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

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Chapter Six. Exploring the Sleep Experience for Patients with FMS The previous two studies, which used quantitative research methods, provided an overview of the scope and nature of sleep difficulties in people with FMS. However, the use of questionnaires limited the range of answers participants could provide about their experience of sleep quality in FMS. As sleep quality is primarily a subjective experience, understanding what poor sleep means to people with FMS and how it affects their daily lives, is essential to inform how rehabilitation can address patients‟ needs. Qualitative approaches enable the exploration of factors that are important to patients, rather than those identified by the researcher. In order to increase our understanding of the sleep difficulties people with FMS experience, and the impact they have on peoples‟ daily living, a qualitative approach was therefore needed to explore the phenomena in more detail. Previous qualitative studies in patients with FMS have explored the illness experience, focusing on the difficulties in managing an illness with a complex range of fluctuating symptoms, no distinctive visible signs and the impact the condition has on quality of life (Arnold et al., 2008; Cunningham & Jillings, 2006; Madden & Sim, 2006; Sim & Madden, 2008). To expand on the findings from the previous two studies within this thesis, this study aimed to increase our understanding of the meaning that sleep has for patients with FMS, the development of sleep difficulties and the impact of poor sleep on patient‟s everyday lives. As the aim of this study was to explore how participants understand their illness and the meaning that their symptoms have for them (including their sleep difficulties), interpretative phenomenology was deemed to be the most appropriate approach for this study. Methodology As the study did not aim to explore relationships in order to develop a theory (which would arguably require a grounded theory approach), or to explore the use of language in describing a phenomena (such as the discourse analysis approach), it was felt that a phenomenological methodology would be the most suitable approach to gain insights into how people with FMS perceive their sleep quality and make sense of the symptoms they experience. 107
The philosophy of phenomenology was developed through the work of Edmund Husserl (Husserl, 1931). Husserl believed that people do not experience life in its actual state, but that people are naturally driven to find meaning in what happens to them. Therefore people‟s life experiences are influenced by how they interpret daily events. These interpretations will have been shaped by personal values, attitudes and prior experiences. Phenomenologists therefore aim to describe the essence of people‟s experiences, and what an experience means for a specific group of people (Spinelli, 2005). Several strands of phenomenology have emerged over time, with Husserl‟s approach seen within the context of what has become known as the „transcendental phenomenological approach‟. This approach aims to describe people‟s conscious experiences and their meaning, with an open mind that is not influenced by pre- understanding (Moustakas, 1994). The hermeneutic phenomenology strand has also emerged, with the key distinctions being that hermeneutic phenomenologists aim to interpret (rather than just describe), people‟s experiences and their meaning, by uncovering hidden assumptions (that the person may not be conscious of) and linking different aspects of experience that may be influenced by the experienced and viewpoint of the researcher (Gupta, 2000). Out of the hermeneutic phenomenological strand (based within the interpretivist paradigm), Interpretative Phenomenological Analysis (IPA) has emerged. This approach, developed within the field of health psychology, aims to explore the lived experience of receiving health care. It was felt to be the most appropriate approach for this study, as it aims to explore how participants make sense of their world and is “ideally suited to exploring topics in health, social and clinical psychology where there is a need to discern how people perceive and understand events in their lives” (Smith & Eatough, 2007, p. 36). IPA differs from „traditional‟ hermeneutic pheneomenology, as it incorporates both hermeneutic and transcendental phenomenological ideals. For example, the IPA approach assumes that there is a link between what people say and what they are thinking, and aims to both describe and interpret people‟s experiences to provide a detailed exploration of the phenomenon. IPA also draws on social interactionism, a sociological perspective that emphasises the importance of social interactions on how people derive meanings from their life experiences. The social interactionism perspective was initially proposed by Blumer (1969) who highlighted three core 108
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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
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and Nicassio et al (1995) only expl
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1) Poor sleep quality, defined by t
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Page 79 and 80: questionnaire 78 (77.2%) of the par
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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
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Page 91 and 92: Relationship between Negative Affec
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Page 97 and 98: eactions are most likely to be detr
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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 and 120: has explored the use of napping on
Page 121 and 122: It became clear, through the analys
Page 123: interventions. With this in mind, t
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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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
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Page 173 and 174: 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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