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Psychology Factsheets

Number 94

Disorders of sleep
This Factsheet summarises explanations of insomnia, sleepwalking, narcolepsy and hypersomnia. Terms in bold are explained in the glossary.

Cataplexy: muscle weakness which occurs when a person is awake. Chronic: long-lasting. Hypnagogic hallucinations: dreamlike experiences which can occur when falling asleep and which are hard to distinguish from reality. Hypothalamus: a part of the brain involved in emotion, hunger, motivation and the stress response. Melatonin: a hormone that is produced by the pineal gland in the brain and which increases sleepiness. Non-REM sleep: stages 1 to 4 of sleep. There is no eye movement during non-REM sleep. REM: stands for rapid eye movement. The stage of sleep in which the muscles are paralysed, apart from those controlling eye movements. Sleep paralysis: when a person is unable to move when falling asleep or waking up.

A. Introduction
• • Sleep disorders are problems which occur with a person’s ability to sleep. Various types of sleep disorder include insomnia, narcolepsy, hypersomnia and sleepwalking. The unsatisfactory sleep caused by sleep disorders has many negative consequences. For example, unsatisfactory sleep can: o Affect the response of the immune system. o Contribute to health problems, like obesity and heart disease. o Increase the risk of accidents at work. o Affect how well a person can concentrate and perform tasks. o Affect learning and the consolidation of memories. Sleep problems are more likely to occur in people who: o Have psychiatric problems, such as depression, substance abuse and schizophrenia (Benca et al., 1992). o Work long or irregular hours. Textbox 1 Factsheet 26 ‘Sleep’ summarises and evaluates what sleep is, how it is measured, its function and the effects of sleep deprivation. Factsheet 82 ‘Biological Rhythms’ summarises and evaluates the biological rhythms involved in sleep.

Some causes of insomnia:
• Insomnia can relate to problems with a person’s biological rhythms (McFarlane et al., 1985). Normally, people fall asleep while their body temperature is dropping. However, in some people, the body temperature rhythm is ‘phase delayed’ so that are trying to fall asleep when their body temperature is higher than normal for going to sleep. This tends to cause onset insomnia. Other people’s body temperature rhythm is ‘phase advanced’, rising sooner than it should towards morning. This tends to cause termination insomnia. See textbox 2. Insomnia can be linked to a lack of the hormone melatonin. There is some evidence that insomniac people who are given melatonin about two hours before going to bed find it easier to get to sleep (Schochat et al., 1997). There is some evidence for a genetic factor to insomnia; about one third of people with insomnia have one parent who has also suffered from insomnia. Insomniacs tend to be more anxious and worried than people who sleep normally, but it is not clear if this is a cause or effect of insomnia. See textbox 3. Insomnia can be related to other problems with sleeping, such as sleep apnoea. Sleep apnoea is a disorder where a person stops breathing while asleep as the muscles of the soft palate relax, blocking the airway. This causes them to momentarily wake up, although they are unaware of waking. They fall back to sleep once breathing has resumed. This can happen hundreds of times in a night, stopping the person from going into deeper, slow wave sleep. It tends to affect overweight, older men. It can cause high blood pressure and may increase the risk of heart attack. The use of tranquilisers as sleeping pills can (ironically) lead to insomnia. Sleeping pills block some of the neurotransmitters that increase arousal. A short-acting tranquiliser may wear off in night, causing the person to wake early. Also, the person may become dependent on them, so when they stop taking them and are in withdrawal, they have difficulty sleeping (Kales et al., 1978). Other possible causes of insomnia include: epilepsy, Parkinson’s disease, chronic pain, noise, etc.

B. Insomnia
• A person suffering from insomnia has the normal desire to sleep but has a chronic inability to sleep normally. They may have one or more of the following: ~ Onset insomnia - difficulty falling asleep. ~ Maintenance insomnia - waking up frequently during the night. ~ Termination insomnia - waking up too early and not being able to get back to sleep. The lack of sleep leaves them feeling poorly rested the next day. It is a common sleep disorder; approximately 30% of adults having symptoms. Females, elderly adults and people who do shift work tend to have higher rates of insomnia than others in the general population. It is also more common in people suffering from depression. Insomnia is categorised into two types as shown in Table 1.

• • •

Table 1: Types of insomnia
Primary insomnia Primary insomnia cannot be attributed to psychological, environmental and/or medical causes. It can be triggered by life changes, such as longlasting stress, travel and work schedules that disrupt the sleep routine Secondary insomnia Secondary insomnia is caused by another condition. It can be attributed to psychological, environmental and/or medical causes. •


