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Click on the topic that you want to go to: Insomnia Sleepwalking Narcolepsy Insomnia Click on the section you would like to go to: Factors influencing insomnia Explanations of primary insomnia Eplanations of secondary insomnia 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 Insomnia Factors influencing insomnia Click on the section you would like to go to: Age & gender Sleep apnoea 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 Return to insomnia menu Return to main menu In women, the greater likelihood of insomnia may be due to hormonal fluctuations (e.g.The menopause) Go to sleep apnoea Insomnia Factors influencing insomnia: Sleep Apnoea: 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. Occasional bouts of sleep apnoea are quite common, but in some it is a regular occurance. Watch someone experiencing sleep apnoea Return to insomnia menu Return to main menu Go to age & gender 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 Sleep Apnoea Return to sleep apnoea Return to insomnia menu Watch clip again Why do you think this condition is linked to insomnia? Insomnia Explanations for Primary insomnia Click on the topic you would like to go to: Personality Hyperarousal 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? Return to insomnia menu Return to main menu 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 Guidance on Go to evaluating hyperarousal studies Insomnia Explantions for Primary insomnia: Hyper-arousal: It has been suggested that insomniacs experience a state of hyper-arousal. Click on the links below for more information. Select two studies out of the three given to put onto your worksheets Definition of hyperarousal Research into hyperarousal Study 1 Research into hyperarousal Study 2 Research into hyperarousal Study 3 Return to insomnia menu 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 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 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 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 Insomnia Guidance on evaluating studies When evaluating studies of insomnia think about the following points: Return to insomnia menu Are method there anyis What are problems with AreWhat What there conclusion anythe problems being used? Are is positive pointsto making with the attempting study there any problems relating to the way generalisations establish attempting a cause to and draw? with using this the study was from from this effect relationship method? study?out? thiscarried study? Return to main menu Play slide again Insomnia Guidance on using IDA to evaluate theories of primary insomnia The nature nurture debate Reductionism Some of these explanations are reductionist What does that mean? Are there any consequences of this (socially sensitive)? Why does it matter? What factors have not been taken into account? Return to insomnia menu Does the explanation fall on the nature or nurture side of the argument? Return to main menu Could we explain the insomnia using the other side of the argument? Insomnia Explanations for secondary insomnia Click on the topic you would like to go to: Medical conditions or First watch a brief case study of secondary insomnia Mental Health Insomnia Return to secondary insomnia Return to insomnia menu Watch clip again What are the factors that seem to be responsible for this woman’s insomnia? 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% Return to insomnia menu Return to main menu Go to mental health Guidance on evaluating studies 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 Insomnia Explanations for secondary insomnia Mental health research study 1: Weiss et al (1962) What do you think Weiss found? Click on the button to find out: Results Percentage of people reporting sleep disturbance 72% Go to Research Study 2 Go to Research Study 3 Guidance on evaluating studies 18% Control group Return to insomnia menu Psychiatric patients Insomnia Explanations for secondary insomnia Mental health research study 1: Weiss et al (1962) What do you think Weiss found? Click on the button to find out: Results Percentage of people reporting sleep disturbance 72% Go to Research Study 2 Go to Research Study 3 Guidance on evaluating studies 18% Control group Return to insomnia menu Psychiatric patients 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: Results 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 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: Results 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 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 Insomnia Guidance on using IDA to evaluate theories of secondary insomnia The nature nurture debate Approaches Which approaches are used in this explanation? What might that lead to? Are there any consequences of this (socially sensitive)? Why does it matter? What factors may not been taken into account? Return to insomnia menu Does the explanation fall on the nature or nurture side of the argument? Return to main menu Could we explain the insomnia using the other side of the argument? 