Sick and Tired: Understanding and Managing Sleep Difficulties in ...

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Based on the current research evidence, it was hypothesised that: 1) People with FMS would have significantly higher perceived levels of stress than healthy controls; 2) People with FMS would have significantly higher dysfunctional beliefs about sleep than healthy controls; 3) People with FMS would have higher levels of poor sleep quality than healthy controls; 4) Higher levels of perceived stress and dysfunctional beliefs about sleep would be associated with poorer sleep quality; 5) Poor sleep quality is a predictive factor in being diagnosed with FMS. Power Calculations A priori power calculation using G*power 3.1.0 based on a two-tailed, Mann Whitney test, with a medium effect size of 0.5, alpha 0.05 and power 0.8 revealed that a minimum of 128 participants (64 per group) would be needed for this study to have power to detect significant differences between the two groups. Participant Recruitment As the recruitment procedure worked effectively in recruiting sufficient numbers of participants with a range of symptom severity in the previous study, an identical recruitment procedure was applied for this study. This involved advertising for volunteers through patient support groups (see Chapter Four for details). To be included in this study as „cases‟, participants were required to have received a diagnosis of FMS by a GP or consultant. Due to financial limitations we were unable to confirm the diagnosis of FMS. To elicit a comparative sample of „control‟ participants of a similar age range, people without a diagnosis of FMS were recruited through community groups run by the University of the Third Age (U3A) organisation. This organisation runs community based activity and socialisation groups within the same regions of the UK as FMS support groups. This approach also aimed to control for any factors relating to being a member of a community group, such as increased social support. 83
For both groups, participants were required to be aged >18 years. Participant‟s data was excluded if: 1) they had been diagnosed with a sleep disorder caused by an identified physical cause such as sleep apnoea or restless legs syndrome; 2) if more than 20% of a measure within the questionnaire was incomplete. Healthy control group participants were excluded if they revealed that they had been diagnosed with FMS. Outcome Measures Three hundred information sheets, consent forms and questionnaires were distributed to potentially eligible participants (150 to „cases‟ and 150 to „controls‟) via the post and through community group meetings. Participants were asked to complete the questionnaire in their own time. They were informed that the questions would be asking about their thoughts on sleep, perceived stress, sleep quality and levels of pain and fatigue. Information on demographic and clinical variables including age, medication use and employment status including shift work) was requested. In addition the questionnaire included the following standardised assessment measures: Dysfunctional Beliefs about Sleep The Dysfunctional Beliefs and Attitudes About Sleep Scale (DBAS-10) (Espie et al., 2000) consists of 10 statements exploring patient beliefs and attitudes about sleep. The participant indicates their level of agreement to each statement on a visual analogue scale, scoring between 1 „strongly disagree‟ to 10 „strongly agree‟. Items are summed to yield a total score (maximum possible score of 100). High scores on the DBAS-10 are indicative of high dysfunctional beliefs about sleep. The DBAS-10 was chosen specifically, as these 10 items were found to be the most sensitive to change in a clinical trial and were found to have improved internal consistency in comparison to the more comprehensive DBAS-30 measure (Espie et al., 2000). The DBAS-10 has been found to be highly correlated with the full DBAS scale (Edinger & Wohlgemuth, 2001; Espie et al., 2000; Morin et al., 1993), indicating that the two scales are measuring similar constructs (Edinger & Wohlgemuth, 2001). The DBAS-10 has also independently revealed respectable internal consistency (a = 0.7 in good sleepers and 0.68 in people with insomnia) (Edinger & Wohlgemuth, 2001) and has been shown to be sensitive to recovery (Edinger, Wohlgemuth, Radtke, Marsh, & Quillian, 2001). The DBAS-16 version of the scales has revealed a test-retest correlation of r=0.83 (Morin, Vallieres, & Ivers, 2007). The measure has been widely used in a clinical context to identify specific 84
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Sick and Tired: Understanding and M
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Chapter Four. The Nature and Effect
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References ........................
