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

Each of the four research studies incorporated within this thesis, will be described in a
separate chapter of this thesis. A discussion of the issues relating specifically to each
study will also be included within the chapter. The findings are then synthesised in the
final chapter (Chapter Eight) with a discussion of the issues relating to the thesis as a
whole.
Defining Terms Central to the Thesis
The term Fibromyalgia Syndrome will be shortened to FMS (a commonly used
acronym) throughout this thesis, to increase the readability of the text. A glossary of
acronyms and terms has been provided at the end of this thesis for ease of reference.
Insomnia is often used interchangeably to describe both a symptom (e.g. lack of sleep)
and a sleep disorder (primary insomnia). There are three different diagnostic
classification systems for insomnia; The International Classification of Disease (ICD-
10), Diagnostic and Statistical Manual of Mental Disorders - Fourth Edition and the
International Classification of Sleep Disorders (2001). In the presence of an underlying
medical condition, insomnia is referred to as „secondary insomnia‟, although the
different guidelines propose different classification criteria. The diagnosis of secondary
insomnia is further complicated as there is a need to identify whether the underlying
medical condition is causal or co-morbid to the insomnia (McCrae & Lichstein, 2001).
Indeed, the ICD-10 only recognises secondary insomnia as a disorder if the complaint
of insomnia is the primary concern above the underlying medical condition (World
Health Organization, 1992). Consequently, secondary insomnia is often not diagnosed
and treatment continues to focus on the underlying medical condition, even though the
insomnia may be partially independent of the underlying condition and may require
specific intervention.
Other common sleep disorders occurring in adulthood include:
Periodic limb movement disorder which is characterized by „periodic episodes
of repetitive and highly stereotyped limb movements that occur during sleep‟
associated with night-time awakening and daytime sleepiness (American
Academy of Sleep Medicine, 2001);
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