows they do not. In a nationally representative sample in the United States, 35% of adults claimed they were afflicted by insomnia within the previous year (Mellinger, Balter, & Uhlenhuth, 1985). In a similar survey of "1,006 representative households in the Los Angeles metropolitan area" 42.3% of respondents complained of insomnia. However, when keeping people overnight in a sleep laboratory, researchers typically find that "insomniacs" are drastically underestimating the amount of time they spend sleeping. Smith (1979) wrote:

What is usually true of people who claim to be insomniacs?

...A woman with a 25-year history of insomnia...entered [a sleep] laboratory. In four successive nights, "she fell asleep quickly, slept more than eight hours per night, and had normal architecture of sleep stages."..."Each morning, however, she reported that she 'didn't sleep a wink.'" Patients consistently exaggerate their insomnia...

A study of 122 drug-free subjects who complained of chronic insomnia found the group was indistinguishable from the normal population in average time asleep. They averaged over 6 hours of sleep per night. Few got less than four hours of sleep (Carskadon, Dement, Mitler, Guilleminault, Zarconi, & Spiegel, 1976).

What accounts for the impression many people have that they are insomniacs?

Carskadon and colleagues found that their group of self-reported insomniacs had many nighttime awakenings. The number increased with age—from 12 per night in the 18-29 age group to an average of 25 in the 60-68 age group. The researchers wrote:

Without exception, subjects consistently underestimated the number of arousals. No significant correlation was found between the recorded and estimated number of arousals in women or men. (Carskadon et al., 1976)

Let us ponder this statement for a moment. The subjects "without exception" were waking up much more often than they realized. When asked the next day how often they had awakened during the night, they had no clue (the estimates were not even correlated with the number of actual arousals). Yet these were people who called themselves insomniacs. Evidently what they were calling insomnia was a sleep with many awakenings.

That is Webb's (1981) conclusion also. He describes pseudo-insomnia (false insomnia) as a complaint of "no sleep" which turns out to be frequent awakenings in an otherwise-normal succession of sleep stages. During each awakening the individual evidently thinks, "I'm still awake; I haven't slept a wink," but such people average about six hours of genuine sleep per night in between their awakenings.

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Copyright © 2007 Russ Dewey