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

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transcripts, with any inconsistencies or revisions to the emerging themes noted in the left hand margin. This approach helped to refine the emerging themes upon completion of the transcript analysis. The emerging themes were discussed between the two independent researchers. Although participants talked about a wide range of issues related to living with FMS, as the aim of the study was to explore the experience of sleep in FMS, the analysis focused primarily on the data focusing on sleep related issues and the additional information was used to provide a context and greater understanding of the sleep related data. Themes were clustered together and reapplied to the interview transcripts, noting any inconsistencies between participants and exploring negative cases to form themes (Mays & Pope, 2000). Although this technique emerged from other qualitative approaches, as the aim of this study was to explore interpretations and meanings for participants, it was felt to be equally applicable to this IPA study. Extracts from the interview transcripts were then related to each theme manually. This was completed by writing each theme on a piece of paper and then placing the interview extracts (labelled by participant number and page number) that related to each theme underneath the respective heading. This process ensued that the interpretations were linked to the raw data. Each extract could be used to demonstrate more than one theme if relevant, although this process often highlighted that two themes could be clustered together. The themes were then refined to ensure the name of the theme reflected the relevant extracts and their interpreted meaning. Each theme was then examined in detail to explore if it included different components. The participant sample was described in terms of mean age, duration of symptoms and percentage of participants in employment and those taking hypnotic and/or pain relieving medication, so that the interpretations could be related to the sample from which they were taken. Direct quotations from participants were used to illustrate each theme and each quote was identified using the study participant number to ensure confidentiality. Information on the participant‟s age and gender is provided for context. 113
Rigour The interview transcripts were transcribed by the researcher conducting the interview to ensure that the context of the interview was reflected and to integrate field notes and observations into the transcripts. For example, describing the nature of any interruptions or noting changes in participants behaviour (such as becoming tearful) in brackets within the transcript (Smith & Osborn, 2008). The text of the interview within the transcript was checked against the audio recording to ensure accuracy of the transcription (Dean, Smith, & Payne, 2006). The independent analysis supported the verification of the identified themes, as there was high consistency between the two researchers; any inconsistencies that became evident were discussed and the themes refined to reflect the consensus decision. Using extracts direct from the participant transcripts ensured that the interpretations and themes reflected the raw data (Smith & Osborn, 2008). If there was not a good fit between the extracts and the name of the themes, then the name of the theme was further refined to reflect the raw data. The two researchers discussed which extracts were then most representative of each theme and its components to be used in the writing up the results. Results A sample of 16 participants took part in the interviews (14 females and 2 males), which lasted between 20 and 65 minutes, with the average duration of the interviews being 40.37 (SD 13.54) minutes. Participants were aged between 21 and 61 years (mean age = 50.95 years, SD 11.94) and all spoke English as their first language. All participants had completed secondary education, with 31.25% of them attending college or university. Only one participant was in full time employment, five were working part-time, five were retired and five were no longer working due to ill-health. The mean duration of FMS symptoms was 17.25 years (SD 14.77) with an average length of time since diagnosis of 4.13 years (SD 4.37). Most participants were using some form of pain relieving medication on a regular basis (62.5%) and just over half of participants were prescribed medication to aid sleep (56.3%). The age and gender sample characteristics 114
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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
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heart disease (Epstein et al., 1999
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In order to explore the links betwe
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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 and 126: The philosophy of phenomenology was
Page 127 and 128: Methods Participants were given a w
Page 129: Table 11. Interview schedule for th
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 (
Page 177 and 178: diagnostic criteria for these sleep
Page 179 and 180: 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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