Although patients with insomnia often show a discrepancy between self-reported and objective sleep parameters, the role of and change in this phenomenon during treatment remain unclear. The present study aimed to assess the effect of cognitive behavioural therapy for insomnia on subjective and objective sleep discrepancy of total sleep time, sleep-onset latency and wake after sleep onset. The total sleep time discrepancy was also assessed across the entire therapy. The second aim was to examine the treatment outcome of two insomnia groups differing in sleep perception. Thirty-six adults with insomnia (mean age = 46.7 years, SD = 13.9; 22 females) were enrolled in the final analyses. Patients underwent a 6-week group cognitive behavioural therapy for insomnia programme. Sleep diary and actigraphy measurements were obtained during the therapy. Patients who underestimated total sleep time (n = 16; underestimating group) were compared with patients who accurately perceived or overestimated total sleep time (n = 20; accurate/overestimating group). After cognitive behavioural therapy for insomnia, a significant decrease of total sleep time and sleep-onset latency discrepancy was observed without a change in wake after sleep onset discrepancy in the total sample. Only the underestimating group reported decreased sleep-onset latency discrepancy after the treatment, whereas total sleep time discrepancy significantly changed in both groups. The underestimating group showed a significant decrease of total sleep time discrepancy from Week 1 to Week 2 when the sleep restriction was implemented, whereas the accurate/overestimating group showed the first significant change at Week 4. In conclusion, both groups differing in sleep perception responded similarly to cognitive behavioural therapy for insomnia, although different In conclusion, both groups differing in sleep perception responded similarly to cognitive behavioural therapy for insomnia, although different therapeutic components could play important roles in each group. components could play important roles in each group.

3rd Faculty of Medicine Charles University Prague Czech Republic

National Institute of Mental Health Klecany Czech Republic

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AASM (2014). International classification of sleep disorders: Third edition (ICSD-3). Darien, IL: Author.

Bastien, C. H., Valliéres, A., & Morin, C. (2001). Validation of the Insomnia Severity Index as an outcome measure for insomnia research. Sleep Medicine, 2(4), 297-307. https://doi.org/10.1016/S1389-9457(00)00065-4

Buysse, D. J., Germain, A., Moul, D. E., Franzen, P. L., Brar, L. K., Fletcher, M. E., … Monk, T. H. (2011). Efficacy of brief behavioral treatment for chronic insomnia in older adults. Archives of Internal Medicine, 171(10), 887-895. https://doi.org/10.1001/archinternmed.2010.535

Castelnovo, A., Ferri, R., Punjabi, N. M., Castronovo, V., Garbazza, C., Zucconi, M., … Manconi, M. (2019). The paradox of paradoxical insomnia: A theoretical review towards a unifying evidence-based definition. Sleep Medicine Reviews, 44, 70-82. https://doi.org/10.1016/j.smrv.2018.12.007

Cole, R. J., Kripke, D. F., Gruen, W., Mullaney, D. J., & Gillin, J. C. (1992). Automatic sleep/wake identification from wrist activity. Sleep, 15(5), 461-469. https://doi.org/10.1093/sleep/15.5.461

Cronlein, T., Lehner, A., Schussler, P., Geisler, P., Rupprecht, R., & Wetter, T. C. (2019). Changes in subjective-objective sleep discrepancy following inpatient cognitive behavior therapy for insomnia. Behavior Therapy, 50(5), 994-1001. https://doi.org/10.1016/j.beth.2019.03.002

Dorsey, C. M., & Bootzin, R. R. (1997). Subjective and psychophysiologic insomnia: An examination of sleep tendency and personality. Biological Psychiatry, 41(2), 209-216. https://doi.org/10.1016/0006-3223(95)00659-1

Edinger, J. D., & Fins, A. I. (1995). The distribution and clinical-significance of sleep time misperceptions among insomniacs. Sleep, 18(4), 232-239. https://doi.org/10.1093/sleep/18.4.232

Edinger, J. D., & Krystal, A. D. (2003). Subtyping primary insomnia: Is sleep state misperception a distinct clinical entity? Sleep Medicine Reviews, 7(3), 203-214. https://doi.org/10.1053/smrv.2002.0253

Edinger, J. D., Wohlgemuth, W. K., Radtke, R. A., Coffman, C. J., & Carney, C. E. (2007). Dose-response effects of cognitive-behavioral insomnia therapy: A randomized clinical trial. Sleep, 30(2), 203-212. https://doi.org/10.1093/sleep/30.2.203

