(Mis)perception of Sleep in Insomnia: A Puzzle and a Resolution

Harvey, Allison G.; Tang, Nicole K. Y.

doi:10.1037/a0025730

Cited by 529Sleep and related disordersAnxiety, Depression, Psychometrics, Treatment, Cognitive ProcessesSleep and Work-Related Fatigue

(Mis)perception of Sleep in Insomnia: A Puzzle and a Resolution

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Harvey, Allison G., Tang, Nicole K. Y.·2012·Psychological Bulletin

DOI 10.1037/a0025730PMC PMC3277880

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Abstract

Insomnia is prevalent, causing severe distress and impairment. This review focuses on illuminating the puzzling finding that many insomnia patients misperceive their sleep. They overestimate their sleep onset latency (SOL) and underestimate their total sleep time (TST), relative to objective measures. This tendency is ubiquitous (although not universal). Resolving this puzzle has clinical, theoretical, and public health importance. There are implications for assessment, definition, and treatment. Moreover, solving the puzzle creates an opportunity for real-world applications of theories from clinical, perceptual, and social psychology as well as neuroscience. Herein we evaluate 13 possible resolutions to the puzzle. Specifically, we consider the possible contribution, to misperception, of (1) features inherent to the context of sleep (e.g., darkness); (2) the definition of sleep onset, which may lack sensitivity for insomnia patients; (3) insomnia being an exaggerated sleep complaint; (4) psychological distress causing magnification; (5) a deficit in time estimation ability; (6) sleep being misperceived as wake; (7) worry and selective attention toward sleep-related threats; (8) a memory bias influenced by current symptoms and emotions, a confirmation bias/belief bias, or a recall bias linked to the intensity/recency of symptoms; (9) heightened physiological arousal; (10) elevated cortical arousal; (11) the presence of brief awakenings; (12) a fault in neuronal circuitry; and (13) there being 2 insomnia subtypes (one with and one without misperception). The best supported resolutions were misperception of sleep as wake, worry, and brief awakenings. A deficit in time estimation ability was not supported. We conclude by proposing several integrative solutions.

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People with insomnia tend to overestimate how long it takes them to get to sleep and underestimate total time asleep, relative to objective measures.
“However, discrepancies between self-report and objective measures of sleep are common [38–42] and there is a tendency for people with insomnia to overestimate how long it takes them to get to sleep and also to underestimate the total amount of time that they spend asleep, relative to objective measures [43].”
From A structural equation model of the relationship between insomnia, negative affect, and paranoid thinking (2017) · cites this paper as [43]

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Insomnia with objective short sleep duration: The most biologically severe phenotype of the disorder
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Authors: Harvey, A. G., & Tang, N. K. Y.
Affiliations: University of California, Berkeley (US)
Arthritis Research UK (GB)
ORCID: Harvey, Allison G.
Tang, Nicole K. Y.
Venue: Psychological Bulletin
Publisher: American Psychological Association (APA)
Published: 2012-01
Volume: 138
Issue: 1
Pages: 77-101
ISSN: 0033-2909 (ISSN-L)
1939-1455
DOI: 10.1037/a0025730
PMC: PMC3277880
OpenAlex: W2001331727
Cited by: 529
References: 171
Citations by year: 2026: 50 · 2025: 49 · 2024: 36 · 2023: 54 · 2022: 48 · 2021: 49 · 2020: 54 · 2019: 29 · 2018: 28 · 2017: 29 · 2016: 20 · 2015: 23 · 2014: 24 · 2013: 25 · 2012: 9
FWCI: 24.32
Type: journal article
Language: en
Open access: green
europepmc.org
Locations: Psychological Bulletin (publishedVersion)
PubMed (publishedVersion)
Europe PMC (PubMed Central) (acceptedVersion)
PubMed Central (acceptedVersion)
Funders: National Institute of Mental Health (R34MH080958)
Topics: Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and Work-Related Fatigue
Keywords: insomnia, sleep misperception, sleep latency, total sleep time, subjective sleep duration, sleep complaints, worry, time estimation, memory bias, confirmation bias, belief bias, recall bias, physiological arousal, cortical arousal, insomnia subtypes
MeSH terms: Arousal, Attention, Darkness, Humans, Sleep Initiation and Maintenance Disorders, Models, Theoretical, Perceptual Distortion, Personality Assessment, Mental Recall, Sleep, Stress, Psychological, Time Perception, Wakefulness, Polysomnography, Actigraphy

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(Mis)perception of Sleep in Insomnia: A Puzzle and a Resolution

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