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

More documents

Recommendations

Info

and time away from daily life to complete the intervention, PMR in itself may have therapeutic benefits. It would have been useful to have included a third group of participants who received usual care in this study, to enable the exploration of effects of the mindfulness and PMR in comparison to a group receiving no intervention and thus to increase understanding of the therapeutic benefits of the interventions. The findings of this study may also have been limited, as the compliance with completion of the intervention could not be reliably explored in this study, and it unclear if participants completed the full intervention on all occasions. Indeed as previously described, some participants in the PMR group provided informal feedback that they discontinued the intervention due to an increase in their FMS symptoms, and some mindfulness group participants reported continuing the intervention in week three (when they had been asked to discontinue the intervention) because they had found it to be of benefit. This informal feedback was useful when interpreting the results of a feasibility study, and the study would have been strengthened by recording this feedback in a more standardised format, such as through a qualitative interview on completion of the study. An interview would have enabled further exploration of participants‟ experiences of the two interventions to inform interpretation of the findings and further research. A key strength of this study is that no participants were lost to follow up or withdrew from the study after randomisation (although the attrition rates may have been due partly to the short intervention duration and follow up). Previous studies have highlighted high attrition rates, with between 21- 39% of participants failing to complete the full intervention program due to scheduling conflicts, difficulties arranging childcare, work commitments, lack of interest and older age (Astin et al., 2003; Kaplan et al., 1993; Lush et al., 2009). This intervention was designed to address these accessibiliy issues and revealed that these issues can be overcome by tailoring the interventions to the needs of the specific population. However, a limitation of this study was that six (16%) participants were unable to tolerate wearing the actiwatch due to skin sensitivity and this will have reduced the ability of the study to detect and change between the two groups on the objective measures. Participants experiencing discomfort were advised to wash their actigraph strap several times to loosen the material and to ease discomfort as advised by the manufacturing company, although this did not appear to resolve the problem for these participants. Modifications to the straps of the actigraphs may therefore be required for future research studies with this population. 147
The aim of this study was to explore the effect of a brief mindfulness intervention on sleep and key health outcomes such as levels of pain and fatigue in people with FMS. However, as revealed throughout this thesis, the sleep experience in FMS is a complex phenomenon and many other factors are likely to have influenced the effects of the intervention that were not explored in this feasibility study. For example, the mindfulness intervention was chosen as it is based on principles of acceptance and has been found to be beneficial in reducing the effects of stress and cognitive arousal which were found to significantly influence sleep quality in FMS (as described in Chapter Five). However, changes in mindfulness state, sense of coherence, perceived stress and dysfunctional thoughts were not explored within this study, so it remains unclear if the trends in improved sleep quality are indeed a result of these mechanisms. Levels of physical activity during the day are also likely to affect sleep quality and it would have been useful to control for this as part of this study, particularly as daytime napping was found to be coping strategy for people with FMS. As highlighted in Chapter Six, reduced activity may have had a negative impact on subsequent sleep quality. In addition, many of the participants (74%) had a co-morbid condition (such as arthritis, irritable bowel syndrome, diabetes) which may have also affected the results. Given there is such a high co-morbidity in FMS, it may be argued that excluding these participants would have reduced the representativeness of the FMS population. The influence of these factors on outcomes from mindfulness interventions to improve sleep would need to be explored as part of a full randomised clinical trial. As the assessments were completed by participants on their own at home (and were not administered by a researcher), the data was collated by one researcher who was not blind to the treatment allocation of participants. This may have resulted in