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

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period. This was reflected in the high attrition rates, with 13-44% of participants withdrawing from the intervention. The authors deemed there to be insufficient evidence to explore the effects of muscle strengthening or flexibility training (Busch et al., 2007). These findings have been supported by qualitative research which has revealed that many patients struggle to complete daily activities requiring physical effort (such as housework), as they exacerbate symptoms of pain and fatigue (Cunningham & Jillings, 2006). These findings have significant clinical implications. Although prescribed a programme of exercise in accordance with management guidelines, many patients may find it difficult to adhere to exercise programmes both due to the fluctuating nature of their symptoms, making engagement in a regular exercise routine difficult and managing the resulting increases in pain and fatigue after an exercise session (Jones, Clark, & Bennett, 2002). As FMS is believed to result from central sensitisation to pain, it may be the case that different types and intensities of physical activity have different effects. Emerging evidence suggests that people with FMS need tailored low intensity exercise programmes that focus on using concentric contraction activities (movements completed slowly and allow the body to return to its resting state before completing further movements such as slow stretching) to avoid intensifying the pain signals sent from the muscles to the nervous system and increasing perceptions of pain. Therefore activities using repetitive movement or movements against a force (such as resistance training or swimming) which can aggravate pain signals, need to be completed for very short periods of time (for example, less than 10 minutes) and include regular rest periods with a focus on avoiding over-stretching (Jones & Liptan, 2009). This has lead to an increase in research exploring the effects of less intense exercise approaches in people with FMS. Promising improvements in health outcomes have been found for pool based exercise (Calandre et al., 2009; Mannerkorpi, Nordeman, Ericsson, & Arndorw, 2009), Pilates (Altan, Korkmaz, Bingol, & Gunay, 2009), vibration exercise (Alentorn-Geli, Padilla, Moras, Lazaro Haro, & Fernandez-Sola, 2008; Gusi, Parraca, Olivares, Leal, & Adsuar), Qi-gong (Haak & Scott, 2008) and increasing lifestyle activities (Fontaine, Conn, & Clauw, 2010). However, the findings continue to be limited by small sample sizes, and full clinical trials that are powered to detect significant differences in health outcomes are needed to provide support for these initial findings (Thomas & Blotman, 2010). The effectiveness of exercise interventions are 13
also likely to depend on a number of individual factors, such as current level of physical condition, age, BMI and presence of other co-morbid conditions. Consequently FMS patients may need individually tailored exercise programmes to help them, both in terms of being able to complete everyday life activities, as well as physical exercise to improve their quality of life and reduce the experience of symptoms. Barriers to engaging in physical activity may also arise from psychological factors, such as fear of aggravating symptoms, low motivation and difficulties understanding and adjusting to living with FMS. To support people with FMS to manage their emotional reactions to the condition and to support them to overcome the challenges they face integrating recommended treatments into their lives (Carville et al., 2008), psychological interventions may be beneficial in FMS. However, systematic reviews of non-pharmacological interventions have not yet been conducted and the effectiveness of approaches focusing on psychological factors remains unclear. Due to the complex nature of symptom presentation in FMS and limitations of current pharmacological treatments, current management guidelines suggest the need for a multi-disciplinary treatment approach to improve patient outcomes and quality of life (Carville et al., 2008; Hauser, Thieme, & Turk, 2009). However, further investigation of the role of psychological factors and interventions addressing these factors is required to inform treatment. Conclusion FMS is a common, chronic pain condition where people may experience a wide range of symptoms including pain, fatigue, cognitive difficulties and sleep disturbance. Due to the lack of an objective diagnostic tool and high degree of symptom overlap with other conditions such as chronic fatigue syndrome, the validity of the diagnosis of FMS continues to be questioned. Current management guidelines suggest the need for a multidisciplinary approach to treatment incorporating pharmacological, exercise and psychological treatments due to the complex clinical presentation of the patient group. However, current treatment approaches have low reported efficacy. The profound impact that the condition has on people‟s lives, in addition to the high health care and societal costs, means that a greater understanding of the condition is needed to improve treatment and quality of life for people with FMS. 14
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 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: Current Management Strategies The t
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
Page 79 and 80: questionnaire 78 (77.2%) of the par
Page 81 and 82:
efficiency, suggesting that partici
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Older age and longer length of illn
Page 85 and 86:
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
Page 97 and 98:
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
Page 117 and 118:
The Exp (B) values revealed that hi
Page 119 and 120:
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
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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
Page 209 and 210:
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
Page 237 and 238:
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
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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
Page 255 and 256:
HAD Scale Read each item and place
Page 257 and 258:
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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