2. Click on the topic that you want to go to: InsomniaSleepwalkingNarcolepsy

3. Insomnia Factors influencing insomnia Explanations of primary insomnia Eplanations of secondary insomnia Click on the section you would like to go to: Return to main menu Guidance on evaluating studies Guidance on IDA for primary insomnia Guidance on IDA for secondary insomnia General commentary on primary insomnia explanations

4. Insomnia Click on the section you would like to go to: Age & gender Sleep apnoea Factors influencing insomnia

5. Insomnia Factors influencing insomnia: Age & Gender: Older people & women are more likely to suffer from insomnia In older people, this may because of increasing physical problems such as arthritis or diabetes In women, the greater likelihood of insomnia may be due to hormonal fluctuations (e.g. The menopause) Return to insomnia menu Return to main menu Go to sleep apnoea

6. Insomnia Factors influencing insomnia: Sleep Apnoea: This is because the pauses in breathing that characterise the condition may occur for up to 50 times an hour, thus having a major disruptive effect on sleep Sleep apnoea can also be considered an explanation of secondary insomnia Occasional bouts of sleep apnoea are quite common, but in some it is a regular occurance. During a bout of apnoea, carbon dioxide builds up in the bloodstream to the point where it stimulates chemoreceptors (neurons that detect specific chemicals in the blood) These cause the sufferer to wake up gasping for breath. Return to insomnia menu Return to main menu Go to age & gender Watch someone experiencing sleep apnoea

8. Sleep Apnoea Why do you think this condition is linked to insomnia? Return to insomnia menu Return to sleep apnoea Watch clip again

9. Insomnia Explanations for Primary insomnia Click on the topic you would like to go to: Personality Hyperarousal

10. Insomnia Explantions for Primary insomnia: Personality: Kales et al (1976) found that insomniacs were more likely to internalise psychological disturbance, rather than acting out problems or being aggressive How well does this research support the view that internalisation causes insomnia? The researchers proposed that internalisation leads to higher levels of emotional arousal and increased likelihood of feeling anxious, which is why it is a risk factor for insomnia Return to insomnia menu Return to main menu Go to hyperarousal Guidance on evaluating studies

11. Insomnia Explantions for Primary insomnia: Hyper-arousal: It has been suggested that insomniacs experience a state of hyper-arousal. Definition of hyper- arousal Research into hyper- arousal Study 1 Research into hyper- arousal Study 3 Research into hyper- arousal Study 2 Click on the links below for more information. Select two studies out of the three given to put onto your worksheets Return to insomnia menu

12. Hyper-arousal definition A majority of patients with insomnia are chronically hyperaroused and, surprisingly, not only at night. This means, among other things, that their metabolism is faster than that of good sleepers, their body temperature is slightly higher, their brain waves are faster, and they are thinking and speaking fast, highly aroused, as if anxious Hyper-arousal definition A majority of patients with insomnia are chronically hyperaroused and, surprisingly, not only at night. This means, among other things, that their metabolism is faster than that of good sleepers, their body temperature is slightly higher, their brain waves are faster, and they are thinking and speaking fast, highly aroused, as if anxious Return to hyperarousal main page

13. Research into hyper-arousal Study 1 Vgontzas (2001) found that insomniacs have increased levels of adrenocorticotropic hormone (ACTH) and cortisol, both of which are associated with stress and arousal Research into hyper-arousal Study 1 Vgontzas (2001) found that insomniacs have increased levels of adrenocorticotropic hormone (ACTH) and cortisol, both of which are associated with stress and arousal Return to hyperarousal main page Go to study 2 Go to study 3 Guidance on evaluating studies

