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

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Abstract Sleep disturbance has been highlighted as one of the key difficulties for people diagnosed with Fibromyalgia Syndrome (FMS). Objective findings have revealed that there may be underlying changes in the sleep structure for this population. However, there is little evidence regarding how people perceive their sleep quality, the nature of the specific difficulties they experience or how sleep affects their daily lives. The purpose of this thesis was to explore the nature and extent of sleep difficulties in people with FMS, the psychological factors that may contribute to poor sleep quality and the impact of sleep on people‟s lives. The thesis also aimed to explore a possible strategy for the management of sleep disturbance in FMS. After completion of a literature review of research focusing on sleep and FMS, mixed research methods were applied to address the aims of this thesis. Two quantitative studies, (one utilising a cross-sectional questionnaire and the other using a case-control design), explored the sleep quality in people with FMS and the links between sleep and other symptoms of FMS. A qualitative study using interpretative phenomenological analysis was employed to elaborate on these quantitative findings, to explore what sleep disturbance means to people with FMS. A pilot study was then conducted to explore a possible intervention to improve sleep quality for people with FMS based on the findings of the previous three studies. Sleep disturbance was found to affect a greater number of people with FMS than previously identified. Poor sleep quality had a profound effect on people‟s lives, affecting other symptoms of the condition such as pain and fatigue, as well as reducing their ability to engage in daily activities. Night-time awakenings and feelings of high levels of arousal on awakening were found to have the most profound impact in FMS, with people experiencing „blocks of sleep‟ lasting several hours throughout the night. Psychological factors such as negative affect, perceived levels of stress and beliefs about sleep were found to be significantly associated with poor sleep quality. A brief mindfulness based intervention aiming to reduce stress and cognitive arousal, proved to be feasible and showed positive trends in sleep quality post-intervention in comparison to a progressive muscle relaxation control group intervention, and may be a potential treatment intervention for people with FMS. xv
The role of sleep in FMS appears to be more complicated than previously described, with sleep, psychological factors and health outcomes highly interlinked. A revised model displaying the relationships between sleep and pain is proposed based on the findings of this thesis. Non-pharmacological interventions specifically aimed at improving perceived sleep quality should form an important component to treatment approaches for people with FMS. xvi
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: Confidential Material No participan
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
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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
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CON = DBAS-10 Dysfunctional beliefs
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The Exp (B) values revealed that hi
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has explored the use of napping on
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It became clear, through the analys
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interventions. With this in mind, t
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The philosophy of phenomenology was
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Methods Participants were given a w
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Table 11. Interview schedule for th
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Rigour The interview transcripts we
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“The main symptom is this overwhe
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Theme Two. Inter-relationship betwe
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where I live, so I don‟t know, I
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Participants also described how the
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“XXXX (name of person) planned a
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A strong theme that emerged in this
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conducted at several time points, w
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Chapter Seven. Investigating the Ef
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activities because they no longer f
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Therefore as this was a feasibility
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Self-reported sleep quality was ass
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The progressive muscle relaxation (
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Exploring the baseline data, there
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Consequently, univariate analysis w
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There was no significant correlatio
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people with FMS (Perlis, Giles, Men
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The aim of this study was to explor
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observed in perceived overall sleep
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elaborated on in Chapter Six, which
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Four) revealed that global sleep qu
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Modifications to the Call-Schmidt a
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MBSR programme in people with FMS (
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diagnostic criteria for these sleep
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comprehensive measures to look at t
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References Abad, V. C., Sarinas, P.
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Brand, S., Gerber, M., Beck, J., Ha
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Crofford, L. J., & Demitrack, M. A.
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Goldenberg, D. L., Kaplan, K. H., N
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Johns, M. W. (2002). Sleep propensi
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Leung, Y. Y., Ho, K. W., Zhu, T. Y.
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Mease, P. J. (2005). Fibromyalgia s
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symptoms in healthy subjects; Corre
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approach with illustration to the h
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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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202
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204
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206
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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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218
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220
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222
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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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