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

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eceived a PSQI global score ≥6 compared to 38 (45.78%) healthy controls. However, using the more conservative cut-off criteria of ≥10, as used by Osorio et al (2006), 70 (84.34%) participants with FMS and 11 (13.25%) controls were identified as meeting the threshold for sleep disturbance (Osorio et al., 2006). Using a 2x2 contingency table, to explore the number of cases and control participants with clinically significant poor sleep quality (as defined by the more stringent PSQI global score of ≥10) (Osorio et al., 2006), an odds ratio was calculated (dividing the odds in the cases by the odds in the controls). It was found that people with FMS were 32 times more likely to have a clinically significant sleep difficulty than healthy controls (95% CI = 14.80 - 83.94). As shown in Table 6, participants with FMS reported significantly poorer sleep quality than controls across all components of sleep quality. The effect size for the differences in the key variables of interest in the study between the two groups; dysfunctional beliefs about sleep and perceived stress, were calculated using the equation proposed by Rosenthal (1991). r = z √N With z representing the z score from the Mann Whitney U test and N representing the number of participants (N=166). Based on a z score of z=-4.86, there was a small effect size for dysfunctional beliefs about sleep, r = -0.38. With a z score of z=-7.07, there was a medium effect size for perceived stress, r = -0.55. The effect size for sleep quality between the two groups was much larger (based on a z score of z=-9.88) at r = -0.77. A post hoc power analysis was calculated using G*power 3.1.0 to check the power of the study to detect true differences between the two groups at the more stringent level of significance (p
Table 6. Participant characteristics and outcome measure scores FMS participants (n = 83) Healthy controls (n = 83) Significance test Cronbach’s (α) Mean (SD) Mean (SD) - - Age 52.59 (11.42) 51.67 (15.47) t = −0.43 - Women Percentage in employment (% shift work) Median (IQR) Median (IQR) - - 91.60% 91.60% 33.73% (4.82%) 55.42% (7.23%) χ 2 = 0.00, df = 2 χ 2 = 9.66, df = 2 Pain‡ 29.58 (18.10) 82.53 (22.13) U = 388.00 0.93 Fatigue 31.00 (8.00) 21.00 (4.00) U = 341.00 ** Dysfunctional 0.73 beliefs total 62.50 (26.25) 46.00 (21.00) U = 1941.00 ** 0.81 (10-100) DBAS Consequences (6-60) DBAS Sleep need (3-30) Perceived stress total (0-40) PSQI Sleep quality PSQI Sleep latency PSQI Sleep duration PSQI Sleep efficiency PSQI Sleep disturbances PSQI Sleep medication PSQI Daytime dysfunction PSQI Global sleep score p < 0.01 ‡ High scores = better outcomes 6.58 (3.21) 4.33 (2.33) U = 1833.00** 0.78 6.33 (3.08) 5.33 (2.33) U = 2904.50 0.61 23.00 (7.25) 14.00 (7.00) U = 1178.00 ** 0.88 2.00 (1.00) 1.00 (1.00) U = 1016.50 - 2.00 (2.00) 1.00 (2.00) U = 1381.00 - 1.00 (2.00) 0.00 (1.00) U = 2005.50 - 2.00 (2.00) 0.00 (1.00) U = 1510.50 - 2.00 (1.00) 1.00 (2.00) U = 876.00 - 3.00 (3.00) 0.00 (0.00) U = 1608.00 - 2.00 (1.00) 1.00 (1.00) U = 886.50 - 14.00 (6.00) 5.00 (4.25) U = 378.50 0.84 - - 94
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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
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(McCracken & Iverson, 2002) which s
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Figure 4. Conceptual model of the d
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Clinical Implications Despite the p
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Chapter Three. Sleep in FMS As high
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& 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 and 100: It has been suggested that the auto
Page 101 and 102: For both groups, participants were
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: Figure 8. Scree plot for the explor
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
Page 151 and 152: Therefore as this was a feasibility
Page 153 and 154: Self-reported sleep quality was ass
Page 155 and 156: The progressive muscle relaxation (
Page 157 and 158: Exploring the baseline data, there
Page 159 and 160: 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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202
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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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