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

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fundamental aspects of the perspective” 1) people respond to life experiences on the basis of the meaning(s) of that experience to them; 2) the meaning of life experiences arise out of the social interaction that someone has with others and society; and 3) that meanings may change over time as a person continually interprets and re-interprets daily events. Therefore how an individual interprets an experience may be influenced by their past and future, and the interpretations of others gained through social interaction. Consequently, this approach lends itself to the focus of health psychology research and has the additional advantage in that it advocates the use of an empathic and flexible questioning approach, which are important components of psychological enquiry. In accordance with hermeneutic phenomenology, IPA acknowledges that the researcher plays an active part in the data analysis, as their prior knowledge and professional background will influence how they interpret people‟s experiences, particularly playing a key role in identifying the underlying concepts that the participant may articulate but may not be consciously aware of (Smith & Eatough, 2007). It should therefore be noted that the transcripts were analysed by two registered health psychologists (Alice Theadom and Mark Cropley) who were involved in the previous two quantitative studies of this thesis and who had experience of working with people with FMS. Psychology is a „scientific study of people, the mind and behaviour‟, with the specialised branch of health psychology focusing on the prevention and management of illness; the identification of psychological factors contributing to physical illness; the improvement of the health care system, and the formulation of health policy. The conduct of this study using IPA methods, and the interpretation of the data, was therefore based on the health psychology perspective and consequently the researchers‟ previous experience and knowledge will have influenced their interpretations of the findings. However, an advantage of the IPA approach is that when coding the transcripts, the researcher is constantly brought back to the raw data to ensure that the interpretations are valid (Smith, 2003). The IPA approach has not previously been used in FMS and therefore had potential to provide a unique contribution to the evidence base by exploring in more detail people‟s experiences of sleep and how poor sleep quality affects them. 109
Methods Participants were given a written information sheet and were offered verbal information about the study through presentations at support group meetings for people with FMS. Participants interested in the study were asked to contact the researcher. Participants were advised that they did not have to be experiencing sleep disturbance to take part in the study, thus enabling the exploration of the effect of both good and poor sleep quality in FMS. Participants were included if: 1) they had received a diagnosis of FMS by a clinician and; 2) were aged over 18 years. Participants were excluded if they were unable to speak or understand English or if they had been diagnosed with an organic sleep disorder with an identified underlying physical cause (such as sleep apnoea or restless legs syndrome). After confirming that the participants had received and read the information sheet, and had been given the opportunity to ask any questions they had about the study, a mutually convenient time was arranged to conduct the interview. Participant Recruitment The IPA approach aims to identify the commonalities of people experiencing a specific phenomenon and therefore participants are sampled to ensure that they can offer a meaningful perspective on the phenomenon being investigated (Smith & Eatough, 2007). For this study, participants were recruited through FMS support groups in the South-East of England in an attempt to achieve a relatively homogenous sample. The IPA approach advocates that small homogenous samples should be used in order to obtain a detailed understanding of individuals‟ personal experiences and to ensure that in-depth analysis is feasible (Reid, Flowers, & Larkin, 2005). The interview process was explained to participants, providing them with the opportunity to ask further questions before they were asked for their permission to record the interview using a digital voice recorder and to sign the consent form. Data Collection To provide a context for the data, background information was collected from the participants, including their date of birth, details of their diagnosis, employment status 110
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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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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
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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
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 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: The philosophy of phenomenology was
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
Page 171 and 172: Four) revealed that global sleep qu
Page 173 and 174: Modifications to the Call-Schmidt a
Page 175 and 176: 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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