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

Outcome Measures:
Participants were engaged in the study for a three week period. In week one (the
baseline week) participants were asked to complete standardised questionnaires and
questions regarding their age, gender, symptom duration, co-morbid conditions,
employment status, hours of paid work, and if they were required to undertake any shift
work.
Mood was assessed using the Hospital Anxiety and Depression Scale (HADS)
(Zigmond & Snaith, 1983). This scale has been widely used for assessing levels of
anxiety and depression in patients with medical problems (Herrmann, 1997). The scale
consists of 14 questions that ask participants how they have been feeling over the past
week. There are two subscales (anxiety and depression) and subscale scores range
between 0-21 (0-7 normal, 8-10 mild, 11-14 moderate and 15-21 representing a severe
level of anxiety/depression). The HADS has been found to have high reasonable
internal consistency of between 0.68 to.093 (mean.83) for the anxiety subscale and
between 0.67 to 0.90 (mean 0.82) for the depression subscales (Bjelland, Dahl, Haug, &
Neckelmann, 2002); and is sensitive to treatment related change with test retest
correlations at six weeks of 0.70 (Herrmann, 1997). As high levels of depression and
anxiety have been found in people with FMS (Epstein et al., 1999) this measure was
utilised to assess levels of anxiety or depression between the two groups, and to reveal
if there if there were any differences that would need to be accounted for in the analysis.
Primary outcome measures
Actigraphy
As highlighted in Chapter Two, actigraphy can be used as an objective measure of
movement (where periods of inactivity are indicative of sleep or rest) and can also
providing a measure of activity levels during the day and over night in a naturalistic
setting (Smith & Haythornthwaite, 2004). This study utilised actigraphs developed by
Cambridge Neurotechnology Ltd., which measured changes in acceleration created by
movement of the arm and summed over one minute epoch intervals. In order to account
for the variability in sleep quality over time, participants were asked to wear the
actigraph throughout the day and night for the three week duration of the study.
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