a researcher bias in the scoring of the assessments, although assessments were scored according to their specific instructions. The participant scores on the assessment measures may also have been affected by the time of day that people completed the assessments measures or the intervention. For example, if the assessments were completed first thing in the morning, the pain ratings were likely to be higher (as this is when pain likely to be at its worst, Moldofsky & MacFarlane, 2005) and are likely to change over the course of the day. This may have affected the scoring if participants completed the assessments at different time for each week of the three week study. A full randomised controlled trial would need to control for these factors by asking participants to complete the assessment measures and the intervention at the same time each day or through the use 148
Page 1 and 2:
Sick and Tired: Understanding and M
Page 3 and 4:
Chapter Four. The Nature and Effect
Page 5 and 6:
References ........................
Page 7 and 8:
List of Tables Table 1. Participant
Page 9 and 10:
Co-authored Works Although the stud
Page 11 and 12:
Acknowledgments This thesis would n
Page 13 and 14:
Intellectual Property Rights There
Page 15 and 16:
Confidential Material No participan
Page 17 and 18:
The role of sleep in FMS appears to
Page 19 and 20:
little information was available as
Page 21 and 22:
Psychophysiologic insomnia which is
Page 23 and 24:
and are less able to inhibit the pa
Page 25 and 26:
widely applied in clinical practice
Page 27 and 28:
of fewer tender points; usually bet
Page 29 and 30:
Current Management Strategies The t
Page 31 and 32:
also likely to depend on a number o
Page 33 and 34:
deep sleep (stages three and four)
Page 35 and 36:
Although sleep moves through the sl
Page 37 and 38:
Figure 3. The Integrative Model of
Page 39 and 40:
However, conducting a blood test is
Page 41 and 42:
As sleep is a complex process invol
Page 43 and 44:
Sleep Diaries Sleep diaries are a k
Page 45 and 46:
pain). Lentz et al (1999) revealed
Page 47 and 48:
These results have also been suppor
Page 49 and 50:
(McCracken & Iverson, 2002) which s
Page 51 and 52:
Figure 4. Conceptual model of the d
Page 53 and 54:
Clinical Implications Despite the p
Page 55 and 56:
Chapter Three. Sleep in FMS As high
Page 57 and 58:
& Penzien, 2003), although alpha wa
Page 59 and 60:
pauses in breathing indicative of s
Page 61 and 62:
Relationships between Sleep and Pai
Page 63 and 64:
Managing Sleep Disturbance in FMS D
Page 65 and 66:
may be possible to help patients im
Page 67 and 68:
person to initiate an action (such
Page 69 and 70:
and Nicassio et al (1995) only expl
Page 71 and 72:
1) Poor sleep quality, defined by t
Page 73 and 74:
elow 0.7 are acceptable. Therefore
Page 75 and 76:
heart disease (Epstein et al., 1999
Page 77 and 78:
In order to explore the links betwe
Page 79 and 80:
questionnaire 78 (77.2%) of the par
Page 81 and 82:
efficiency, suggesting that partici
Page 83 and 84:
Older age and longer length of illn
Page 85 and 86:
Table 2. Correlations between demog
Page 87 and 88:
Logistic Regression As 97% of the s
Page 89 and 90:
in bed, participants may have devel
Page 91 and 92:
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 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 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: people with FMS (Perlis, Giles, Men
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
Page 207 and 208: 190
Page 209 and 210: The following questions relate to y
Page 211 and 212: There are lots of ways to try to de
Page 213 and 214: 42. I try hard to prevent other thi
Page 215 and 216:
During the past month have you had
Page 217 and 218:
Appendix E: Published paper of Stud
Page 219 and 220:
202
Page 221 and 222:
204
Page 223 and 224:
206
Page 225 and 226:
Sleep and Fibromyalgia Syndrome Con
Page 227 and 228:
Appendix H: Participant Questionnai
Page 229 and 230:
Below are 10 statements reflecting
Page 231 and 232:
The questions in this scale ask you
Page 233 and 234:
Appendix I. Published Paper for Stu
Page 235 and 236:
218
Page 237 and 238:
220
Page 239 and 240:
222
Page 241 and 242:
Appendix K. Information Sheet and C
Page 243 and 244:
Sleep in Fibromyalgia Syndrome Cons
Page 245 and 246:
Appendix L: Letter of Ethical Appro
Page 247 and 248:
Appendix M. Letter to GPs for Study
Page 249 and 250:
What are the side effects of any tr
Page 251 and 252:
Appendix O: Poster Advertising Stud
Page 253 and 254:
Appendix Q: Participant Questionnai
Page 255 and 256:
HAD Scale Read each item and place
Page 257 and 258:
During the past month have you had
Page 259 and 260:
Appendix R. Letter from Dr Mark Cro
Page 261 and 262:
PUBLICATIONS Peer Reviewed Journal
Page 263:
and panic-like episodes, Faculty of
show all

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

Create successful ePaper yourself

Delete template?

Save as template?