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

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1994; Kaplan et al., 1993) with participants reporting that due to symptom variability, they often find it difficult to attend appointments if they have an unexpected flare-up, and many found that travelling to health care centres lead to an increase in fatigue. Such difficulties may prevent people with FMS from fully engaging in rehabilitation interventions, therefore introducing a self-selection bias into these studies (Lush et al., 2009). Participants with FMS may also find some of the techniques difficult, for example, sitting in one position for a long period of time may increase levels of pain. Consequently, in order to overcome some of these feasibility issues, mindfulness interventions may need to be delivered in an alternative format which will increase accessibility for patients with FMS. The Mindfulness Body Scan Although commonly taught in intensive group sessions, the mindfulness approach also lends itself to the use of particular „mindfulness based‟ techniques at home. One such technique is the mindfulness body scan, which is an introductory exercise used at the beginning of the MBSR programme to help patients learn the skills of mindfulness and to increase self awareness through directing their attention to their breathing and different parts of the body. Participants are asked to scan different parts of their body to notice if they are experiencing any physical sensations in that part of the body, to explore what they feel like and to accept these sensations whether they are pleasant or unpleasant. The mindfulness body scan can be delivered by audiotape (Ditto, Eclache, & Goldman, 2006) which can increase accessibility of mindfulness interventions for patients unable to access the full MBSR programme. This study aims to explore if a brief audio body scan intervention, delivered within a community setting, is feasible and associated with improvements in sleep quality and health related quality of life for people with FMS. Previous studies have highlighted feasibility difficulties in implementing mindfulness with people with FMS. However, the aim of this study was to explore the feasibility of a modified mindfulness intervention for this population. The study also aimed to explore trends in health outcomes to determine if the modified intervention warrants further investigation in studies powered to explore the size and direction of any effects. 133
Therefore as this was a feasibility study rather than a study aiming to determine the size of an effect, a priori power calculation was not conducted. It was hypothesised that: 1. There would be improvements in objective sleep quality in people receiving the brief mindfulness body scan intervention in comparison to people receiving a control group intervention; 2. There would be improvements in subjective sleep quality in people receiving the Method brief mindfulness body scan intervention in comparison to people receiving a progressive muscle relaxation intervention (control group). Participant Recruitment Thirty six participants were recruited though patient support groups in the South East of England. To be eligible to participate in the study participants were required to: 1) have a diagnosis of FMS by their GP or consultant; and 2) be >18 years of age. Participants were excluded if they had: 1) a diagnosed organic sleep disorder (such as sleep apnoea; or 2) if they had experienced a change in their medical treatment within the last three months, to prevent these factors from affecting the findings of the study. Participants were recruited via advertisements disseminated through patient support groups of the Fibromyalgia Association UK. Participants expressing an interest in the study gave permission to the support group coordinators to pass their contact details on to the research team. Potentially eligible participants were contacted by the research team, by telephone, to explain the study and what would be involved in more detail, to check their eligibility, and to offer participants the opportunity to ask any questions about the study. Eligible participants were then sent an information sheet and consent form via the post, and were contacted a week later to ask if they would like to take part. They were also given an opportunity to ask any further questions over the telephone and those wishing to participate returned a signed consent form. 134
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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
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participants, who may be less likel
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emotional problems, increased pain
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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 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: activities because they no longer f
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
Page 195 and 196: symptoms in healthy subjects; Corre
Page 197 and 198: approach with illustration to the h
Page 199 and 200: 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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