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 Click on the section you would like to go to: Predisposing factors Precipitating factors Perpetuating factors Return to insomnia menu 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 Guidance on evaluating studies Return to insomnia menu 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 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 Predisposing factors Precipitating factors I’m I’m I don’t not going going feel to Maybe I should feel to be lousy tired able again to try counting get tomorrow to sleep sheep three two one Damn! Return to insomnia menu Sleepwalking Click on the section you would like to go to: Explanation of sleepwalking: incomplete arousal Explanation of sleepwalking: genetics Explanation of sleepwalking: stress-diathesis Guidance on evaluating studies of sleepwalking Guidance on using IDA for sleepwalking Return to main menu Sleepwalking Explanations: Incomplete arousal 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 Click on the links to remind yourself what the different brain waves look like: Awake Stage 4 sleep Return to sleepwalking menu It looks as though sleepwalking occurs when the person is awakened, but the arousal of the brain is incomplete But why does this state of incomplete arousal occur? Return to incomplete arousal Awake Awake Go to stage 4 sleep High frequency, low amplitude waves A 1 2 3 4 R C Go to awake Return to incomplete arousal Stage 44 Stage EEG recording consists purely of delta waves A 1 2 3 4 R C Sleepwalking Explanations: genetics There is some evidence to suggest that sleepwalking may be genetically transmitted Look at the pieces of evidence to support the genetic explanation and add the details to your worksheets: study 1 Study 2 Study 3 Return to sleepwalking menu Sleepwalking Explanations: genetics Return to sleepwalking menu Research study 1: Bakwin (1970) What do you think Bakwin found? Click on the button to find out: Results Concordance rate for sleepwalking Go to Research Study 2 Go to Research Study 3 Guidance on evaluating studies MZ twins (19 pairs) DZ twins (14 pairs) Sleepwalking Explanations: genetics Return to sleepwalking menu Research study 1: Bakwin (1970) What do you think Bakwin found? Click on the button to find out: Results Concordance rate for sleepwalking Go to Research Study 2 Go to Research Study 3 47% MZ twins (19 pairs) 7% DZ twins (14 pairs) Guidance on evaluating studies Sleepwalking Explanations: genetics Research study 2: Lecendreux et al (2003) What do you think Lecendreux et al found? Click on the button to find out: Results Concordance rate for sleepwalking Return to sleepwalking menu Go to Research Study 1 Go to Research Study 3 Guidance on evaluating studies MZ twins DZ twins Sleepwalking Explanations: genetics Research study 2: Lecendreux et al (2003) What do you think Lecendreux et al found? Click on the button to find out: Results Concordance rate for sleepwalking Return to sleepwalking menu Go to Research Study 1 Go to Research Study 3 50% 1015% MZ twins DZ twins Guidance on evaluating studies Sleepwalking Explanations: genetics Research study 3: Bassetti (2002) suggests that the same HLA gene abnormality that is implicated in Narcolepsy, may be associated with sleepwalking. He found that 50% of sleepwalkers that he tested had a version of the HLA gene found only in 24% of the nonsleepwalkers Can you think of any problems with drawing conclusions from this piece of research? Return to sleepwalking menu Go to Research Study 1 Go to Research Study 2 Guidance on evaluating studies Sleepwalking Explanations: stress-diathesis This theory suggests that a genetic predisposition towards sleepwalking will be triggered by external factors Factors that increase the risk of sleepwalking Click on the boxes to reveal what they are: Return to sleepwalking menu Guidance on using IDA for theories of sleepwalking Hormonal changes Hormonal Stress or other changes Sleep Having Alcohol deprivation a fever associated with associated psychiatricwith conditions menstruation puberty Sleepwalking Guidance on evaluating studies When evaluating studies of sleepwalking think about the following points: Are there any Are What What there are method any the problems is problems with with positive being attempting used? points Are tois What conclusion making establish relating there any ato cause problems the way and the study generalisations effect the with study relationship usingwas this from attempting to draw? from this this carried method? study?out? study? Return to sleepwalking menu Return to main menu Play slide again Sleepwalking Guidance on using IDA to evaluate theories of sleepwalking The nature nurture debate Approaches Which approaches are used in this explanation? If there is more than one, how could that be considered an advantage? Are there any consequences of this (socially sensitive)? Why does it matter? Are there any factors that have not been taken into account? Return to sleepwalking menu