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

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esulting variables re-checked for obscure values and missing data. Missing data was treated with person mean substitution as described on p. 60-61. The mindfulness based body scan audio intervention was found to be feasible and well tolerated within this population. This was demonstrated as no participants were lost to follow up during the course of the three week study (as illustrated in Figure 9). However, feasibility issues did arise for the actigraphy outcome measures as no actigraph data was available for six participants (N=2 in the mindfulness group and N = 4 in the PMR group) for the three week duration of the study. This was due to the participants reporting that it was too uncomfortable to wear the actigraph as a result of skin irritation. Participants who were unable to wear the actigraph were not included in the analysis of the actigraphy data, although they were included in the analysis of the subjective questionnaire measures. Figure 9. Flow chart of the study population Allocated to Mindfulness Group (N = 19) Lost to follow up at week 2 (N = 0) Lost to follow up at week 3 (N = 0) Randomised (N = 36) Allocated to PMR Group (N = 17) Lost to follow up at week 2 (N = 0) Lost to follow up at week 3 (N = 0) For all other variables, the pattern of missing data appeared to be random (e.g. there were no more than two missing data points per variable, and missing data points occurred across participants). To minimise bias and to prevent data from being discarded from the analysis on these variables, the group median was imputed for missing values to account for repeated measures effects. As highlighted by Scheffer (2002) imputation for missing values can be effective if
Exploring the baseline data, there were no significant differences between the two groups on any of the demographic, mood or medical details data (see Table 12). Table 12. Participant characteristics Mindfulness PMR Test of N=19 N=17 significance Gender 2 males 2 males Χ 17 females 15 females 2 =0.14 n.s Age (Mean and SD) Age range 26-78yrs 52.94 (13.34) 52.71 (11.71) t=0.06 n.s Symptom duration in years (Mean and SD) 16.88 (13.60) 10.60 (8.07) U=113.00 n.s Other medical Y=15 Y=14 Χ conditions N=4 N=3 2 =1.01 n.s Employment Yes 2 3 Χ No 9 6 No longer working 2 2 Retired 6 6 2 =0.69 n.s Taking pain relieving Y = 15 Y = 12 Χ medication N = 4 N= 5 2 = 0.33 n.s HADS depression (Mean and SD) 18.78 (2.02) 19.41 (1.97) U = 128.00 n.s HADS anxiety (Mean and SD) 17.44 (2.66) 17.53 (2.18) U = 152.00 n.s. n.s = non significant at P
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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
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It has been suggested that the auto
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For both groups, participants were
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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 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: The progressive muscle relaxation (
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)
Page 201 and 202: Yunus, M. B., Masi, A. T., & Aldag,
Page 203 and 204: Appendices Appendix A: Search Strat
Page 205 and 206: 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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