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

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quality in FMS (Crofford et al., 2005; Hauser, Bernardy et al., 2009; Russell et al., 2009); however, this study revealed that participants taking these medications still experienced significant sleep disturbance that disrupted their daily lives, supporting the need for a multifaceted treatment approach. Strength and Limitations The findings of this study strengthen the increasing body of evidence that sleep quality plays an important role in the exacerbation of symptoms in FMS (Korszun et al., 2002). This qualitative study expanded on a number of areas highlighted in previous quantitative studies. For example, participant‟s descriptions of the effects of poor sleep provide further evidence that the links between pain and sleep in FMS are bi-directional. In addition, it also became evident that in support of the quantitative findings, night- time awakenings appeared to be a significant difficulty for people with FMS. However, it also emerged from the interviews, that people described waking up suddenly during the night and feeling very alert which may help in our understanding of the causes of these disturbances. The anxiety surrounding sleep and the expectations of a bad night elicited in this study supports the exploration of stress and beliefs about sleep discussed in Study Two, and highlights the need to address the reported mental alertness at night as part of a sleep intervention to improve sleep quality for this population. This study has also aided the explanation of the unexpected finding in the first study which revealed low correlations between coping and health outcomes in FMS. It became apparent in this qualitative study that coping in FMS is a complex process, and that the high symptom variability affected the strategies people employed to cope with their symptoms. For example in this study, poor sleep was found to reduce people‟s ability to utilise problem focused coping strategies, and many participants reported using relaxation based approaches to improve their sleep. Increases in the use of relaxation and physical activity were found to be significantly related to improvements in outcome, in a clinical trial of a multifaceted cognitive behavioural intervention in people with FMS (Nielson & Jensen, 2004). The use of relaxation and increasing physical activity were not specifically explored as coping strategies within the generic coping measure (The COPE scale) used in the study, described in Chapter Four. This suggests that further studies using a more specific measure of coping in FMS, 127
conducted at several time points, would provide further clarity on the role of coping on FMS outcomes. In addition to talking about their sleep experience, participants also raised a number of issues unrelated to sleep as part of the interview. Some of these issues such as the demands of living with an „invisible illness‟, the impact of diagnosis, their relationship with their health care provider and their daily lives have been described in previous research (Arnold et al., 2008; Cunningham & Jillings, 2006; Madden & Sim, 2006; Sim & Madden, 2008), and were therefore not incorporated in this analysis. However, it is important to acknowledge these issues in the interpretation of the findings from this study. The ability to generalise the findings from this study may be reduced as the sample may not be representative of the population of people with FMS. Variations in sleep quality may exist between patients with different degrees of disease severity or due to other aspects of the patient‟s history. However, one of the aims of IPA is to identify a relevant homogenous sample for the research question in order to conduct a detailed exploration of the research question and the individual experience. A further limitation of the study was that the sleep experience was only explored at one point in time and it is likely that the quality of sleep changes over the course of time and over the course of the illness. Qualitative interviews conducted across several time- points would provide a greater understanding of these changes and the adaptations people make to adjust to living with FMS and poor sleep. One of the key strengths of qualitative research is that it can elicit new information to inform future research. The findings also highlighted that a number of studies are needed to increase our understanding of the role of sleep in FMS, including the effect and use of daytime napping as a coping strategy, existence of possible sleep disorders and further exploration of the use of hypnotic medication within this population. 128
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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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questionnaire 78 (77.2%) of the par
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efficiency, suggesting that partici
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Older age and longer length of illn
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Table 2. Correlations between demog
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Logistic Regression As 97% of the s
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in bed, participants may have devel
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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 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 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: A strong theme that emerged in this
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
Page 181 and 182: References Abad, V. C., Sarinas, P.
Page 183 and 184: Brand, S., Gerber, M., Beck, J., Ha
Page 185 and 186: Crofford, L. J., & Demitrack, M. A.
Page 187 and 188: Goldenberg, D. L., Kaplan, K. H., N
Page 189 and 190: Johns, M. W. (2002). Sleep propensi
Page 191 and 192: Leung, Y. Y., Ho, K. W., Zhu, T. Y.
Page 193 and 194: 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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