Insomnia

Question 1

What is the most prevalent sleep disorder?

Answer 1

Insomnia

Question 2

Is insomnia difficult to diagnose?

Answer 2

Yes because it is subjective

Question 3

What is initial insomnia?

Answer 3

Trouble falling asleep

Question 4

What is middle insomnia?

Answer 4

Trouble remaining asleep

Question 5

What is terminal insomnia?

Answer 5

Waking up too early

Question 6

What is insomnia?

Answer 6

It is about not having the right amount of sleep but not the right quality of sleep

Question 7

When is insomnia diagnosed? (2)

Answer 7

1) Experiencing sleep difficulties for more than a month

2) Resulting in daytime fatigue causes severe distress or impairs work, social or personal functioning

Question 8

Name 4 symptoms of insomnia

Answer 8

1) Waking up in the night
2) Not feeling refreshed after sleep, not being able to function normally during the day, irritable and tired, difficult to concentrate
3) Waking when disturbed by pain or noise
4) Waking up early in the morning

Question 9

What is transient insomnia?

Answer 9

Short-term

Question 10

What is intermittent insomnia?

Answer 10

Occasional

Question 11

What is chronic insomnia?

Answer 11

Long term - more than 4 weeks

Question 12

What is short-term insomnia?

Answer 12

Transient

Question 13

What is occasional insomnia?

Answer 13

Intermittent

Question 14

What is long-term insomnia?

Answer 14

Chronic

Question 15

What is primary insomnia?

Answer 15

More common in women and increasing in age - not directly associated with any other health condition or physical cause which occurs alone with no cause for than one month

Question 16

What is secondary insomnia?

Answer 16

Underlying medical, psychiatric or environmental problem

Question 17

Name and explain 2 risk factors of insomnia

Answer 17

1) Age and gender - increased physical problems with age (arthritis and diabetes), females affected by hormonal fluctuations
2) Personality - Kales (1976) found insomniacs more likely to internalise psychological disturbance, internalisation leads to increased levels of emotional arousal and increased likelihood of anxiety

Question 18

What might actually cause primary insomnia?

Answer 18

Poor sleep hygiene like staying up late, sleep where too light, playing computer games that cause sleep difficulties

Question 19

Name 5 causes of secondary insomnia

Answer 19

1) Hormonal changes
2) Decreased melatonin - older
3) Medical conditions - allergies, arthritis, asthma, heart disease, high blood pressure
4) Psychiatric - symptom of depression, associated anxiety, PTSD and dementia
5) Other sleep disorders like sleep apnoea - obstructions in breathing

Question 20

Name the main study supporting insomnia

Answer 20

Smith (2002)

Question 21

Outline Smith (2002)

Answer 21

Neuro-transmitting of NREM sleep - found clear evidence of abnormalities in insomniacs - 9 females (5 insomniacs and 4 controls) for 3 nights - insomniacs showed consistent and significant reduced blood flow in frontal medial, occipital and parietal cortices - provide evidence may be associated with abnormal nervous activity during NREM sleep

Question 22

Explain a positive evaluative point about insomnia

Answer 22

External validity - studies examined whether the findings from sleep labs related to reported sleep disorders from patients, so Garcia-Borregeuro (2004) found positive correlation between rating scales and lab measures of sleep of the sleep disorder restless leg syndrome - so some evidence that lab measures are good indicators of certain disorders & Schramm (1993) examined test-retest reliability of structured-sleep interview compared to lab recordings and found excellent reliabilities

Question 23

Outline Garcia-Borregeuro (2004)

Answer 23

Found positive correlation between rating scales and lab measures of sleep of the sleep disorder restless leg syndrome - so some evidence that lab measures are good indicators of certain disorders

Question 24

Outline Schramm (1993)

Answer 24

Examined test-retest reliability of structured-sleep interview compared to lab recordings and found excellent reliabilities