14. Research into hyper-arousal Study 2 Nofzinger et al (2004) found that the transition from being awake to being asleep is usually associated with a decrease in activity in the brain stem, thalamus and prefrontal cortex. Using PET scans, Nolfzinger et al showed that insomniacs experienced a smaller decline in such activity when going to sleep. In fact, they found elevated level of activity in the brains of insomniacs Research into hyper-arousal Study 2 Nofzinger et al (2004) found that the transition from being awake to being asleep is usually associated with a decrease in activity in the brain stem, thalamus and prefrontal cortex. Using PET scans, Nolfzinger et al showed that insomniacs experienced a smaller decline in such activity when going to sleep. In fact, they found elevated level of activity in the brains of insomniacs Return to hyperarousal main page Go to study 1 Go to study 3 Guidance on evaluating studies

15. Research into hyper-arousal Study 3 Winkleman (2008) Insomnia may be caused by specific changes in brain chemistry. They found that people who had been suffering with insomnia for more than six months have reduced levels in their brain of the neurotransmitter GABA. This is known to reduce levels of activity in the brain. Therefore, reduced GABA would lead to an inability to ‘switch off’ at night. Research into hyper-arousal Study 3 Winkleman (2008) Insomnia may be caused by specific changes in brain chemistry. They found that people who had been suffering with insomnia for more than six months have reduced levels in their brain of the neurotransmitter GABA. This is known to reduce levels of activity in the brain. Therefore, reduced GABA would lead to an inability to ‘switch off’ at night. Return to hyperarousal main page Go to study 1 Go to study 2 Guidance on evaluating studies

17. Insomnia Guidance on evaluating studies When evaluating studies of insomnia think about the following points: What conclusion is the study attempting to draw? What method is being used? Are there any problems with using this method? Are there any problems with attempting to establish a cause and effect relationship from this study? What are the positive points relating to the way the study was carried out? Are there any problems with making generalisations from this study? Return to insomnia menu Return to main menu Play slide again

18. Insomnia Guidance on using IDA to evaluate theories of primary insomnia Reductionism Some of these explanations are reductionist What does that mean? Why does it matter? What factors have not been taken into account? The nature nurture debate Does the explanation fall on the nature or nurture side of the argument? Are there any consequences of this (socially sensitive)? Could we explain the insomnia using the other side of the argument? Return to insomnia menu Return to main menu

19. Insomnia Explanations for secondary insomnia Click on the topic you would like to go to: Medical conditions Mental Health First watch a brief case study of secondary insomnia or

21. Insomnia What are the factors that seem to be responsible for this woman’s insomnia? Return to secondary insomnia Return to insomnia menu Watch clip again

22. Insomnia Explanations for secondary insomnia Medical conditions: A range of medical conditions have been shown to be associated with insomnia Research into medical conditions and insomnia Katz et al (2002) conducted a study involving 3,445 patients with a diagnosis of one or more of five chronic medical conditions, including hypertension, congestive heart failure. Responses to self-administered questionnaires showed that 50% of them reported syptoms indicative of insomnia, such as difficulty initiating and maintaining sleep. Insomnia was rated mild in 34% of the patients and severe in 16% Research into medical conditions and insomnia Katz et al (2002) conducted a study involving 3,445 patients with a diagnosis of one or more of five chronic medical conditions, including hypertension, congestive heart failure. Responses to self-administered questionnaires showed that 50% of them reported syptoms indicative of insomnia, such as difficulty initiating and maintaining sleep. Insomnia was rated mild in 34% of the patients and severe in 16% Return to insomnia menu Return to main menu Go to mental health Guidance on evaluating studies

23. Insomnia Explanations for secondary insomnia Mental health: There is evidence to suggest that insomnia is an additional symptom for many people suffering with mental health difficulties Add the details of the following pieces of research to you worksheets: Research into secondary insomnia Study 1 Research into secondary insomnia Study 2 Research into secondary insomnia Study 3 Return to insomnia menu

25. Insomnia Explanations for secondary insomnia Mental health research study 1: Weiss et al (1962) Percentage of people reporting sleep disturbance Psychiatric patients Control group 18% 72% Return to insomnia menu Go to Research Study 2 Go to Research Study 3 What do you think Weiss found? Click on the button to find out: Guidance on evaluating studies Results