Does the explanation fall on the nature or nurture side of the argument? Return to main menu Could we explain the sleepwalking using the other side of the argument? Narcolepsy Click on the section you would like to go to: Explanations of narcolepsy: the role of hypocretin Explanations of narcolepsy: genetics Guidance on evaluating studies Guidance on using IDA for narcolepsy Return to main menu Narcolepsy Explanations: The role of hypocretin (Hcrt) It has been suggested that narcolepsy is caused by the loss of cells in the hypothalamus that secrete Hcrt More information on hypocretin Study 1 Study 2 Return to narcolepsy menu Go to study 2 Narcolepsy This study only shows that cells in the lateral hypothalamus (LH) are Explanations: The role of Ithypocretin related to a decline in Hcrt. is not a study of narcolepsy itself. Research studywith 1: narcolepsy have a As humans more than 80% reduction in CSF Hcrt, we canet presume they will Gerashchenko al (2003) have a reduced number of cells in the LH (Hcrt) Destroyed the cells in the lateral hypothalamus in rats with a neurotoxin. They found a relationship between the number of cells lost and a decline in the levels of Hcrt in the cerebrospinal fluid (CSF). A 73% decline in Hcrt neurons resulted in a 50% reduction in CSF Hcrt What does the rat have to say about it all? Click on the rat to see his interpretation of the study Guidance on evaluating studies Return to narcolepsy menu Narcolepsy Explanations: The role of hypocretin (Hcrt) Research study 2: Thannickal et al (2007) People with Parkinson’s disease show sleep complaints that strongly resemble narcolepsy. Parkinson’s is a degenerative brain disorder which involves the loss of cells in many brain areas. Thannickal et al conducted a post mortem analysis of the brains of people who had suffered Parkinson’s disease and found that the brains had lost up to 62% of the cells that contain Hcrt. It is further supported by other research which has shown reduced levels of Hcrt in the CSF of people with Parkinson’s disease More information on Parkinson’s disease Go to study 1 Guidance on evaluating studies Return to narcolepsy menu Narcolepsy Explanations: Genetics Research has indicated that there is a genetic link in narcolepsy in dogs. It was discovered in the 1970s that certain breeds of dog appeared to have an inherited form of narcolepsy. This led to the establishment of a breeding colony of narcoleptic dogs and a concerted effort to find the gene or genes responsible for the disorder study 1 study 2 Click on this picture to see a film of a narcoleptic dog Return to narcolepsy menu Narcolepsy Explanations: Genetics Research study 1: Nishino & Mignot (1997) Narcoleptic Doberman Pinschers have a genetic mutation affecting Hcrt Click on the statement you think is correct: Research has shown that human narcloleptics also have a faulty Hcrt gene But... Research has shown that human narcoleptics do not have a faulty Hcrt gene Can we generalise to humans? Go to study 2 Guidance on evaluating studies Return to narcolepsy menu Go to study 1 Narcolepsy Guidance on evaluating studies Explanations: Genetics Research study 2: Sixteen identical twin pairs with at least one narcoleptic in each pair were studied. In only four of the pairs did both twins have the condition This would suggest that: (Click on the statements you think are correct) This is good evidence that narcolepsy is caused by genetic factors It seems likely that a genetic vulnerability must be combined with environmental factors to trigger the disorder Return to narcolepsy menu This is weak support for a genetic link in narcolepsy The research suggests that genetics are more important than environment in narcolepsy It seems highly unlikely that genetics alone can explain narcolepsy. It is the exception rather than the rule that narcolepsy runs in families Despite the lack of genetic abnormality in humans, 90% of narcoleptics have extremely low levels of Hcrt Narcolepsy Guidance on evaluating studies When evaluating studies of narcolepsy think about the following points: Are there any Are What What there are method any the problems is problems with with positive being attempting used? points Are tois What conclusion making establish relating there any ato cause problems the way and the study generalisations effect the with study relationship usingwas this from attempting to draw? from this this carried method? study?out? study? Return to narcolepsy menu Return to main menu Play slide again Narcolepsy Guidance on using IDA to evaluate theories of Narcolepsy Reductionism Approaches Which approach is used in this explanation? Which approaches have not been considered? Why does it matter? Are there any factors relating to other approaches that have not been taken into account? Return to narcolepsy menu Return to main menu Is the explanation reductionist? How is it reductionist? How does the reductionist nature of the research affect its ability to explain narcolepsy? How could the reductionist nature of the explanation be considered socially sensitive?