title: The discrepancy between subjective and objective measures of sleep in older adults receiving CBT for comorbid insomnia.
abstract: OBJECTIVE
  To examine the effect of cognitive-behavioral therapy for insomnia (CBT-I) on the underreporting of sleep relative to objective measurement, a common occurrence among individuals with insomnia.
  
  
  METHODS
  Pre-treatment and post-treatment self-report measures of sleep were compared with those obtained from home-based polysomnography (PSG) in 60 adults (mean age = 69.17; 42 women) with comorbid insomnia. The self-report data were published previously in a randomized controlled trial demonstrating the efficacy of CBT-I compared with a placebo treatment.
  
  
  RESULTS
  Self-report measures significantly underestimated sleep at pre-treatment and CBT-I led to a correction in this discrepancy. There were no significant changes in PSG after CBT-I. Path analysis showed that an increase in an objective proxy measure of sleep quality (i.e., decreased stage N1 sleep) after CBT-I was significantly related to improvements in self-report of sleep, with full mediation by reductions in discrepancy.
  
  
  CONCLUSIONS
  This is the first CBT-I outcome study to analyze discrepancy changes and demonstrate that these changes account for a significant portion of self-report outcome. In addition, improved sleep quality as measured by a decrease in percentage of stage N1 sleep following treatment may be one mechanism that explains why sleep estimation is more accurate following CBT-I.
authors.affiliation: Virginia Commonwealth University Richmond, VA.
authors.forename: Hannah G
authors.initials: HG
authors.lastname: Lund
authors.forename: Bruce D
authors.initials: BD
authors.lastname: Rybarczyk
authors.forename: Paul B
authors.initials: PB
authors.lastname: Perrin
authors.forename: David
authors.initials: D
authors.lastname: Leszczyszyn
authors.forename: Edward
authors.initials: E
authors.lastname: Stepanski
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015928:Cognitive Behavioral Therapy / Q000592:standards*; D015897:Comorbidity; D003324:Coronary Artery Disease / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010003:Osteoarthritis / Q000453:epidemiology; D017286:Polysomnography; D029424:Pulmonary Disease, Chronic Obstructive / Q000453:epidemiology; D057566:Self Report; D012890:Sleep / Q000502:physiology*; D007319:Sleep Initiation and Maintenance Disorders / Q000175:diagnosis* / Q000453:epidemiology / Q000503:physiopathology; D016896:Treatment Outcome
keywords: cognitive-behavioral therapy; health psychology; insomnia