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

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of diary to assess levels of pain at several different times over the course of a 24 hour period (Affleck et al., 1998). It may also be the case that the intervention may have different affects on weekdays and weekends, and between those who are employed and those not working, as people are more likely to have a consistent sleep pattern during the week if they are employed. Further exploration of these factors needs to be considered in future research. As the focus of this feasibility study was to explore the effect on sleep quality, the measures of pain and fatigue were kept short and concise and therefore did not provide a comprehensive assessment of the different aspects (physical and mental) of fatigue (Moldofsky & MacFarlane, 2005; Shaver et al., 1997). A more comprehensive assessment of these outcomes would have been beneficial to explore the effects of the intervention within this population and whether certain types of people or illness characteristics are more likely to benefit from the intervention than others (Nielson & Jensen, 2004). As highlighted by Mace (2008) some people find it easier than others to experience mindfulness. Indeed, one study revealed that 12.5% of participants were classed as „marked responders‟ (participants showing an improvement of 75% or more on the outcome measures), suggesting that they benefitted from the intervention far more than those classed as responders (participants showing an improvement of 25% or more on the outcome measures) (Kaplan et al., 1993). Subsequent to the onset of this study further recommendations on the outcome measures that should be employed in clinical trials in people FMS were published. Although this study had already included many of the recommended outcome measures, such as measures of pain, fatigue, sleep disturbance and depression, the trial did not include a measure of patient global satisfaction. A measure of global satisfaction should be employed within future clinical trials to ensure that comprehensive outcomes found both to be important to people with FMS and utilised in other clinical trials are included to enable comparisons to be made (Mease et al., 2009). Implications This study revealed that a brief mindfulness body scan intervention may improve subjective and objective sleep quality for people with FMS, as positive trends were 149
observed in perceived overall sleep quality, sleep efficiency, pain and fatigue. Previous research has utilised intensive mindfulness interventions that are delivered by a trained professional and are carried out for a minimum of 30 minutes for eight to 10 weeks alongside home practice for approximately 45 minutes each day (Grossman et al., 2007; Lush et al., 2009). Accessing these interventions can be challenging for people with FMS, as they often experience difficulties travelling long distances and maintaining concentration for long periods of time, and these factors may have influenced the high attrition rates reported in previous studies (Astin et al., 2003; Kaplan et al., 1993; Lush et al., 2009). Therefore this brief intervention (which can be self-delivered at home), offers increased accessibility and feasibility for people with FMS. As the mindfulness experience is likely to become more effective with practice, the improvements in perceived overall sleep quality, sleep efficiency, pain and fatigue as observed in this study after completing the intervention for only one week, are likely to continue to increase over the longer term. Therefore, studies employing a longer intervention period and follow up are warranted. Many studies exploring the effectiveness of interventions to improve sleep quality, also explore the clinical significance of the findings. For example, observing how many people fall within the parameters defining a „good sleeper‟ (e.g. sleep onset latency
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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
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As previously described on page 61,
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Figure 7. Scree plot for the explor
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Figure 8. Scree plot for the explor
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Table 6. Participant characteristic
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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 and 164: people with FMS (Perlis, Giles, Men
Page 165: The aim of this study was to explor
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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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
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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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