27. Insomnia Explanations for secondary insomnia Mental health research study 1: Weiss et al (1962) Percentage of people reporting sleep disturbance Psychiatric patients Control group 18% 72% Return to insomnia menu Go to Research Study 2 Go to Research Study 3 What do you think Weiss found? Click on the button to find out: Guidance on evaluating studies Results

29. Insomnia Explanations for secondary insomnia Mental health research study 2: Ohayon & Roth (2003) Interviewed 14,195 participants representative of the general populations of the UK, Italy, Portugal and Germany over the telephone about their psychiatric history and their sleep patterns What do you think they found? Click on the button to find out: People with insomnia were six times more likely to report a mental health problem, such as depression or anxiety, than people without insomnia Return to insomnia menu Go to Research Study 1 Go to Research Study 3 Guidance on evaluating studies zzz Results

31. Insomnia Explanations for secondary insomnia Mental health research study 2: Ohayon & Roth (2003) Interviewed 14,195 participants representative of the general populations of the UK, Italy, Portugal and Germany over the telephone about their psychiatric history and their sleep patterns What do you think they found? Click on the button to find out: People with insomnia were six times more likely to report a mental health problem, such as depression or anxiety, than people without insomnia Return to insomnia menu Go to Research Study 1 Go to Research Study 3 Guidance on evaluating studies zzz

32. Insomnia Explanations for secondary insomnia Mental health research study 3: Serretti et al (2003) Found that insomniacs and Depressives may have similar abnormalities in their biological clocks. Patients with depression who have been found to have an abnormality in the genes that govern circadian pacemakers are more likely to experience severe insomnia Why does this study maybe challenge the view that insomnia is caused by secondary factors? Return to insomnia menu Go to Research Study 1 Go to Research Study 2 Guidance on evaluating studies

33. Insomnia Guidance on using IDA to evaluate theories of secondary insomnia Approaches Which approaches are used in this explanation? What might that lead to? Why does it matter? What factors may not been taken into account? The nature nurture debate Does the explanation fall on the nature or nurture side of the argument? Are there any consequences of this (socially sensitive)? Could we explain the insomnia using the other side of the argument? Return to insomnia menu Return to main menu

34. Insomnia General commentary on explanations of primary insomnia: When discussing explanations of primary insomnia, we need to understand the interaction between predisposing, precipitating and perpetuating factors Predisposing factors Precipitating factors Perpetuating factors Return to insomnia menu Click on the section you would like to go to:

35. Insomnia Predisposing factors These are factors that make it more likely that a person will develop insomnia and include having a genetic predisposition towards insomnia In a twin study, Watson et al (2006) found that 50% of the variance in the risk for insomnia could be attributed to genetic factors Precipitating factors Perpetuating factors Return to insomnia menu Guidance on evaluating studies

37. Insomnia Precipitating factors It is unlikely that predisposing factors alone can explain chronic primary insomnia. It is likely that precipitating factors play a part These include factors such as environmental stressors or change, which may trigger insomnia in those who are vulnerable Which IDA point does this link to? Predisposing factors Perpetuating factors Return to insomnia menu

39. Insomnia Perpetuating factors Perpetuating factors are factors which maintain the insomnia even when the original causes have disappeared These include being tense about going to bed because of previous experience of insomnia, or simply the expectation that sleep will be difficult I don’t feel tired Predisposing factors Precipitating factors Return to insomnia menu I’m not going to be able to get to sleep I’m going to feel lousy again tomorrow Maybe I should try counting sheep onetwothree Damn!

40. Sleepwalking Risk Factors & Explanations: Sleepwalking is a disorder that is most common in childhood It affects around 20% of children, but less then 3% of adults Sleepwalking occurs only in NREM sleep

41. Sleepwalking Risk Factors & Explanations: Sleepwalking is a disorder of arousal EEG recordings show a mixture of delta waves which are characteristic of SWS sleep, but also higher frequency beta waves which are characteristic of an awake state It looks as though sleepwalking occurs when the person is awakened, but the arousal of the brain is incomplete Incomplete arousal This abnormal arousal is likely to be genetic

