Sham sleep feedback delivered via actigraphy biases daytime symptom reports in people with insomnia: Implications for insomnia disorder and wearable devices

Abstract

This study investigated whether providing sham feedback about sleep to individuals with insomnia influenced daytime symptom reports, sleep-related attentional bias and psychomotor vigilance. Sixty-three participants meeting DSM-5 criteria for insomnia disorder were recruited from the community. Following baseline assessments and actigraphy briefing, participants were randomised to receive next-day sham feedback on sleep quality ("positive" vs. "negative" sleep efficiency condition). Feedback was delivered at habitual rise-time using an integrated actigraphy-diary watch to simulate wearable device behaviour. Participants completed symptom reports immediately before receiving feedback, and at 12:00 and 15:00 hr, using the experience sampling method. Following this they returned to the laboratory in the evening to complete symptom reports and computerised tests of sleep-related attentional bias and basic psychomotor vigilance. Participants randomised to negative feedback (n = 32) evidenced impaired daytime function (decreased alert cognition [d = 0.79], increased sleepiness/fatigue [d = 0.55]) in the evening compared with those given positive feedback (n = 31). Within-day trajectories revealed that the positive-feedback group, relative to the negative-feedback group, displayed a significantly greater increase in positive mood and alert cognition (from rise-time to 12:00 hr), and significantly greater decrease in sleepiness/fatigue. There were no significant between-group differences on measures of sleep-related attentional bias [d = 0.20] or psychomotor vigilance [d = 0.12]. This controlled experiment shows that sham feedback about sleep biases appraisal of daytime symptoms, highlighting a pathway connecting sleep misperception with daytime features of insomnia. Findings have important implications for wearable devices that claim to measure "objective" sleep yet may provide inaccurate data relative to gold-standard measurement.

Subjective–objective sleep discrepancy in patients with insomnia during and after cognitive behavioural therapy: An actigraphy study

“…For patients who overestimate sleep quantity, objective feedback may not be beneficial or may be even harmful. In fact, Gavriloff et al (2018) showed that negative feedback about sleep can adversely affect patients' perceptions of daytime functioning. This can subsequently trigger distress through cognitive processes and exacerbate sleep impairment (Harvey, 2002).…”

The relationship between subjective sleep quality and cognitive performance in healthy young adults: Evidence from three empirical studies

“…Subjective sleep quality can be especially informative in populations with extremities in subjective sleep experience that are more susceptible to sleep disturbance. For instance, D Gavriloff, B Sheaves, A Juss, CA Espie, CB Miller and SD Kyle [63] in a recent paper showed that providing sham feedback to patients with insomnia influenced their daytime symptoms and cognitive performance such as attention and vigilance.…”

The relationship between subjective sleep quality and cognitive performance in healthy young adults: Evidence from three empirical studies

“…This phenomenon can be particularly prevalent amongst university students since the pressure for academic performance in this population is exceptionally high. The possible overestimation of the importance of one's subjective sleep quality can even lead to placebo or nocebo effects on cognitive performance 1,2 . However, scientific evidence on the relationship between experienced subjective sleep quality and cognition is still inconclusive [3][4][5][6][7] .…”

“…Stepanski et al 7 showed that, within insomniac patients, the decisive factor of whether a patient seeks medication is their subjective evaluation of their sleep quality and daytime functioning. Furthermore, Gavriloff et al 1 found that providing sham feedback about their sleep to patients with insomnia influenced their daytime symptoms and performance in attention and vigilance tasks. Similarly, in a placebo sleep study, young adults were randomly told they had below or above average sleep quality based on their brainwaves and other psychophysiological measures 2 .…”