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

of fewer tender points; usually between 5 and 11 tender points (Yunus & Masi, 1985).
Children have been found to have a more favourable prognosis than adults (Buskila,
2009) and the consequences of their symptoms due to the different daily demands
placed on them, are likely to be different to that of adults, therefore making comparisons
difficult. Consequently this thesis will focus specifically on adults (>18 years of age)
with FMS.
Longitudinal studies have revealed that there is little or no change in the health status of
people with FMS, with symptoms persisting at the same level of severity for as long as
15 years after diagnosis (Kennedy & Felson, 1996; Ledingham, Doherty, & Doherty,
1993; Mengshoel & Haugen, 2001; Wolfe et al., 1997). Although one study has
revealed that older age was associated with lower levels of pain, fatigue and depression
in FMS (Reisine, Fifield, Walsh, & Forrest, 2008). It should be noted that the earlier
studies showing little change in symptom severity over time were conducted before a
change in recommended clinical treatment, as described in the current management
section at the end of this chapter (Carville et al., 2008).
FMS is associated with significantly high societal and health care costs (Bernatsky,
Dobkin, De, & Penrod, 2005; Hughes et al., 2006; Penrod et al., 2004; Sicras-Mainar et
al., 2009). For example, in the UK, FMS patients have been found to make more than
double the number of visits to health care services than non-FMS controls and have
higher prescription rates (Hughes et al., 2006). This increased level of health care use
has been found to remain stable over the course of the illness, despite an initial decrease
in service utilisation during the year following diagnosis (White et al., 1999c). FMS is
also associated with high indirect costs to society, as many people with FMS are forced
to leave employment, reduce their working hours or have increased absence from work
as a result of their FMS symptoms (Burckhardt, Clark, & Bennett, 1992; Kivimaki et
al., 2007; Sicras-Mainar et al., 2009; White, Speechley, Harth, & Ostbye, 1999a). The
UK findings are supported by a survey conducted in the US which found that 26% of
people with FMS were receiving some form of disability benefit. Considering that FMS
predominantly affects working age adults and that the long term prognosis remains
poor, the costs of FMS to society are considerable.
On an individual basis, FMS can have a profound effect on peoples‟ lives (Arnold et al.,
2008). Research has shown that people with FMS report significantly lower quality of
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