1. FACTORS AFFECTING INSOMNIA… A01: SLEEP APNOEA…  A disorder whereby a person stops breathing whilst asleep.  These pauses can last anything between a few seconds to minutes and they may occur between 5 and 30 times in one hour, thus having a major effect on sleep.  Obstructive Sleep Apnoea (OSA) is a form of apnoea where a obstruction to the airways prevents air entering the lungs.  This can be the result of being overweight, excessively drinking or smoking, but also from having a set- back lower jaw or enlarged tonsils.  During a bout of apnoea, the sufferer will often wake up gasping for air; once sufficient oxygen is taken up, sleep will usually return, however, soon after apnoea will return and the cycle continues to repeat itself, thus leading to insomnia.  When insomnia occurs alongside sleep apnoea, this is said to be a form of secondary insomnia. A02: CHEST 2001  CHEST found a significant positive correlation between insomnia and OSA, suggesting a relationship between the 2 conditions.  Similarly, SMITH 2004 also found the same link and additionally suggested that sufferers of sleep apnoea and insomnia were more likely to suffer from depression + anxiety than people just suffering from OSA.  This suggests that it is a reliable finding that sleep apnoea can influence insomnia. A02: STICKGOLD 2009  STICKGOLD believes that a range of mental disorders may be caused by sleep apnoea, including not only depression + anxiety but disorders such as attention deficit disorder (ADD) too.  He found that apnoeic insomniacs had twice the incidence of depression than the normal population, suggesting that the best way to treat such disorders is to alleviate the apnoea.  However, HORNE 2009 also questions whether insomnia and apnoea can actually lead to mental disorders as suggested by STICKGOLD.  He argues that this remains unproven believing that it is more probable that certain mental disorders lead to insomnia, suggesting there is a cause and effect issue with the research. A02: RESEARCH PRAISED FOR USEFULNESS  The research linking sleep apnoea to insomnia can be praised as it has led to the development of successful treatment, including losing weight, stopping smoking and reducing alcohol intake.  However, some evidence suggests that casual factors of sleep apnoea and insomnia may be different depending upon the age of the sufferer.  For example, it is thought that the higher incidence of sleep apnoea in older sufferers is caused by changes to the cardiovascular system, whereas in younger sufferers it is believed to be caused by the growing problem of obesity, suggesting different treatments dependant upon age.

2. A01: PERSONALITY  Another factor that may influence insomnia is personality.  Psychasthenia is a personality disorder similar to OCD, where a sufferer is plagued with unreasonable fears and doubts, excessive anxiety and obsessive compulsions is especially implicated.  Other personality factors that are implicated with insomnia are over-sensitivity, low self-esteem, lack of autonomy and heightened emotional arousal.  There has been general agreement that sufferers of insomnia tend to score higher on scales of anxiety, have a greater tendency to internalise emotions and report a greater number of life events. A02: ISSUE/DEBATE – REDUCTIONISM  One problem with focusing on any particular factor is that it is reductionist, meaning an explanation of insomnia focused solely on sleep apnoea or personality for example might be reducing what is in actual fact a complex interplay of factors, not just one.  For example, many with an anxious personality do not suffer from insomnia and equally many people suffer from sleep apnoea without ever realising it as it has not resulted in any noticeable effects.  This suggests that a combination of factors are likely too affect insomnia and research that focuses just on one factor may be ignoring other important factors. A02: ALTERNATIVE APPROACH  Insomnia could be better explained by attribution theory (cognitive approach) whereby an insomniac for some reason thinks their sleep difficulties are attributed to insomnia and so continue to suffer.  In one study, insomniacs were given a pill and told either that the pill would stimulate or relax them; those who experienced arousal went to sleep faster because they attributed their arousal to the pill and therefore relaxed.  This suggests that it might be successful to focus on an insomniacs thought-processes as opposed to any one singular factors. A02: LUNDH 1995  LUNDH tested 233 persistent insomnia patients and found that the predominant factor is psychasthenia and, in addition, high scores of anxiety; they also tended to score low on self-esteem and tended to be over dependant.  Further research also found that insomniacs tended to have what they referred to as a ‘borderline personality disorder’, suggesting there is a lot of personality factors that can affect insomnia.  However, as so many different aspects of personality have been highlighted, the picture is clearly a complicated one. A02: CAUSE AND EFFECT  There are problems with cause and effect when researching the influence of personality on insomnia.  This is because there is the possibility that rather than personality traits leading to insomnia, instead, insomnia could lead to personality changes; sleep deprivation itself can lead to loss of functioning and poor concentration, all of which could suggest that personality traits could be a result of a lack of sleep.  This is problematic as it suggests it is difficult to disentangle personality and insomnia in order to measure them accurately. FACTORS AFFECTING INSOMNIA