making weight loss more difficult. affecting about 5 people in every 10. in their diaries they had overestimated how long it took them to get to sleep. The most common cause is other disorders that result in inadequate amounts of sleep. with REM sleep occurring at inappropriate times. participants who had been shown the discrepancy were now more accurate at estimating how long it took them to get to sleep. Narcolepsy is when a person has repeated. The researchers conclude that a distorted perception of sleep does perpetuate insomnia by feeding anxiety and preoccupation with sleep. After the second three-night session. E. the actigraph measurements were used to show half of the participants that there was a discrepancy between measurements. An adult is considered to have hypersomnia if he/she regularly sleeps for over 10 hours per day. Swaab and Van Someren (2008) examined whether wearing a warming body suit (warmed by small water-filled pipes) could affect a person’s sleep. lasting from 5 to 30 minutes. Participants wore the actigraph and kept a sleep diary for three nights. for at least two weeks. such as reductionism vs. They also reported significantly less sleep-related anxiety than the other participants. • Considering the biological approach in general. the increase in skin temperature reduced the likelihood of being awake at 6am and increased the likelihood of older insomniacs being in a deep. you can consider the advantages and disadvantages of studying sleep disorders in laboratories or of using self-report measures of sleep. slow wave sleep at any point in the night. It affects about 4% to 5% of the population. Orexin stimulates acetylcholine-releasing cells which increase wakefulness and arousal (Thanickal et al. • Evaluating the research methods used. These periods of sleep are brief. which may perpetuate a cycle of sleep-related anxiety.Disorders of sleep D. Exam Hint: Do not use rote-learnt points of evaluation. • Considering relevant debates.4°C (this did not affect their core body temperature). such as when the person is awake or as soon as they fall asleep. The procedure was repeated for three more nights. They recruited 24 adults for the study. unexpected and uncontrollable periods of sleep during the day. which can often worsen weight problems as excessive sleeping decreases energy consumption. Persistent sleepwalking happens in 1% to 6 % of children and affects boys more often than girls. biological explanations of behaviour are criticised for being reductionist (see Curriculum Press factsheet ‘The Biological Approach to Psychology’). F.. The researchers propose that skin temperature affects cells in the hypothalamus which are responsible for controlling sleep. Sleep disorders are largely considered in terms of their biology and you can evaluate this biological approach. Sleepwalking (somnambulism) • • • • • Sleepwalking is an episode of complex behaviour in which a person may act out their dreams. This happens quite a lot. It occurs during stages 3 and 4 of non-REM sleep which are the deepest stages of sleep and when the muscles are not paralysed. they are ‘glassy’. Evaluation You can evaluate research studies into sleep disorders and/or the explanations of what causes such sleep disorders by: • Using supporting evidence or contradictory evidence which shows a limitation of the study/explanation. “Not so funny an experience is when I go to sleep with a cup of hot tea in my hand and it goes all over me. particularly sleep of the deeper stages. The participants spent one night in the body suit at a sleep laboratory. make sure that your information applies directly to the question and do not used pre-prepared material on the wrong topic.” Experience of a narcoleptic reported on the Narcolepsy Association UK’s website. It is rare. 2000). • • • • C. 2 . For example. hypnagogic hallucinations and sleep paralysis. It can also be related to depression. A sleepwalking person may sit up. It is caused by a problem with the mechanisms in the brain which control wakefulness and sleep. Acknowledgements: This Psychology Factsheet was researched and written by Amanda Albon. Overweight people may be more likely to suffer from hypersomnia. although their eyes are open. holism. such as narcolepsy and sleep apnoea. The suit alternated between keeping their skin temperature at 35°C or 35. For example.000 in Europe and North America. The person usually has no recollection of the episode afterwards. Narcolepsy • Psychology Factsheet Textbox 2 Raymann. For example. After three nights. walk around and get dressed and. Up to 4% of adults sleepwalk. half of whom suffered from insomnia. They recorded the participants’ brain waves during the night. Make sure that you show your knowledge by applying your evaluation specifically to the study/explanation which you are discussing. They may experience cataplexy. followed by a night at home. and then by another night in the body suit at the laboratory. • Considering any ethical issues which arise in studies of sleep disorders. • • • • Textbox 3 Tang and Harvey (2004) examined whether insomniac people overestimate how long it takes them to get to sleep. Exam Hint: When answering an exam question on sleep disorders.94 . They recruited 40 university students who had primary insomnia. For participants with insomnia. Hypersomnia • • Hypersomnia is persistent and excessive sleepiness during the day. some sleep disorders may be genetic or may be influenced by environmental factors – this relates to the naturenurture debate. This may be due to a lack of nerve cells in the hypothalamus which produce and release the neurotransmitter orexin (also called hypocretin). They fitted the participants with a watch-like device (an actigraph) that objectively recorded how much they moved in the night.

What types of measure did they use? Evaluate these measures. such as those used in Tang and Harvey’s (2004) study. if writing about insomnia. For example. Give two points of evaluation of Raymann et al. You could also focus on the strengths and weaknesses of the research methods used to obtain this evidence. you could evaluate the explanation that it is caused by anxiety by referring to other evidence which supports this explanation or which contradicts it. --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------2. you can consider the points mentioned in section F of this factsheet. What is the difference between primary and secondary insomnia? ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------3. Tang and Harvey (2004) used two measures of participants’ sleep. --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------4. To evaluate an explanation for the disorder. (Remember that you can use both positive and negative criticisms).94 . For example. Describe one explanation for insomnia.Disorders of sleep Psychology Factsheet Worksheet: Disorders of sleep Name 1. you can choose any one of the disorders in this Factsheet. Describe two characteristics of a sleep disorder. To answer this question. The command word ‘outline’ is asking you to briefly describe that disorder.’s (2008) study into insomnia. you can write about its characteristics (symptoms) and how often it occurs in a population. 3 . ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------5. ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------Example exam question Outline one sleep disorder and evaluate one explanation for that disorder.