Edinger, J. D., Wohlgemuth, W. K., Radtke, R. A., Marsh, G. R., & Quillian, R. E. (2001). Does cognitive-behavioral insomnia therapy alter dysfunctional beliefs about sleep? Sleep, 24(5), 591-599. https://doi.org/10.1093/sleep/24.5.591

Gavriloff, D., Sheaves, B., Juss, A., Espie, C. A., Miller, C. B., & Kyle, S. D. (2018). Sham sleep feedback delivered via actigraphy biases daytime symptom reports in people with insomnia: Implications for insomnia disorder and wearable devices. Journal of Sleep Research, 27(6), e12726. https://doi.org/10.1111/jsr.12726

Harper, A., Power, M., & Grp, W. (1998). Development of the World Health Organization WHOQOL-BREF quality of life assessment. Psychological Medicine, 28(3), 551-558. https://doi.org/10.1017/S0033291798006667

Harvey, A. G. (2002). A cognitive model of insomnia. Behaviour Research and Therapy, 40(8), 869-893. https://doi.org/10.1016/S0005-7967(01)00061-4

Herbert, V., Pratt, D., Emsley, R., & Kyle, S. D. (2017). Predictors of Nightly Subjective-Objective Sleep Discrepancy in Poor Sleepers over a Seven-Day Period. Brain Sciences, (2076-3425), 7(3), 1-16.

Jin, P. (1992). Toward a reconceptualization of the law of initial value. Psychological Bulletin, 111(1), 176-184. https://doi.org/10.1037/0033-2909.111.1.176

Johns, M. W. (1991). A new method for measuring daytime sleepiness: The Epworth Sleepiness Scale. Sleep, 14(6), 540-545. https://doi.org/10.1093/sleep/14.6.540

Kay, D. B., Buysse, D. J., Germain, A., Hall, M., & Monk, T. H. (2015). Subjective-objective sleep discrepancy among older adults: Associations with insomnia diagnosis and insomnia treatment. Journal of Sleep Research, 24(1), 32-39. https://doi.org/10.1111/jsr.12220

Koffel, E. A., Koffel, J. B., & Gehrman, P. R. (2015). A meta-analysis of group cognitive behavioral therapy for insomnia. Sleep Medicine Reviews, 19, 6-16. https://doi.org/10.1016/j.smrv.2014.05.001

Kyle, S. D., Miller, C. B., Rogers, Z., Siriwardena, A. N., Macmahon, K. M., & Espie, C. A. (2014). Sleep restriction therapy for insomnia is associated with reduced objective total sleep time, increased daytime somnolence, and objectively impaired vigilance: Implications for the clinical management of insomnia disorder. Sleep, 37(2), 229-237. https://doi.org/10.5665/sleep.3386

Kyle, S. D., Morgan, K., Spiegelhalder, K., & Espie, C. A. (2011). No pain, no gain: An exploratory within-subjects mixed-methods evaluation of the patient experience of sleep restriction therapy (SRT) for insomnia. Sleep Medicine, 12(8), 735-747. https://doi.org/10.1016/j.sleep.2011.03.016

Lakens, D. (2013). Calculating and reporting effect sizes to facilitate cumulative science: A practical primer for t-tests and ANOVAs. Frontiers in Psychology, 4,1-12.https://doi.org/10.3389/fpsyg.2013.00863

Lund, H. G., Rybarczyk, B. D., Perrin, P. B., Leszczyszyn, D., & Stepanski, E. (2013). The discrepancy between subjective and objective measures of sleep in older adults receiving CBT for comorbid insomnia. Journal of Clinical Psychology, 69(10), 1108-1120. https://doi.org/10.1002/jclp.21938

Manconi, M., Ferri, R., Sagrada, C., Punjabi, N. M., Tettamanzi, E., Zucconi, M., … Ferini-strambi, L. (2010). Measuring the error in sleep estimation in normal subjects and in patients with insomnia: Insomnia. Journal of Sleep Research, 19(3), 478-486. https://doi.org/10.1111/j.1365-2869.2009.00801.x

Maric, A., Burgi, M., Werth, E., Baumann, C. R., & Poryazova, R. (2019). Exploring the impact of experimental sleep restriction and sleep deprivation on subjectively perceived sleep parameters. Journal of Sleep Research, 28(3), e12706. https://doi.org/10.1111/jsr.12706

