Psychology Factsheets

www.curriculum-press.co.uk

Number 94

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

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 persons 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 persons 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 peoples 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, Parkinsons 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.

94 - Disorders of sleep D. Narcolepsy

Psychology Factsheet

Textbox 2
Raymann, Swaab and Van Someren (2008) examined whether wearing a warming body suit (warmed by small water-filled pipes) could affect a persons sleep. They recruited 24 adults for the study, half of whom suffered from insomnia. The participants spent one night in the body suit at a sleep laboratory, followed by a night at home, and then by another night in the body suit at the laboratory. The suit alternated between keeping their skin temperature at 35C or 35.4C (this did not affect their core body temperature). They recorded the participants brain waves during the night. For participants with insomnia, the increase in skin temperature reduced the likelihood of being awake at 6am and increased the likelihood of older insomniacs being in a deep, slow wave sleep at any point in the night. The researchers propose that skin temperature affects cells in the hypothalamus which are responsible for controlling sleep.

Narcolepsy is when a person has repeated, unexpected and uncontrollable periods of sleep during the day. They may experience cataplexy, hypnagogic hallucinations and sleep paralysis. These periods of sleep are brief, lasting from 5 to 30 minutes. It is rare, affecting about 5 people in every 10,000 in Europe and North America. It is caused by a problem with the mechanisms in the brain which control wakefulness and sleep, with REM sleep occurring at inappropriate times, such as when the person is awake or as soon as they fall asleep. This may be due to a lack of nerve cells in the hypothalamus which produce and release the neurotransmitter orexin (also called hypocretin). Orexin stimulates acetylcholine-releasing cells which increase wakefulness and arousal (Thanickal et al., 2000).

Textbox 3
Tang and Harvey (2004) examined whether insomniac people overestimate how long it takes them to get to sleep, which may perpetuate a cycle of sleep-related anxiety. They recruited 40 university students who had primary insomnia. They fitted the participants with a watch-like device (an actigraph) that objectively recorded how much they moved in the night. Participants wore the actigraph and kept a sleep diary for three nights. After three nights, the actigraph measurements were used to show half of the participants that there was a discrepancy between measurements; in their diaries they had overestimated how long it took them to get to sleep. The procedure was repeated for three more nights. After the second three-night session, participants who had been shown the discrepancy were now more accurate at estimating how long it took them to get to sleep. They also reported significantly less sleep-related anxiety than the other participants. The researchers conclude that a distorted perception of sleep does perpetuate insomnia by feeding anxiety and preoccupation with sleep.

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. This happens quite a lot. Experience of a narcoleptic reported on the Narcolepsy Association UKs website.

E. Hypersomnia
Hypersomnia is persistent and excessive sleepiness during the day. An adult is considered to have hypersomnia if he/she regularly sleeps for over 10 hours per day, for at least two weeks. It affects about 4% to 5% of the population. The most common cause is other disorders that result in inadequate amounts of sleep, particularly sleep of the deeper stages, such as narcolepsy and sleep apnoea. It can also be related to depression. Overweight people may be more likely to suffer from hypersomnia, which can often worsen weight problems as excessive sleeping decreases energy consumption, making weight loss more difficult.

C. Sleepwalking (somnambulism)
Sleepwalking is an episode of complex behaviour in which a person may act out their dreams. A sleepwalking person may sit up, walk around and get dressed and, although their eyes are open, they are glassy. 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. The person usually has no recollection of the episode afterwards. Persistent sleepwalking happens in 1% to 6 % of children and affects boys more often than girls. Up to 4% of adults sleepwalk.
Exam Hint: When answering an exam question on sleep disorders, make sure that your information applies directly to the question and do not used pre-prepared material on the wrong topic.
Exam Hint: Do not use rote-learnt points of evaluation. Make sure that you show your knowledge by applying your evaluation specifically to the study/explanation which you are discussing.
Acknowledgements: This Psychology Factsheet was researched and written by Amanda Albon.

F. 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. Evaluating the research methods used. For example, you can consider the advantages and disadvantages of studying sleep disorders in laboratories or of using self-report measures of sleep. Considering the biological approach in general. Sleep disorders are largely considered in terms of their biology and you can evaluate this biological approach. For example, biological explanations of behaviour are criticised for being reductionist (see Curriculum Press factsheet The Biological Approach to Psychology). Considering any ethical issues which arise in studies of sleep disorders. Considering relevant debates, such as reductionism vs. holism. For example, some sleep disorders may be genetic or may be influenced by environmental factors this relates to the naturenurture debate.

94 - Disorders of sleep

Psychology Factsheet Worksheet: Disorders of sleep

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