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

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sleep is linked to poor pain fatigue and social functioning the following day and therefore items one, „I need 8 hours of sleep to feel refreshed and function the next day‟; three, „I am concerned that chronic insomnia may have serious consequences on my physical health‟; six, „After a poor nights sleep, I know that it will interfere with my activities the next day‟; and nine, „When I feel tired, have no energy, or just seem not to function well during the day, it is generally because I did not sleep well the night before‟; may actually reflect „accurate‟ rather than „dysfunctional‟ beliefs and the term may therefore not be a true reflection of the nature of these beliefs in this or potentially other clinical populations. Never-the-less, even if they are „accurate‟ beliefs, they may still need to be addressed in clinical intervention to prevent self fulfilling prophecies emerging and maintaining sleep disturbance. The logistic regression analysis highlighted that increased pain and fatigue and poor overall sleep quality were significant predictors of being diagnosed with FMS. Dysfunctional beliefs about sleep, stress and negative affect did not significantly contribute to the model, suggesting that although these factors may be important to the experience of sleep quality and health outcomes in FMS, they were not significant risk factors in the diagnosis of FMS. Strengths and Limitations To date, this is the first study that has highlighted the role of beliefs and stress on sleep quality in participants with FMS. The findings revealed that psychological factors such as dysfunctional beliefs about sleep and stress were significantly related to sleep quality, pain and fatigue. However, due to limitations of a cross-sectional questionnaire based design, it is unclear if dysfunctional beliefs and attitudes about sleep and stress lead to, or are the result of, chronic sleep problems in FMS and whether they are directly related to pain, sleep quality and fatigue, or if all these factors interrelate. The finding that beliefs about sleep and stress appear to influence different aspects of sleep quality (e.g. dysfunctional beliefs about sleep need were significantly associated with reduced sleep duration and high levels of stress were associated with increased night-time awakenings), further highlights the importance of exploring the separate components of sleep quality when establishing the effect of psychosocial factors on sleep. 103
It became clear, through the analysis of the data, that there were significant differences in the levels of dysfunctional beliefs about sleep and stress between people with FMS and healthy controls, suggesting that these psychological factors may have a role in the FMS experience and symptom severity. However, this study may not have accounted for all possible influential factors on these relationships. For example, previous research has found that social support is a protective factor of the effects of stress and this study was limited as it did not control for the effects of social support on the relationships explored. Although dysfunctional beliefs about sleep need, overall levels of stress and distress were significantly associated with health outcomes such as pain, fatigue and components of sleep quality, the relationship between these psychological factors may have been affected by the more stringent significance level utilised to reduce the risk of type one errors. As can be seen in Tables 8 (p. 97) and 9 (p. 98), a number of relationships were significant at the p
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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
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pauses in breathing indicative of s
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Relationships between Sleep and Pai
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Managing Sleep Disturbance in FMS D
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may be possible to help patients im
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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
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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 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: has explored the use of napping on
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
Page 161 and 162: There was no significant correlatio
Page 163 and 164: people with FMS (Perlis, Giles, Men
Page 165 and 166: The aim of this study was to explor
Page 167 and 168: observed in perceived overall sleep
Page 169 and 170: 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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