Sleep Disorders (College Board AP® Psychology): Revision Note

Sleep disorders

• Many disorders disrupt healthy sleep, with effects on waking behavior, cognitive performance, and physical health

  • Sleep disruptions can impair both physical and cognitive performance during wakefulness

• Treating sleep disorders and following regular sleep schedules can improve waking performance and overall wellbeing

• Five commonsleep disorders include:

  • insomnia

  • narcolepsy

  • REM sleep behavior disorder

  • sleep apnea

  • somnambulism

Insomnia

• Insomnia is a persistent difficulty falling asleep, staying asleep, or waking too early, despite having adequate opportunity for sleep

  • It is the most common sleep disorder, affecting a large proportion of the population at some point in their lives

• Insomnia can be acute (short-term, triggered by stress or life events) or chronic (lasting three months or longer)

• Effects on waking behavior include:

  • fatigue

  • impaired concentration

  • irritability

  • reduced cognitive performance

• Treatment options include cognitive behavioral therapy for insomnia (CBT-I) and sleep hygiene improvements such as maintaining a consistent sleep schedule

Narcolepsy

• Narcolepsy is a neurological disorder characterized by excessive daytime sleepiness and sudden, uncontrollable episodes of falling asleep during waking hours

  • Episodes can occur at any time, including during conversations, eating, or driving, making the disorder potentially dangerous

• Narcolepsy is associated with a deficiency of hypocretin (also called orexin), a neurotransmitter that regulates wakefulness and arousal

• Some individuals with narcolepsy also experience cataplexy

  • This involves sudden temporary muscle weakness triggered by strong emotions such as laughter

• Narcolepsy can be managed with medication and structured napping schedules, but there is currently no cure

REM sleep behavior disorder

• REM sleep behavior disorder (RBD) is a condition in which the normal muscle paralysis that occurs during REM sleep fails to function

  • This causes a person to physically act out their dreams

• Behaviors may include:

  • talking

  • shouting

  • punching

  • kicking

  • getting out of bed while fully asleep

• The person typically has no memory of these actions on waking and can result in injury to the individual or their bed partner

• It is more common in older adults and has been associated with neurodegenerative conditions such as Parkinson's disease

Sleep apnea

• Sleep apnea is a disorder in which breathing repeatedly stops and restarts during sleep

  • It causes the person to wake briefly, often without awareness, throughout the night

• The most common form is obstructive sleep apnea, in which the throat muscles relax and block the airway during sleep

• Symptoms include:

  • loud snoring

  • gasping for air

  • excessive daytime sleepiness

• Because sleep is repeatedly fragmented, individuals with sleep apnea often feel unrefreshed despite spending adequate time in bed

  • It can lead to increased risk of cardiovascular disease, high blood pressure, and cognitive impairment

• Treatment typically involves a CPAP (continuous positive airway pressure) machine, which keeps the airway open during sleep

Somnambulism

• Somnambulism (sleepwalking) involves abnormalities of movement and behavior during deep NREM sleep (Stage 3)

  • Episodes typically occur in the first third of the night when Stage 3 sleep is most prevalent

• Behaviors may include:

  • walking around

  • talking,

  • performing routine activities while fully asleep

• The individual is usually difficult to wake during an episode and has no memory of it afterward

• Contrary to popular belief, waking a sleepwalker is not dangerous, although they may be disoriented and confused on waking

• Somnambulism is more common in children and tends to resolve with age

Cultural and contextual influences

• Cultural norms and circumstances influence how sleep disorders are recognized, reported, and treated

  • E.g., in cultures that normalize chronic sleep deprivation (e.g. high-pressure work environments), symptoms of insomnia may be dismissed as normal or even desirable

• Stigma around mental health and sleep disorders in some cultural contexts may prevent individuals from seeking diagnosis or treatment

• Cultural sleeping practices, such as co-sleeping, may influence the diagnosis of disorders like somnambulism

  • In cultures where sleeping alone is the norm, episodes may go undetected and therefore undiagnosed

  • In cultures where co-sleeping is the norm, another person is present to observe and report the behavior, increasing the likelihood of diagnosis