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

MBSR programme in people with FMS (Chapter Seven) revealed that a number of
clinical trials of non-pharmacological studies have been completed; although the
effectiveness of the intervention remains unclear, due to small sample sizes and
consequent low statistical power to detect any effect. A meta-analysis of these studies,
(and other non-pharmacological) interventions, may help to clarify the effectiveness of
these findings by combining studies of comparable interventions. Due to the influential
role of psychological factors identified within this thesis, non-pharmacological
interventions may be ideally placed to address these factors in clinical treatment and an
analysis of their effectiveness would therefore provide important information to inform
treatment of the condition. A Cochrane review of non-pharmacological interventions is
currently underway (Theadom et al., 2009).
Thesis Limitations and Recommendations for Future Research
Limitations relating specifically to each study of this thesis were discussed within the
relevant chapters. However, there were some general limitations across the four
interlinked studies completed as part of this thesis that will be considered here.
Another factor related to sleep that was not explored within this thesis was the role of
chronotype on sleep disturbance. As described in Chapter Two, people have underlying
natural circadian rhythms, and a natural sleep chronotype (patterns of when they feel
more alert and when they feel more tired) (Randler, 2008). For example, people are
often referred to as „larks‟ if they prefer to go to sleep earlier and wake up earlier in the
morning, or „owls‟ if they prefer to stay up later in the evening and wake up later in the
morning (Cavallera & Giudici, 2007). It is currently unclear if people with FMS are
affected by their underlying sleep chronotype. Understanding if chronotype does play a
role in the sleep experience may help to inform the treatment of sleep disturbances for
people with FMS. If chronotype is associated with sleep disturbance, then clinicians
could help to support people with FMS to manage their sleep disturbance through
identifying times of the day when they may be more alert, within which to schedule
daily activities, and periods when the person may be feeling more fatigued, within
which to schedule in rest or more passive activities, to be in harmony with their
underlying circadian rhythm. A further study is currently being planned to explore the
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