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

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effect of chronotype of sleep disturbance in FMS utilising a cross-sectional internet survey. Although the studies within this thesis explored the effect of sleep on a number of outcome variables in people with FMS, not all outcomes that are likely to be affected by sleep disturbance were explored. For example, cognitive difficulties have been proposed as a key symptom of FMS, and one study has shown that memory impairments, mental confusion and speech difficulties are associated with sleep disturbance in people with FMS (Katz, Heard, Mills, & Leavitt, 2004). Although this study has drawn attention to the role of sleep on cognitive factors in FMS, the findings were limited as cognitive disturbance was only measured by self-report. Research exploring the effects of sleep disturbance using more objective measures of cognitive functioning (such as through the use of standardised computer administered neuropsychological tests), may reveal more accurately the links between sleep and cognitive functioning in people with FMS. This would enable the exploration of the effect of sleep on different components of cognitive ability (such as memory, attention and executive functioning) and further exploration is warranted. Some researchers in the field of sleep have suggested that measures of daytime sleepiness are a useful tool (in addition to measures of nocturnal sleep quality), and it has been proposed that measures of daytime sleepiness may even be a more reliable indicator of poor sleep quality (Lundh & Broman, 2000). For example, nocturnal sleep quality measures (such as the PSQI used within this thesis) consider a sleep duration of
diagnostic criteria for these sleep disorders (such as periodic limb movement disorder, bruxism, sleep apnea or restless legs syndrome). The findings of this thesis should be interpreted with some caution as the analyses did not account for possible measurement and sampling error. As little research has been completed in the field of FMS using the measures incorporated within this thesis, little is known about the psychometric properties of these measurement tools with the FMS population. Consideration of the most evidence based measures for use within this thesis (as described in Chapter Four) and procedures for reducing systematic error were applied (such as double entering data, the measures being administered by one trained researcher). However, despite these efforts there remains a risk of measurement error; (that the assessment tools do not measure what they state they are measuring or due to human consistency) which may bias the results. There may be a particular risk of possible misclassification of participants into outcome groups for the logistic regression, (as conducted in Chapter 5) due to measurement error and therefore caution needs to be applied in the interpretation of these findings. There is a need for further studies to explore the psychometric properties of these assessment tools in more detail to ensure the accuracy of research findings. It has been found that measurement error can reduce the power of a study by over 25% (Cheng, Branscum, & Stamey, 2010). Therefore, in future studies it is recommended that adjustments for possible sampling error be made in sample size calculations for studies utilising these tools, particularly when exploring constructs that are known to frequently occur within a given population. As the high frequency of sleep difficulties was unknown at the time of study completion, this was not accounted for within this thesis; but on reflection accounting for this risk of error would have increased confidence in the research findings. Participants were recruited through community based support groups and although this approach was chosen to ensure the capture of people with varying degrees of severity of FMS (rather than only those requiring support from hospital services or specialist clinics), this may limit the generalisability of the results to people who do not attend support groups. People attending support groups may differ from people with FMS who do not, such as an increased need for social support or seeking information (Davison, Pennebaker, & Dickerson, 2000). For example, it was found in a study in HIV patients 160
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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
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It became clear, through the analys
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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 and 172: Four) revealed that global sleep qu
Page 173 and 174: Modifications to the Call-Schmidt a
Page 175: MBSR programme in people with FMS (
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
Page 217 and 218: Appendix E: Published paper of Stud
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Page 225 and 226: 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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