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

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sensitivity and 81% specificity to distinguish people with FMS from controls (Wolfe et al., 1990). Figure 1. Tender point sites according to the ACR (1990) diagnostic criteria Reprinted with permission from the Arthritis Research Council, UK The ACR criteria (Wolfe et al., 1990) offered a more refined approach to diagnosis in comparison to previously proposed criteria (Smythe & Moldofsky, 1977; Yunus, Masi, & Aldag, 1989a). However, the ACR criteria have received wide criticism due to their reliance on patients‟ subjective views of pain and inability to account for the observed high variability in symptoms. For example, someone who may meet the criterion number of tender points on one day, may not meet the criteria the following day; and patients are often diagnosed with less than 11 tender points (Bennett, 1998). The ACR criteria may also be criticised for not acknowledging the wide range of symptoms that patients with FMS experience, including fatigue, cognitive difficulties (such as difficulty concentrating and word retrieval) and sleep disturbance (Mease, 2005). It has also been argued that tender points may not be measuring a discrete entity, as many people without FMS have increased sensitivity in these areas of the body. One study has revealed that the ACR criteria are not reliable in their ability to distinguish people with FMS from those with chronic widespread pain, and that the criteria only distinguishes patients with more severe pain symptoms (Bidari, Ghavidel-Parsa, & Ghalehbaghi, 2009). MacFarlane, Croft, Schollum, and Silman (1996) proposed more stringent criteria proposing that pain should be experienced in two or more sections of the “contralateral limbs and axial pain” in order to be defined as FMS. However, this criterion is not 7
widely applied in clinical practice and continues to be subject to similar criticisms of the ACR criteria, such as not being sensitive to the high variability in symptoms and being reliant on patient self-report. Consequently, despite the known limitations, the ACR criteria is the current recommended diagnostic criteria for FMS and is the most commonly applied criteria in clinical practice. Despite the fact that the ACR criteria has been the recognised diagnostic criteria for two decades, in view of its critique it is perhaps not surprising that recognition and diagnosis of FMS remains highly variable between clinicians (Hughes, Martinez, Myon, Taieb, & Wessely, 2006). The high co-morbidity observed with other conditions such as chronic fatigue syndrome (CFS), irritable bowel syndrome (Hudson, Goldenberg, Pope, Keck, & Schlesinger, 1992) systematic lupus erythematosus (Gladman, Urowitz, Gough, & MacKinnon, 1997) and rheumatoid arthritis (Weir et al., 2006) makes diagnosis difficult. The most common confusion occurs between CFS and FMS which have many overlapping symptoms. Based on comparison of the two diagnostic criteria (ACR, Wolfe et al., 1990), and the US Centers for disease control criteria for CFS, it appears that the main distinction relates to the most prominent symptom experienced by the patient; pain is a core criteria for FMS with the possible co-occurrence of fatigue, while fatigue is the essential criteria for CFS with the possible co-occurrence of pain. The high degree of overlap between symptoms of these two conditions, and indeed others, has led some clinicians to argue that FMS may not be a distinct medical condition but rather that these conditions may lie on a spectrum of pain and fatigue. This has resulted in some clinicians questioning the legitimacy of FMS (Schaefer, 2003). In light of the recent evidence, described at the beginning of this chapter, implicating the central nervous system for the symptoms experienced by people with FMS, it appears that FMS may be a distinct clinical entity from CFS (which is believed to linked to a hyper- reactive immune system and triggered by viral or other infectious agents) and that the two conditions should therefore be studied separately to avoid possible contamination of the findings. In recent qualitative studies, many FMS patients have described that the diagnosis of FMS appears „empty‟ due to the lack of recognition, respect, knowledge and effective treatment options for the condition (Madden & Sim, 2006; Sim & Madden, 2008; Undeland & Malterud, 2007). This has important implications for patients for whom it may take several years to receive a diagnosis to explain the symptoms that they are experiencing (which will be discussed further in the exploring the impact of FMS 8
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 and 18: The role of sleep in FMS appears to
Page 19 and 20: little information was available as
Page 21 and 22: Psychophysiologic insomnia which is
Page 23: and are less able to inhibit the pa
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
Page 71 and 72: 1) Poor sleep quality, defined by t
Page 73 and 74: elow 0.7 are acceptable. Therefore
Page 75 and 76:
heart disease (Epstein et al., 1999
Page 77 and 78:
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
Page 89 and 90:
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
Page 121 and 122:
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,
Page 203 and 204:
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
Page 217 and 218:
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
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Appendix M. Letter to GPs for Study
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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
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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
Page 261 and 262:
PUBLICATIONS Peer Reviewed Journal
Page 263:
and panic-like episodes, Faculty of
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