Primary Insomnia

Primary Insomnia: Definition: problems with sleep patterns, particularly difficulties falling asleep or maintain sleep. Frequent to the extent it affects health and daily functioning. Speilman and Glovinsky: Predisposing (genetic/neurological =biological): females more likely to suffer due to hormonal differences Precipitating (triggering factors- environmental stressors): having a baby, stress, changing time zones. Perpetuating (maintains insomnia after trigger causes have ceased): tense when going to sleep or expectation of poor sleep. 60% insomnia patients could identify a trigger – Bastein et al

Research into the cause of insomnia Biological factors Smith et al. (2002) conducted a study into neuro-imaging of NREM sleep in insomniacs, finding there was clear evidence for biological abnormalities in individuals with insomnia. By studying both ‘normal’ sleeper and insomniacs via polysomnographies for 3 nights, those with insomnia showed a consistent and significant decrease in blood flow when compared to ‘normal’ sleepers. This was evident in the frontal medial, occipital and parietal cortices, showing that insomnia may well be linked to abnormality within the individual’s brain. This supports the idea that insomnia does have a biological basis.

Evaluation + Polysomnographies were used to measure blood flow, which is a scientific measure which provides empirical results. This increases the internal validity of the findings. +A control group of ‘normal sleepers’ was used.

Environmental factors Gregory et al (2006) studied the effects of family conflict on insomnia which linked to high levels of anxiety. A longitudinal study in New Zealand followed kids from 1972-2006. They used questionnaires to find out and record household life events. Extraneous variables were controlled e.g. socio-economic status, gender, health, and depression. They found the correlation between family conflict experience from 9 to 15 years and onset of insomnia by 18.

Evaluation Variables were well controlled Since it was a longitudinal – lots of information gathered. However a longitudinal may have suffered attrition rates. Low population validity since it was only conducted on chilfren from New Zealand (Can’t generalize results) Questionnaires were used which can lead to social desirability and demand characteristics.

Genetic factors Beaulieu-Bonneau et al (2007) found 37% of insomniacs had a close relative with the problem. Watson et al (2006) found monozygotic twin insomnia was highly correlated (+0.47) but dizygotic twin insomnia was not.

Personality factors Kales et al (1976) found insomniacs share certain personality characteristics. These include how they handle stress and conflict by internalizing their problems. Another study by Kales et al (1983) found traits such as depression, obsessiveness and inhibition of anger are all shared in insomniacs.

IDA One problem with explanation of insomnia is that we cant separate how much is due to environmental causes and how much is due to genetic causes. Genetic factors alone are unlikely to explain chronic insomnia as for some there are no other cases in the family. For others they do not respond well to behaviourally therapies suggesting environmental factors are insufficient in their own. This can make it difficult to treat as we do not always know what has causes.

Practical applications: Medication can be used to reduce the severity of insomnia: melatonin pills can be taken to increase drowsiness and ability to get to sleep. CBT can address the cognitive/psychological elements of insomnia by developing strategies to reduce stress and anxiety before sleep.