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List of Tables Table 1. Participant
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Co-authored Works Although the stud
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Acknowledgments This thesis would n
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Intellectual Property Rights There
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Confidential Material No participan
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The role of sleep in FMS appears to
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little information was available as
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Psychophysiologic insomnia which is
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and are less able to inhibit the pa
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widely applied in clinical practice
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of fewer tender points; usually bet
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Current Management Strategies The t
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also likely to depend on a number o
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deep sleep (stages three and four)
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Although sleep moves through the sl
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Figure 3. The Integrative Model of
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However, conducting a blood test is
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As sleep is a complex process invol
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Sleep Diaries Sleep diaries are a k
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pain). Lentz et al (1999) revealed
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These results have also been suppor
Page 49 and 50: (McCracken & Iverson, 2002) which s
Page 51 and 52: Figure 4. Conceptual model of the d
Page 53 and 54: Clinical Implications Despite the p
Page 55 and 56: Chapter Three. Sleep in FMS As high
Page 57 and 58: & Penzien, 2003), although alpha wa
Page 59 and 60: pauses in breathing indicative of s
Page 61 and 62: Relationships between Sleep and Pai
Page 63 and 64: Managing Sleep Disturbance in FMS D
Page 65 and 66: may be possible to help patients im
Page 67 and 68: person to initiate an action (such
Page 69 and 70: and Nicassio et al (1995) only expl
Page 71 and 72: 1) Poor sleep quality, defined by t
Page 73 and 74: elow 0.7 are acceptable. Therefore
Page 75 and 76: heart disease (Epstein et al., 1999
Page 77 and 78: In order to explore the links betwe
Page 79 and 80: questionnaire 78 (77.2%) of the par
Page 81 and 82: efficiency, suggesting that partici
Page 83 and 84: Older age and longer length of illn
Page 85 and 86: Table 2. Correlations between demog
Page 87 and 88: Logistic Regression As 97% of the s
Page 89 and 90: in bed, participants may have devel
Page 91 and 92: Relationship between Negative Affec
Page 93 and 94: participants, who may be less likel
Page 95 and 96: emotional problems, increased pain
Page 97 and 98: eactions are most likely to be detr
Page 99: It has been suggested that the auto
Page 103 and 104: with and without chronic medical co
Page 105 and 106: As previously described on page 61,
Page 107 and 108: Figure 7. Scree plot for the explor
Page 109 and 110: Figure 8. Scree plot for the explor
Page 111 and 112: Table 6. Participant characteristic
Page 113 and 114: Table 7. Measures of central tenden
Page 115 and 116: CON = DBAS-10 Dysfunctional beliefs
Page 117 and 118: The Exp (B) values revealed that hi
Page 119 and 120: has explored the use of napping on
Page 121 and 122: It became clear, through the analys
Page 123 and 124: interventions. With this in mind, t
Page 125 and 126: The philosophy of phenomenology was
Page 127 and 128: Methods Participants were given a w
Page 129 and 130: Table 11. Interview schedule for th
Page 131 and 132: Rigour The interview transcripts we
Page 133 and 134: “The main symptom is this overwhe
Page 135 and 136: Theme Two. Inter-relationship betwe
Page 137 and 138: where I live, so I don‟t know, I
Page 139 and 140: Participants also described how the
Page 141 and 142: “XXXX (name of person) planned a
Page 143 and 144: A strong theme that emerged in this
Page 145 and 146: conducted at several time points, w
Page 147 and 148: Chapter Seven. Investigating the Ef
Page 149 and 150: activities because they no longer f
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Therefore as this was a feasibility
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Self-reported sleep quality was ass
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The progressive muscle relaxation (
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Exploring the baseline data, there
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Consequently, univariate analysis w
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There was no significant correlatio
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people with FMS (Perlis, Giles, Men
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The aim of this study was to explor
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observed in perceived overall sleep
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elaborated on in Chapter Six, which
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Four) revealed that global sleep qu
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Modifications to the Call-Schmidt a
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MBSR programme in people with FMS (
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diagnostic criteria for these sleep
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comprehensive measures to look at t
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References Abad, V. C., Sarinas, P.
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Brand, S., Gerber, M., Beck, J., Ha
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Crofford, L. J., & Demitrack, M. A.
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Goldenberg, D. L., Kaplan, K. H., N
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Johns, M. W. (2002). Sleep propensi
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Leung, Y. Y., Ho, K. W., Zhu, T. Y.
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Mease, P. J. (2005). Fibromyalgia s
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symptoms in healthy subjects; Corre
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approach with illustration to the h
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Thomas, E. N., & Blotman, F. (2010)
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Yunus, M. B., Masi, A. T., & Aldag,
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Appendices Appendix A: Search Strat
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Sleep and Fibromyalgia Syndrome Con
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190
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The following questions relate to y
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There are lots of ways to try to de
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42. I try hard to prevent other thi
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During the past month have you had
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Appendix E: Published paper of Stud
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Sleep and Fibromyalgia Syndrome Con
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Appendix H: Participant Questionnai
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Below are 10 statements reflecting
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The questions in this scale ask you
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Appendix I. Published Paper for Stu
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Appendix K. Information Sheet and C
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Sleep in Fibromyalgia Syndrome Cons
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Appendix L: Letter of Ethical Appro
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Appendix M. Letter to GPs for Study
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What are the side effects of any tr
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Appendix O: Poster Advertising Stud
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Appendix Q: Participant Questionnai
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HAD Scale Read each item and place
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During the past month have you had
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Appendix R. Letter from Dr Mark Cro
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PUBLICATIONS Peer Reviewed Journal
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and panic-like episodes, Faculty of
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