Sleep Disorders: Insomnia
One of the most common sleep disorders is insomnia. It is not defined in terms of number of hours of sleep a person has because there are large individual differences in the amount of sleep that is ‘normal’ to each person. Some people who have very
little sleep suffer no ill consequences whereas other who have many hours of sleep may feel unrefreshed and complain of insomnia.
Both length and efficiency of sleep are important:

Insomnia can be transient (short term), intermittent or long term

It may involve trouble falling aswell (initial insomnia)

Trouble remaining asleep (middle insomnia)

Waking up too early (terminal insomnia)
AO1: Explanations of Insomnia
AO2: Evaluation and Commentary
AO2: MAID
Short Term Insomnia
 Low Population Validity
 Correlational Analysis
Some people suffer difficulties in sleeping for a short period of time – days or a few
One issue with explanations into insomnia is that the research conducted in this area is largely
One methodological issue with the explanations into insomnia is
weeks. Such short term insomnia tends to be caused by immediate worries, such as
low in population validity.
that much of the research used correlational analysis and so it
an exam or a death in the family, noises at night, jet lag, or a temporary medical
This is because the vast majority of the research into insomnia is conducted on adults (as it is
cannot establish cause and effect relationships.
condition, such as a cold.
recognised as a disorder of adulthood). However, Roberts et al (2008) found that teenage
For example, Savard et al (2003) found links between insomnia
insomnia is a major problem amongst teenagers, as common as substance abuse or depression
and immune system under-functioning and Zammit et al (1999)
Long Term (chronic) Insomnia
but given less publicity. They analysed data from over 4000 adolsecents, ages between 11 – 17
found a relationship between insomnia and cognitive
Chronic insomnia describes sleep difficulties lasting more than four weeks (DSM
and found 25% of the young people had symptoms of insomnia and 5% reported their lack of
impairment.
definition). A distinction is then made between secondary and primary insomnia.
sleep interfered with their ability to function during the day. In a follow-up study of those with
Conducting correlational analyses is a positive thing because it
Secondary insomnia is much more common.
symptoms of insomnia, 41% were found to still have symptoms one year later.
allows us to see potential relationships between insomnia and a
This is an issue because, although there has been a distinction made between short term, long
second variable. It would be highly unethical to induce chronic

Primary Insomnia – This occurs when a person is having sleep problems
term, primary and secondary insomnia we may not be able to generalise these findings to
insomnia in a participant to see if it causes such disorders as
that are not directly associated with any other health condition or
teenagers who suffer from the sleep disorder. Roberts et al (2008) argued that it may be the
immune system under-functioning or cognitive impairment.
physical cause (such as drug abuse or medications). A person may be
case that teenagers turn to drugs as a means of dealing with their sleep problems. This has
However, we cannot establish a cause and effect relationship
feeling stressed or depressed but such psychological states are not the
important implications in the treatment of addiction for teenagers.
between insomnia and a second variable such as cognitive
cause of the insomnia. It may be that the individual has developed bad
impairment. It may be that it is in fact cognitive impairment that
sleep habits (e.g. staying up late) and this causes insomnia, but insomnia As a result, this reduces the credibility of the explanations into insomnia.
is causing the imsomnia or a third unknown variable.
is the only problem. Sometimes insomnia may have had an identifiable
 Support for research into insomnia
As a consequence, this weakens the explanation of primary
cause but this has disappeared, yet the insomnia persists because of an
One strength of the explanations into insomnia is that it had led to further research into the
insomnia as a causal relationship cannot be established.
expectation of sleep difficulty – in other words, the individual have
consequences of the disorder.
come to expect that they will have sleep difficulties and these
For example, Zammit et al (1999) found that patients with insomnia had problems with
 The Cognitive Approach
expectations lead to anxiety which then continue to cause insomnia.
concentration, memory, reasoning and problem solving compared to controls. Furthermore,
One strength of the explanations into insomnia is that it has real