Means, M. K., Edinger, J. D., Glenn, D. M., & Fins, A. I. (2003). Accuracy of sleep perceptions among insomnia sufferers and normal sleepers. Sleep Medicine, 4(4), 285-296. https://doi.org/10.1016/S1389-9457(03)00057-1

Morin, C. M. (2003). Measuring outcomes in randomized clinical trials of insomnia treatments. Sleep Medicine Reviews, 7(3), 263-279. https://doi.org/10.1053/smrv.2002.0274

Morin, C. M., Bootzin, R. R., Buysse, D. J., Edinger, J. D., Espie, C. A., & Lichstein, K. L. (2006). Psychological and behavioral treatment of insomnia:Update of the recent evidence (1998-2004). Sleep, 29(11), 1398-1414. https://doi.org/10.1093/sleep/29.11.1398

Morin, C. M., & Espie, C. A. (2003). Insomnia: A clinical guide to assessment and treatment. New York, NY: Kluwer Academic/Plenum Press.

Morin, C. M., Stone, J., Trinkle, D., Mercer, J., & Remsberg, S. (1993). Dysfunctional beliefs and attitudes about sleep among older adults with and without insomnia complaints. Psychology and Aging, 8(3), 463-467. https://doi.org/10.1037//0882-7974.8.3.463

O'Donnell, D., Silva, E. J., Munch, M., Ronda, J. M., Wang, W., & Duffy, J. F. (2009). Comparison of subjective and objective assessments of sleep in healthy older subjects without sleep complaints. Journal of Sleep Research, 18(2), 254-263. https://doi.org/10.1111/j.1365-2869.2008.00719.x

Regestein, Q. R., Dambrosia, J., Hallett, M., Murawski, B., & Paine, M. (1993). Daytime alertness in patients with primary insomnia. American Journal of Psychiatry, 150(10), 1529-1534. https://doi.org/10.1176/ajp.150.10.1529

Riemann, D., Baglioni, C., Bassetti, C., Bjorvatn, B., Dolenc Groselj, L., Ellis, J. G., … Spiegelhalder, K. (2017). European guideline for the diagnosis and treatment of insomnia. Journal of Sleep Research, 26(6), 675-700. https://doi.org/10.1111/jsr.12594

Sidak, Z. (1967). Rectangular confidence regions for means of multivariate normal distributions. Journal of the American Statistical Association, 62(318), 626-633. https://doi.org/10.2307/2283989

Tang, N. K., & Harvey, A. G. (2004). Correcting distorted perception of sleep in insomnia: A novel behavioural experiment? Behavior Research and Therapy, 42(1), 27-39. https://doi.org/10.1016/S0005-7967(03)00068-8

Tang, N. K., & Harvey, A. G. (2006). Altering misperception of sleep in insomnia: Behavioral experiment versus verbal feedback. Journal of Consulting and Clinical Psychology, 74(4), 767-776. https://doi.org/10.1037/0022-006X.74.4.767

Trajanovic, N. N., Radivojevic, V., Kaushansky, Y., & Shapiro, C. M. (2007). Positive sleep state misperception - A new concept of sleep misperception. Sleep Medicine, 8(2), 111-118. https://doi.org/10.1016/j.sleep.2006.08.013

Vacha-Haase, T., & Thompson, B. (2004). How to estimate and interpret various effect sizes. Journal of Counseling Psychology, 51(4), 473-481. https://doi.org/10.1037/0022-0167.51.4.473

Vallieres, A., & Morin, C. M. (2003). Actigraphy in the assessment of insomnia. Sleep, 26(7), 902-906. https://doi.org/10.1093/sleep/26.7.902

van Straten, A., van der Zweerde, T., Kleiboer, A., Cuijpers, P., Morin, C. M., & Lancee, J. (2018). Cognitive and behavioral therapies in the treatment of insomnia: A meta-analysis. Sleep Medicine Reviews, 38, 3-16. https://doi.org/10.1016/j.smrv.2017.02.001

Vanable, P. A., Aikens, J. E., Tadimeti, L., Caruana-Montaldo, B., & Mendelson, W. B. (2000). Sleep latency and duration estimates among sleep disorder patients: Variability as a function of sleep disorder diagnosis, sleep history, and psychological characteristics. Sleep, 23(1), 71-79. https://doi.org/10.1093/sleep/23.1.1d

WHO (2004). The international classification of diseases and related health problems. Geneva, Switzerland: WHO.