42. Sleepwalking Risk Factors & Explanations: The following have all been associated with the occurrence of sleep walking: Various factors Sleep deprivation Alcohol Having a fever Stress or psychiatric conditions Hormonal changes during puberty & menstruation

43. Sleepwalking Risk Factors & Explanations: It has been suggesting that sleepwalking may be more common in children because children have more SWS sleep than adults Why Children? Another recent suggestion is that the system that inhibits motor activity in SWS is not sufficiently developed in some children and may be underdeveloped in some adults (Oliviero, 2008) This was demonstrated in a study that examined the motor excitability of adult sleep walkers during wakefulness. Compared to a control group, the sleepwalkers showed immaturity in the relevant neural circuits

44. Sleepwalking Commentary: There is evidence to support a stress diathesis model of sleepwalking This is because there is quite strong evidence that there is a genetic predisposition towards sleep walking Broughton (1968) found that the prevalence of sleepwalking in a first degree relative of a sufferer, is at least 10 times greater than in the general population What conclusion is being drawn from this research? Why might it be difficult to draw such a conclusion from this type of study?

45. Sleepwalking Commentary: There is evidence to support a stress diathesis model of sleepwalking This is because there is quite strong evidence that there is a genetic predisposition towards sleep walking Lecendreux et al (2003) found around 50% concordance in MZ twins compared to 10–15% in DZs and have also identified a gene which may be implicated in sleepwalking and night terrors (DQB1*05) What are the problems with drawing cause and effect conclusions from twin studies?

46. Sleepwalking Commentary: There is evidence to support a stress diathesis model of sleepwalking The stress part of the model looks at the external factors that may trigger the disorder Sleep deprivaton, alcohol and fever all lead to an increase in SWS, which could explain a greater likelihood of sleepwalking It is important that we can accurately assess whether or not a person really does experience sleepwalking, as it has been used as a defence in murder trials...

47. The Case of Ken Parks Guilty or not guilty?

48. The Case of William Wade Guilty or not guilty?

49. Narcolepsy It is estimated that approximately 1 in 2,000 people are sufferers, although this may be an underestimate as many cases go undiagnosed Risk Factors & Explanations: REM In the 1960s the view was that narcolepsy was linked to a malfunction in the system that regulates REM sleep This would explain some of the features of narcolepsy, such as hallucinations and loss of muscle tone (cataplexy) which are characteristic of REM sleep

50. Narcolepsy It is estimated that approximately 1 in 2,000 people are sufferers, although this may be an underestimate as many cases go undiagnosed Risk Factors & Explanations: REM Commentary: The REM hypothesis was first proposed after it was observed that a narcoleptic patient experienced REM at the onset of sleep (Vogel, 1960) The explanation was further supported by the brainstem recordings of narcoleptic dogs that showed that cataplexy is linked to the activation of cells that in normal animals are only active during REM sleep. However, general support from research is weak.

51. Narcolepsy It is estimated that approximately 1 in 2,000 people are sufferers, although this may be an underestimate as many cases go undiagnosed Risk Factors & Explanations: REM Commentary: http://www.youtube.com/watch?v=X0h2nleWTwI Is there a problem with generalising from dogs to humans in this study?

52. Narcolepsy It is estimated that approximately 1 in 2,000 people are sufferers, although this may be an underestimate as many cases go undiagnosed Risk Factors & Explanations: Hypocretin More recent research has uncovered a link between the neurotransmitter hypocretin and narcolepsy

53. Narcolepsy It is estimated that approximately 1 in 2,000 people are sufferers, although this may be an underestimate as many cases go undiagnosed Risk Factors & Explanations: Hypocretin Commentary: The same drugs that are used to treat the cataplexy part of narcolepsy in humans, also work on narcoleptic dogs A mutant gene was found in these animals that affects specialist brain cells called hypocretin neurons These neurons secrete a chemical called hypocretin, which is involved in sleep regulation It has been found that humans with narcolepsy have lost around 90% of their hypocretin neurones These neurons are found in the hypothalamus of both dogs and humans

54. Narcolepsy What does this say about the generalisability of the animal research?