Insomnia is the 'inability to sleep', including struggling to fall asleep (initial insomnia), difficultly remaining asleep (middle insomnia) or waking up too early (terminal insomnia). Risk factors that influence insomnia can include age or gender with women being more likely to suffer. Older age groups may suffer health problems, which in turn affects sleep quality.
There are two types of insomnia; primary which is a disorder on its own and secondary which is a symptom of another underlying problem. Primary insomnia is sleeplessness not attributed to any medical, psychiatric or environmental cause, lasting over a month, according to the DSM. Primary insomnia consists of two sub types; pyschophysiological insomnia, a form of anxiety induce insomnia, referred to as learnt or behavioural insomnia. As the individual worries about falling asleep, and becomes tense making it harder to sleep. Idiopathic insomnia has no visible cause. It is a lifelong syndrome, apparent from birth, and is theorised to be caused by an under active sleep system or over active awakening system.
Horne suggested that there is only secondary insomnia and with 'primary insomnia' the cause is yet to be identified. Secondary insomnia is a symptom of another underlying cause e.g. depression or heart disease. It could also be due to due caffeine or alcohol intake or medication. Therefore treating the underlying cause should help treat the insomnia e.g. those suffering from depression may sleep better after taking anti-depressants.
Spielman et al proposed a distinction of component of insomnia. Predisposing factors may include a genetic vulnerability or physiological factors such as hyperarousal. In order for insomnia to be triggered the Diathesis-stress model proposes environmental factors are needed to expose the predisposed vulnerability, therefore triggering insomnia. Perpetuating factors such as stress and tension contribute to maintaining insomnia and may explain how chronic insomnia develops. This suggests that insomnia is a complex disorder and therefore it may be appropriate to consider these different component in deciding on appropriate treatment.
Morin et al examined the relationship between stress, coping skills and pre-sleep arousal between good sleepers and insomniacs. Both groups reported similar stressful events but insomniacs rated minor daily hassles with greater intensity compared to good sleepers suggesting personality may be a risk factor. Those with internalising problems will have higher levels of emotional arousal which can contribute to the onset of insomnia. However, with the correctional data we cannot establish cause and effect, it may be those who suffer insomnia also suffered more stress life events, and not reported all of them, than the control group. Therefore results may lack internal validity, and such confounding variables affect the generalisation of results therefore we cannot determine the extent to which personality and the ability to cope with stress links to insomnia. However, positive real world applications come from research such as developing therapies such as CBT in order to reduce symptoms. If stress can be managed it may reduce tendencies for insomnia.
Roth et al found insomnia often proceeded rather than followed cases of mood disorders suggesting it may be beneficial to treat the insomnia regardless of it being primary or secondary. This study used a large sample of 15,000 Europeans which is beneficial as it increases the reliability of findings allowing for wider generalisations. This gives us a greater understanding of the disorder and that in some cases the insomnia may cause other disorders.
Such research by Spielman, Morin and Roth highlights the complex nature of the disorder and suggests insomnia can have different attributable causes therefore it is deterministic to assume that all cases can be identified or attributed to a cause. Chronic insomnia is highly complex and for it to be broken down and explained in any simple way is reductionist. Reliability and validity of measures of insomnia have been criticised as they are based on reports of patients and interviews. Interviewers may interpret the information differently than what the patient intended, highlighting the subjective nature of diagnosing insomnia itself.
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