Feeling awake while asleep: A neurophenomenological study of sleep state misperception in insomnia and narcolepsy

Sleep is a basic need that represents a critical public health issue when disturbed or insufficient. Sleep state misperception (SSM) – the mismatch between subjective reports (what individuals perceive) and objective measures (what sleep specialists record) – complicates the diagnosis and treatment of sleep disorders. SSM is common in sleep disorders, including insomnia and narcolepsy, both of which struggle with managing the transition from wakefulness to sleep and exhibit severe overestimation of sleep onset latency. Despite recent advances in understanding the neurophysiological aspects of SSM, its subjective dimensions remain largely unexplored. This project aims to address this gap by integrating novel first-person methods from consciousness science, Micro-phenomenology and Temporal Experience Tracing, with objective neurophysiological data to better understand the experiential mechanisms behind SSM in insomnia, narcolepsy, and healthy controls. We will investigate SSM at three critical levels: 1) during the shift from wakefulness to sleep, using polysomnography and micro-phenomenology to identify the minimal requirements for feeling asleep and strategies developed by sleep disorder patients to facilitate/resist this transition; 2) during morning retrospective evaluation of sleep, using Temporal Experience Tracing to capture the dynamics of how sleep experiences are remembered and evaluated across a night of sleep, and its impact on morning fatigue; and 3) across multiple nights, to assess how day-to-day fluctuations in daytime cognition (mind-wandering, tiredness) and nighttime cognition (dreams) relates to SSM and mental health, using a 2-week protocol with actigraphy. This project has the potential to reveal key experiential dimensions related to SSM that have been overlooked, as well as a better knowledge of how SSM fluctuates over many days, which could lead to better evaluation tools or more personalized treatments for patients with sleep disorders.