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

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for a period of one week, the study showed that the mindfulness body scan intervention was feasible to implement in a community setting and participants receiving the mindfulness body scan intervention displayed greater improvements in sleep quality and levels of pain in comparison to the PMR control group. This contrasts with a previous study using sleep quality as an outcome measure, which found that mindfulness had no effect on sleep quality in people with FMS (Sephton et al., 2007). The discrepancy in the findings may be explained as the study, completed as part of this thesis, employed a unique approach, which was feasible for people with FMS to implement in their own homes, rather than an intensive interventions delivered by a trained specialist (as applied by Sephton et al., 2007), which may be difficult for people with FMS to access. The low attrition rates and positive trends in this feasibility study suggest that a brief mindfulness body scan is a promising intervention for improving sleep quality and symptoms of pain and fatigue for people with FMS. Added Value of the Thesis to the Research Literature This thesis has helped to clarify the nature of the sleep disturbance experienced in FMS and has explored some of the factors that may be influencing sleep quality in this population. By exploring the separate components of sleep quality, these studies have highlighted the complex nature of the sleep process and how psychological factors may be involved in the sleep process. For example, some factors such as perceived levels of stress were found to affect night-time awakenings but not sleep duration in FMS. The findings of this thesis revealed that the influence of psychological factors on sleep quality provides support for the integrative model of sleep-interfering and sleep- interpreting processes proposed for insomnia (Lundh & Broman, 2000). However, looking specifically at the models proposed for people with chronic pain conditions, the findings of this thesis suggest that the maintenance of sleep disturbances in FMS is far more complex than current models suggest. Previous models of sleep and pain have highlighted the cyclical relationships between fatigue, poor sleep and pain which are supported by the findings of this thesis for people with FMS. However the links between coping, sleep and pain remain unclear in people with FMS. 155
Modifications to the Call-Schmidt and Richardson (2003) model (re-illustrated in Figure 11) are proposed in Figure 12 (p. 157), to ensure the model fits with the research evidence for people with FMS. The variables of stress, dysfunctional beliefs about sleep and negative affect have been added into the model as a result of the findings from this thesis. The box in the bottom right hand corner has also been amended to describe the effect of poor sleep quality (rather than good sleep quality as specified in the original model). This box has been further integrated with the other variables in the model to reflect how poor sleep is part of a cycle in which people with FMS seem to find themselves, as suggested by the findings of this thesis. As the direction of the associations cannot be determined by the cross-sectional nature of the completed studies, links between the included variables have been considered as bi-directional. Figure 11. Original Conceptual Framework of Pain and Sleep adapted from Call- Schmidt and Richardson (2003) Chronic Pain Stimulation of arousal Suppression of sleep Awake Disrepair Energy Depletion Impaired Coping Loss of Adaptation Central Nervous System Sleep Reparation Restoration Coping Adaptation 156
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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
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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
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 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: Four) revealed that global sleep qu
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
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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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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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