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

Four) revealed that global sleep quality was significantly associated with poorer health
outcomes including physical functioning, role limitations due to emotional difficulties,
fatigue, well-being, social functioning and pain. Higher levels of perceived pain and
poorer physical functioning were significantly associated with more frequent night-
time awakenings. This supports previous research findings which found that poor
sleep quality is associated with higher levels of pain (Nicassio et al., 2002) and that
fatigue was only associated with worse daytime dysfunction. In the qualitative study,
(Chapter Six), participants described a strong interrelationship between their sleep
quality and other symptoms relating to their condition (such as pain and fatigue), with
a poor nights sleep leading to higher levels of pain and fatigue the following day and
high levels of pain interfering with their sleep at night. Participants also described
feeling more fatigued and less able to participate in daytime activities after a poor
nights sleep, supporting the quantitative findings (Chapters Four and Five). As sleep
quality, pain and fatigue fluctuated over time, this caused participants with FMS
significant difficulties in being able to plan activities and they often had to cancel
arrangements due to a poor nights sleep. As a way of coping with their poor sleep and
symptoms, participants described planning rest periods and using daytime naps, to
help them to increase their energy levels over the course of the day. It was also
observed that most people with FMS perceived that the onset of their sleep difficulties
occurred prior to, or at the same time as, the onset of their other FMS symptoms;
suggesting that sleep difficulties are not just a consequence of pain and fatigue. As
shown in Chapter Five, sleep disturbance is a significant risk factor for diagnosis of
FMS, and sleep appears to be a significant cause of disability and reduced social
functioning in people with FMS. This supports the recent recommendations on
outcome measures for clinical trials in FMS which state that sleep should be
considered to be key outcome for interventional studies within this population (Mease
et al., 2009).
Objective Four. An Intervention to Improve Sleep Quality
Lastly this study aimed to trial an intervention with the aim to improve sleep quality
for patients with FMS. Drawing on the findings from the first three studies, this
feasibility study explored the effect of a brief mindfulness intervention, based on the
principles of acceptance of physical sensations and thoughts and thereby reducing
stress and arousal on sleep quality in FMS. Although the intervention was only piloted
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