Secondary Insomnia – This is when a person is having sleep problems
Savard et al (2003) found fewer immune cells in the bodies of people with chronic insomnia
world applications underpinned by the cognitive approach.
because of something else. There is a single, underlying medical,
compared with good sleepers. This can leave us vulnerable to infection and disease.
This is because one of the causes of primary insomnia is a
psychiatric or environmental cause. In such cases insomnia is a
This is a strength because it demonstrates the importance of understanding and treating
person’s belief that they are going to have difficulty sleeping.
symptom of the main disorder, i.e. it comes second after the main
insomnia correctly. For example, the distinction between primary (insomnia not directly linked
Such an expectation becomes self-fulfilling because the person
disorder. For example, insomnia is a characteristic symptom of illnesses,
to any other health condition) or secondary (insomnia linked with another issue) disorders has
is tense when they are trying to sleep. One clever way to treat
such as depression and heart disease. In such cases there is a medical
already improved the way the disorder is treated. Making links to other consequences of
this method is based on attribution theory*. The insomniac has
condition first and this is the underlying cause of the insomnia
insomnia will allow sufferers to improve their quality of life in the future.
learned to attribute their sleep difficulties to ‘insomnia’. If they
experienced.
As a result, this increases the explanatory power of the explanations into insomnia.
can be convinced that the course of their difficulty lies
Insomnia is also typical of people who have circadian rhythm disorders,
elsewhere this will end their dysfunctional attribution.
such as phase delay syndrome, where abnormal biological rhythms
 Distinguishing between Primary and Secondary Insomnia
For example in a study by Storms and Nisbett (1970), insomniacs
cause sleepiness at inappropriate times. Older people tend to be more
One strength of the explanations into insomnia is that it has led clinicians to make a distinction
were given a pill and told either that the pill would stimulate
likely to experience insomnia because of discomfort when sleeping due
between primary and secondary insomnia because it has important implications for treatment.
them or act as a sedative. Those who expected arousal actually
to, for example rheumatism. They also have more difficulty sleeping
For example, if insomnia is a symptom if another disorder then it is important to treat the
went to sleep faster because they attributed their arousal to the
because of reduced deep sleep (SWS) and therefore are more easily
disorder rather than the insomnia. If insomnia is the result of chronic depression, it would be
pill and therefore actually relaxed.
awoken.
unhelpful to simply treat the symptom.
As a consequence, this increases the credibility of the
Insomnia may also be the result of environmental factors, such as too
However, it may not be that simple to work out the cause of a person’s insomnia – does
explanations into insomnia as the cognitive approach can
much caffeine (in coffee or even chocolate) or alcohol. Finally other
depression cause insomnia or does insomnia cause depression? A study of almost 15,000
account for its assumptions.
sleep disorders (parasomnias), such as sleep apnoea, can cause
Europeans found that insomnia more often precedes rather than followed cases of modd
insomnia. Apnoea is a disorder where a person stops breathing while
disorders, such as depression (Ohayon and Roth, 2003). This means that, in some cases, it might
*Attribution theory describes the idea that we explain behaviour
asleep. The pauses can last from a few seconds to minutes and might
be unhelpful to treat insomnia regardless of whether it is a primary or secondary effect.
as being caused by something else. In this case, people who can’t
occur 5 – 30 times an hour, this having a major disruptive effect on
As a consequence, although making the distinction between primary and secondary insomnia is
sleep explain this behaviour in terms of insomnia. When they
sleep. Other parasomnias include sleep walking and teeth grinding
a good idea in principle; we cannot say for sure that this is beneficial for treatment. Perhaps a
attribute it to something other than insomnia (i.e. a pill) the
(bruxism). All such parasomnias increase the likelihood that a person
more appropriate treatment would be to tackle a number of symptoms (including insomnia) in a difficulty sleeping disappears.
will experience some loss of sleep and therefore insomnia.
patient suffering from a mood disorder.