Individuals who are convinced that they are insomniacs are at greater risk of fatigue, anxiety, and other health problems than people who do not view themselves so, regardless of whether they sleep well or not.
So concludes a review of sleep research by Kenneth Lichstein, a professor of psychology from the University of Alabama in Tuscaloosa, who recently reported his findings in the journal of Behaviour Research and Therapy.
Insomnia is a common disorder in which people find it hard to fall asleep, stay asleep, or both. This can cause them to have insufficient or poor-quality sleep that leaves them feeling unrefreshed at the start of their day.
But the new findings support the idea that insomnia may also have a psychological component.
Prof. Lichstein, who has been researching sleep for more than 30 years, revealed that believing oneself to suffer from poor sleep — which he defines as having “insomnia identity” — is a better predictor of poor health than the sleep that is actually measured.
“We can independently assess people’s view of their sleep and their sleep,” he explains, adding that “[i]nsomnia identity is a more potent predictor of daytime impairment than poor sleep.”
Prof. Lichstein is not arguing with the fact that insufficient sleep — which is thought to affect around a third of adults in the United States — is linked to prolonged illnesses such as heart disease, diabetes, and depression.
What he concluded, after reviewing 12 sleep studies that have been published during the past 20 years, is that regardless of whether one actually has poor sleep or not, believing oneself to be an insomniac can do just as much, if not more, harm.
Individuals with insomnia identity become anxious about not getting what they perceive be a good sleep. Perhaps they take longer to fall asleep than they wish, or they wake briefly during a sleep, and they see these problems as being major causes of sleep deprivation when their impact is actually quite minor.
“Insomnia identity drives worry,” Prof. Lichstein says, “and worry is the fuel of stress. That stress has physical effects on our life.”
In his review, he compared the “presence or absence of poor sleep” — which can be measured — with the “presence or absence of insomnia identity” and found patterns that run counter to “conventional wisdom.”
Regardless of whether or not poor sleep was actually present, individuals who labeled themselves as insomniacs — that is, “claimed an insomnia identity” — were at greater risk of conditions that are associated with poor sleep, such as depression, self-stigma, suicidal thoughts, anxiety, fatigue, and high blood pressure.
Prof. Lichstein suggests that around a third of people who believe themselves to be insomniacs actually sleep well.
He also proposes that around 25 percent of people are what he terms “uncoupled sleepers” — that is, they have an “uncoupling,” or disconnect, between their actual sleep and how they appraise sleep.
This gives rise, Prof. Lichstein explains, to “complaining good sleepers” and “noncomplaining poor sleepers,” and that “daytime impairment accrues more strongly to those who endorse an insomnia identity.”
Noncomplaining poor sleepers seemed to be in better health, according to self-reported outcomes, than individuals with insomnia identity, he found.
“There are clearly people with poor sleep who are relaxed about it,” Prof. Lichstein says. They just let it “roll off their back, and they are at low risk for impaired functioning.”
“Insomnia identity drives the daytime dysfunction, not the sleep,” he adds, and he argues that research supports the idea that “there is a cost to pathologizing sleep.”
The review concludes with suggestions for future research and theories on insomnia identity, as well as how it might be treated and managed.
“It’s helpful to reconceptualize our view of insomnia in such a way that focuses on the critical clinical aspects of the disorder.”
Prof. Kenneth Lichstein