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

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that people who attended support groups had higher levels of education and a longer duration of the illness than non-attenders (Walch, Roetzer, & Minnett, 2006). This has not yet been specifically explored in the FMS population. A further limitation of the overall thesis is that there were minimal eligibility criteria for inclusion as an „FMS participant‟. Participants were required to have received a formal diagnosis of FMS from a GP or a consultant, however as discussed in Chapter One, many patients are not diagnosed based specifically on the ACR (1990) criteria in clinical practice, or in some cases the criteria were applied incorrectly. Therefore we cannot be completely confident that all participants would have met the ACR criteria and this may affect the reliability of the findings. However, it could be argued that as some researchers believe the ACR criteria only diagnose people with more severe symptoms of the condition (Bidari et al., 2009), the fact that this study included participants who did not have a diagnosis based specifically on the ACR criteria, meant this thesis was more inclusive of the FMS clinical population. In response to the criticisms of the ACR criteria, proposals are underway to review the criteria and to reduce the reliance on the tender point examination which is most commonly misapplied. The proposed new criteria aims to focus more on the other symptoms of FMS, such as sleep disturbance, fatigue and cognitive difficulties in order to provide a more comprehensive measure of symptoms experienced. This new approach will provide a method of verifying the diagnosis of FMS in research studies and enable an exploration of different severities of FMS, without the need for a tender point examination by a trained clinician (Wolfe et al., 2010). Recent recommendations on the use of outcome measures that were published after the design of the studies included in this thesis, suggest that a FMS disease-specific measure such as the Fibromyalgia Impact Questionnaire should be employed in clinical trials for this population. This scale lists items relating to specific symptoms of FMS including fatigue, sleep and pain. As these concepts needed to be explored in detail for this thesis (for example, to explore the effect of sleep on the different components of fatigue) more comprehensive measures of these specific constructs were used within this thesis. However, such an approach prevented this research from being directly compared to other research findings for people with FMS. This should be considered in future research to facilitate comparability of the findings, in addition to more 161
comprehensive measures to look at the constructs under investigation in more detail (Scheuermann, 2008). Implications for Practice Due to the extremely high prevalence of sleep difficulties in FMS and the identified links between sleep and pain and fatigue, interventions designed to improve sleep may lead to improvements in not only sleep quality, but also quality of life and reduction in medication use for participants with FMS. This thesis has extended the current knowledge base by exploring the components of sleep quality and highlighting that sleep maintenance, rather than sleep onset difficulties, are most problematic for people with FMS. In addition, a number of factors were shown to be influential to sleep quality (including negative affect, beliefs about sleep, stress, worry and high levels of cognitive arousal) and these need to be addressed in targeted interventions to facilitate sleep quality. There is currently contrasting opinions about whether sleep difficulties in patient populations should be treated as part of the illness or as a separate entity (Mahowald & Mahowald, 2000; Watts et al., 1994). As sleep and other symptoms of the condition were found to be highly interlinked within this thesis, this supports the notion that sleep interventions should be an integral component of interventions for people with FMS. 162
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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
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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 and 176: MBSR programme in people with FMS (
Page 177: diagnostic criteria for these sleep
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
Page 227 and 228: 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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