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

Chapter Seven. Investigating the Effects of Mindfulness on Sleep Quality in
FMS
The first three studies within this thesis revealed that people with FMS experience high
levels of cognitive arousal and difficulties maintaining sleep throughout the night. In
addition, psychological factors such as stress and beliefs about sleep were also found to
be associated with poor sleep quality. Due to the limitations of current treatment
approaches there is an urgent need to explore the applicability and potential
effectiveness of non-pharmacological interventions to improve sleep quality in patients
with FMS. Based on the models of sleep and pain, described in Chapter Two, improving
sleep quality may also lead to improvements in other symptoms such as pain and
fatigue. To address the difficulties experienced by people with FMS, an intervention
that aims to reduce the impact of stress, beliefs about sleep and cognitive arousal may
help to improve sleep quality in people with FMS.
There are currently contrasting opinions about whether sleep difficulties in patient
populations should be treated as part of the illness or as a separate entity (Harvey, 2001;
Mahowald & Mahowald, 2000; Watts, Coyle, & East, 1994). However, as the evidence
suggests that sleep has a significant influence on health outcomes in FMS, interventions
that improve sleep quality are likely to lead to improvements in the overall symptom
experience and therefore sleep problems should be specifically addressed. After an
initial search of the literature and as part of a systematic review (completed in addition
to this thesis), it became evident that there were few completed, fully powered,
randomised controlled trials exploring the efficacy of non-pharmacological
interventions to improve sleep quality in FMS (Theadom, Cropley, Hankins, & Smith,
2009).
There is emerging evidence from pilot studies, that non-pharmacological interventions
addressing dysfunctional beliefs, incongruent sleep behaviours and lifestyle factors that
may exacerbate sleep difficulties, can reduce the experience of FMS symptoms and the
amount of time spent awake during the night, in comparison to patients receiving usual
care or using sleep hygiene principles alone (Edinger et al., 2005; Singh, Berman,
Hadhazy, & Creamer, 1998). These studies have employed intensive group therapy
approaches, delivered by a trained specialist lasting for one hour, for at least six weeks.
A full scale trial is now underway to explore the efficacy of a group therapy
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