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

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Introduction Sleep disturbance has a substantial impact on functioning and quality of life for people with Fibromyalgia Syndrome (FMS), however little is known about the nature of the sleep disturbance experienced or how sleep quality can be improved in this population. In order to improve healthcare provision and quality of life, a greater understanding about the nature of the sleep disturbance experienced and the role of sleep in FMS is needed. The purpose of this thesis was to extend the current knowledge base using a mixed methods approach. The specific objectives of this thesis were to: Describe the nature and extent of self-reported sleep difficulties in FMS Explore the psychological factors that may contribute to poor sleep quality in patients with FMS Explore how sleep quality affects patients‟ symptoms and daily lives Pilot a possible intervention to improve sleep quality for patients with FMS The first step of this thesis was to review the existing literature on FMS and sleep (see Appendix A for search strategy). To extend the current knowledge base, and to answer the overall research question and objectives of this thesis, a combination of quantitative and qualitative research methods needed to be employed. Psychological processes (such as the experience of physical illness) are highly complex, and can be influenced by a number of causative and influential factors. A concurrent mixed methods design (where the methods are used to complement each other) offers the best approach to understanding such a complex phenomenon. In addition, to address the aims of this thesis, exploring both the extent and the nature of sleep disturbance in FMS and possible management approaches, a mixed methods approach forms the framework of this thesis. Four interlinked, but distinct research studies are discussed within this thesis. Each study explores a different objective, with the findings combined into a cohesive whole in order to address the overarching research question. The studies completed as part of this thesis were developed over a five year period. At the onset of this thesis in 2005 1
little information was available as to the underlying cause of the condition, let alone the types of sleep difficulties people perceived they were experiencing. Over the duration of this thesis, there have been significant advances in our understanding of the condition, including a movement towards FMS being considered as a neurological, rather than a rheumatological condition. Consequently, it was important to ensure that the most current literature was used to inform the interpretation of the findings. Literature available up until March 2010 has, therefore, been included within this thesis where most appropriate to make sense of the field and the research. The overall thesis has been structured into eight chapters following the development of the work completed: Chapter One explores the literature on FMS, its impact on both individuals and society and current treatment approaches. In Chapter Two, the current knowledge base on sleep and insomnia, and the factors affecting sleep quality in the general population are discussed. Chapter Three integrates and extends the information within the first two chapters by reviewing the literature specifically focusing on sleep in FMS. In response to the findings of the literature review outlined in the first three chapters, Chapter Four aims to address some of the gaps identified in the current literature by exploring the links between sleep quality, coping and other symptoms of FMS such as pain and fatigue. Chapter Five extends the findings of the study described in Chapter Four by examining the psychological factors that may influence sleep quality in FMS, by comparing people with FMS with healthy controls. Using a qualitative approach to elaborate on the quantitative findings of the studies in Chapters Four and Five, Chapter Six examines people‟s experiences of sleep, the role of sleep on quality of sleep and the meaning of poor sleep quality for people with FMS. This chapter aims to explore the needs of patients with FMS, to identify the key areas that would need to be addressed in a proposed intervention to improve sleep quality. Chapter Seven pilots an intervention to improve sleep quality for people with FMS based on the results of the previous studies within this thesis. The discussion in Chapter Eight combines evidence from the existing literature with the research conducted within this thesis. Implications of the research findings for clinical practice and future research are proposed. 2
Page 1 and 2: Sick and Tired: Understanding and M
Page 3 and 4: Chapter Four. The Nature and Effect
Page 5 and 6: References ........................
Page 7 and 8: List of Tables Table 1. Participant
Page 9 and 10: Co-authored Works Although the stud
Page 11 and 12: Acknowledgments This thesis would n
Page 13 and 14: Intellectual Property Rights There
Page 15 and 16: Confidential Material No participan
Page 17: The role of sleep in FMS appears to
Page 21 and 22: Psychophysiologic insomnia which is
Page 23 and 24: and are less able to inhibit the pa
Page 25 and 26: widely applied in clinical practice
Page 27 and 28: of fewer tender points; usually bet
Page 29 and 30: Current Management Strategies The t
Page 31 and 32: also likely to depend on a number o
Page 33 and 34: deep sleep (stages three and four)
Page 35 and 36: Although sleep moves through the sl
Page 37 and 38: Figure 3. The Integrative Model of
Page 39 and 40: However, conducting a blood test is
Page 41 and 42: As sleep is a complex process invol
Page 43 and 44: Sleep Diaries Sleep diaries are a k
Page 45 and 46: pain). Lentz et al (1999) revealed
Page 47 and 48: These results have also been suppor
Page 49 and 50: (McCracken & Iverson, 2002) which s
Page 51 and 52: Figure 4. Conceptual model of the d
Page 53 and 54: Clinical Implications Despite the p
Page 55 and 56: Chapter Three. Sleep in FMS As high
Page 57 and 58: & Penzien, 2003), although alpha wa
Page 59 and 60: pauses in breathing indicative of s
Page 61 and 62: Relationships between Sleep and Pai
Page 63 and 64: Managing Sleep Disturbance in FMS D
Page 65 and 66: may be possible to help patients im
Page 67 and 68: person to initiate an action (such
Page 69 and 70:
and Nicassio et al (1995) only expl
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1) Poor sleep quality, defined by t
Page 73 and 74:
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
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Methods Participants were given a w
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Table 11. Interview schedule for th
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Rigour The interview transcripts we
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“The main symptom is this overwhe
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Theme Two. Inter-relationship betwe
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where I live, so I don‟t know, I
Page 139 and 140:
Participants also described how the
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“XXXX (name of person) planned a
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A strong theme that emerged in this
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conducted at several time points, w
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Chapter Seven. Investigating the Ef
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activities because they no longer f
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Therefore as this was a feasibility
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Self-reported sleep quality was ass
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The progressive muscle relaxation (
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Exploring the baseline data, there
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Consequently, univariate analysis w
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There was no significant correlatio
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people with FMS (Perlis, Giles, Men
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The aim of this study was to explor
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observed in perceived overall sleep
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elaborated on in Chapter Six, which
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Four) revealed that global sleep qu
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Modifications to the Call-Schmidt a
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MBSR programme in people with FMS (
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diagnostic criteria for these sleep
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comprehensive measures to look at t
Page 181 and 182:
References Abad, V. C., Sarinas, P.
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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)
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Yunus, M. B., Masi, A. T., & Aldag,
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Appendices Appendix A: Search Strat
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Sleep and Fibromyalgia Syndrome Con
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190
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The following questions relate to y
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There are lots of ways to try to de
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42. I try hard to prevent other thi
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During the past month have you had
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Appendix E: Published paper of Stud
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202
Page 221 and 222:
204
Page 223 and 224:
206
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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218
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220
Page 239 and 240:
222
Page 241 and 242:
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
Page 247 and 248:
Appendix M. Letter to GPs for Study
Page 249 and 250:
What are the side effects of any tr
Page 251 and 252:
Appendix O: Poster Advertising Stud
Page 253 and 254:
Appendix Q: Participant Questionnai
Page 255 and 256:
HAD Scale Read each item and place
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During the past month have you had
Page 259 and 260:
Appendix R. Letter from Dr Mark Cro
Page 261 and 262:
PUBLICATIONS Peer Reviewed Journal
Page 263:
and panic-like episodes, Faculty of
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