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Intra-Night Sleep Perception in Patients with Sleep Disorders

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Abstract

Measured and rated sleep differ in normal sleepers and even more in patients with sleep disorders. The study aimed to asses sleep/wake perception in electrophysiologically defined sleep in patients with sleep disorders. 117 consecutively referred patients (75 females), median age 50.3 years, range 20–73 years) with various sleep disorders were randomized for one induced waking, either out of stage 2 (S2) or REM sleep, as part of a clinical routine polysomnography. Patients were classified as either non-sleepy (Epworth Sleepiness Scale score ESS ≤ 10) or sleepy (ESS ≥ 11). The most frequent diagnoses of non-sleepy patients were insomnia and RLS, while sleepy patients suffered predominantly from OSAS, hypersomnia and insufficient sleep syndrome. Subjects were deliberately aroused once, either out of consolidated stage 2 sleep (n = 66) or REM sleep (n = 51) and asked for sleep/wake perception (sleep/wake and related questions). While 81 (69.2%) of the subjects estimated that they had been sleeping or dozing before they were aroused, 36 (30.8%) reported that they had been awake. Awake ratings were significantly more frequent for S 2 (45.5%) than for REM sleep (11.8%). The difference between sleep states was most pronounced for insomniacs (58.1% awake ratings in S2 vs. 5.3% in REM sleep). Mismatches between measured sleep and perceived state are quite frequent, with a greater disparity for S2 than for REM sleep, especially in insomniac patients. We suggest that state judgement is contingent not only on the state of the sleep regulating system but also on cognitive processes associated with processing of external and internal stimuli, and dreaming.

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Acknowledgements

The authors thank the team of technicians of the sleep laboratory of the Neurological Clinic, Bärbel Rothe, Diana Wickner, Birgit Schubert, Janine Döring, and Eyline Heyde for excellent support and cooperation.

Author information

Authors and Affiliations

  1. Department of Neurology, HELIOS Klinikum Erfurt, Erfurt (Former Institution), Erfurt, Germany

    Hartmut Schulz & Björn W. Walther

  2. SRH Zentralklinikum Suhl, Abteilung für Neurologie, Suhl, Germany

    Hartmut Schulz & Björn W. Walther

Authors
  1. Hartmut Schulz
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  2. Björn W. Walther
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Corresponding author

Correspondence to Hartmut Schulz.

Appendix

Appendix

Questions of the interview

1. Were you awake or did you sleep before you heard the tone signal?

2. How sure are you about your decision?

(a) Absolutely sure, (b) Fairly sure, (c) Not sure

3 a. If “sleep” was answered to question 1:

Before you heard the tone signal, were you…

(a)… in deep sleep, (b)… in light sleep, or (c)… in a transient state between awake and sleep?

3b. If “awake” was answered to question 1:

Before you heard the tone signal, were you…

(a)… wide awake, (b)… awake but sleepy, or (c)… in a transient state between awake and sleep?

4. If “awake” was answered to question 1:

How long had you been awake before you heard the signal?

5. On which impressions is your judgement of having been awake or asleep based?

6. Was there something on your mind before being awakened?

If yes:

(a) Was it rather clear and distinct or rather vague and blurred? (b) Was it rather image-like or rather thought-like? (c) Could you control it yourself or did it just happen?

7. Did you notice a transition from sleep to wakefulness?

If yes: Can you describe it further?

8. Before you heard the signal were you aware of where you were and where the things around you were located?

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Schulz, H., Walther, B.W. Intra-Night Sleep Perception in Patients with Sleep Disorders. Sleep Vigilance 1, 89–95 (2017). https://doi.org/10.1007/s41782-017-0023-8

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  • DOI: https://doi.org/10.1007/s41782-017-0023-8

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