Question 25

Name and explain 4 negative evaluative points about insomnia

Answer 25

1) Difficulty in generalisations as there are so many types - Zisapel (2000) melatonin effective in a small group of elderly patients but ineffective in general treatment
2) May not be a sleep disorder at all but a symptom of something else so doctors should search for the cause of it (Dement 1999)
3) Vgontzas (1993) argue that using a number of sleep lab criteria is unsatisfactory in diagnosing - study 375 insomniacs & 150 controls and found ‘sleep lab recording provide little relevant info for confirming or excluding the presence of insomnia’
4) Research complications - highly complex with large number of factors contributing to insomnia and research only finds small effects and is unlikely to uncover clear solutions to the problem

Question 26

Outline Zisapel (2000)

Answer 26

Melatonin effective in a small group of elderly patients but ineffective in general treatment

Question 27

Outline Vgontzas (1993)

Answer 27

Argue that using a number of sleep lab criteria is unsatisfactory in diagnosing - study 375 insomniacs & 150 controls and found ‘sleep lab recording provide little relevant info for confirming or excluding the presence of insomnia’

Question 28

Why is it important to distinguish between primary and secondary insomnia?

Answer 28

If insomnia is a symptom it is important to treat the underlying disorder

Question 29

Why is it not important to distinguish between primary and secondary insomnia?

Answer 29

Does depression cause insomnia or is insomnia causing depression? Ohayon & Roth (2003) - 15,000 Europeans and found insomnia more often precedes cases of mood disorders so suggests it is helpful to treat insomnia regardless of primary and secondary

Question 30

Name the 4 consequences of insomnia and the research studies associated with them

Answer 30

1) Cognitive impairment - Zammit (1999)
2) Accidents - Arendt (2001)
3) Psychological disturbance - Breslau (1996)
4) Immune system under functioning - Savard (2003)

Question 31

Explain cognitive impairment for insomnia

Answer 31

Memory loss & poor concentration - Zammit (1999) found insomniacs scored lower on Medical Outcomes Study Cognitive Scale than controls demonstrating problems with concentration, memory, reasoning & problem solving

Question 32

Explain accidents for insomnia

Answer 32

Arendt (2001) - compared performance of adults deprived of one night’s sleep with adults given alcohol and found keeping people awake for 3 more hours than usual led to impairments equivalent to modest levels of alcohol

Question 33

Explain psychological disturbance for insomnia

Answer 33

Depression and anxiety - Breslau (1996) found insomnia associated with increasing risks for drugs and alcohol abuse

Question 34

Explain immune system under functioning for insomnia

Answer 34

Savard (2003) - found fewer immune cells in chronic insomniacs so more vulnerable to illness however problem with cause and effect as stress associated with insomnia

Question 35

Who came up with the 3 P’s model for insomnia?

Answer 35

Spielman & Glovinsky (1991)

Question 36

What are the 3 P’s for insomnia?

Answer 36

1) Predisposing factors
2) Precipitating factors
3) Perpetuating factors

Question 37

Explain predisposing factors for insomnia

Answer 37

For example genetic vulnerability - Watson (2006) found 50% variance in risk insomnia attributed to genetic factors

Question 38

Explain precipitating factors for insomnia

Answer 38

Events that trigger the disorder in a vulnerable individual - for example stress at work, exams, and shift work

Question 39

Explain perpetuating factors for insomnia

Answer 39

Factors that maintain insomnia when original casses disappeared or treated for example being tense when going to bed because of previous sleep problems

Question 40

Name and explain the IDA point for insomnia

Answer 40

Real-world application in the form of the cognitive approach - causes of insomnia is belief that going to have difficulty in sleeping so expectation becomes self-fulfilling as tense when going to sleep. So treatment - learnt to attribute sleep difficulties to ‘insomnia’ but if convinced source of difficulty lies elsewhere, it will end their dysfunctional attribution - Stroms & Nisbett (1970) gave insomniacs pill and told stimulate or sedative and found those expected arousal went to sleep faster as attributed arousal to pill and thus relaxed

Question 41

Outline Stroms & Nisbett (1970)

Answer 41

Gave insomniacs pill and told stimulate or sedative and found those expected arousal went to sleep faster as attributed arousal to pill and thus relaxed