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

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Chapter Two. The Role of Sleep The Normal Sleep Process Sleep is considered to be the most important recovery mechanism available to humans, and good sleep is essential for optimal well-being, daily functioning and health (Morin & Espie, 2003). Poor sleep quality can lead to increased fatigue, negative mood changes and in extreme cases, can even lead to impaired immune function (Lorton et al., 2006; Rogers, Szuba, Staab, Evans, & Dinges, 2001). Even moderate sleep loss is associated with deficits in alertness and performance on cognitive and physical tasks (Jewett, Dijk, Kronauer, & Dinges, 1999). The amount people sleep has also been linked with life expectancy, with too little or too much sleep associated with increased mortality risk (Doghramji, 2006; Gallicchio & Kalesan, 2009). Sleep may be as important as diet, exercise and genetics (Hublin, Partinen, Koskenvuo, & Kaprio, 2007). The sleep process usually consists of five sleep stages; four stages of Non-Rapid Eye Movement (NREM) sleep, and one stage of Rapid Eye Movement (REM) sleep (Morin & Espie, 2003). Stage one sleep is a transitional stage, lasting approximately five minutes, where the body prepares itself for sleep. This stage is a state of drowsiness and if woken up during this stage, the person may not feel that they have been to sleep at all. Stage two sleep is a light sleep stage where brain activity, heart rate and breathing slow down, and muscle tension is reduced. Sleep becomes progressively deeper through stages three and four (also referred to as slow wave sleep). It is thought that the body has the opportunity to rejuvenate and repair itself during stage four. From stage four sleep people then return back through the sleep stages to the lighter stage of sleep (stage two) before entering REM sleep (stage five). REM sleep is characterised by observed rapid eye movements as if the person is awake, with increased brain activity, heart rate and breathing rates. It is thought that this is the stage where dreaming occurs and the brain processes and stores new information to aid long term memory, although this remains unclear (Morin, 1993). It has been suggested that the brain blocks signals to the muscles in this stage to prevent people from acting out their dreams. People move through each sleep stage in a cycle (see Figure 2, p. 16) lasting approximately 90 minutes which is repeated approximately five times over the course of the night. The length of each sleep stage within a cycle changes over the course of the night, with most 15
deep sleep (stages three and four) occurring at the beginning of the night and more REM sleep towards the end of the night. It therefore assumed that sleep must be continuous to enable the body to adequately repair and restore itself (Walsh & Lindblom, 1997). Figure 2. The cycle of sleep stages ▀ = REM Sleep Source: Morin, CM (1993). Insomnia: Psychological Assessment and Management, p. 17, New York Guildford Press. Reprinted with authors permission. The sleep process is regulated by the hypothalamus which acts as a biological clock controlling states of being awake and sleepiness (known as circadian rhythms). There are variations in people‟s circadian rhythms, with some people preferring to go to bed earlier and awakening earlier, whereas others may prefer to go to bed later and wake up later (Randler, 2008). These preferences (known as sleep chronotype) may be affected by personality (Cavallera & Giudici, 2007) or mood (Chelminski, Ferraro, Petros, & Plaud, 1999). Further, there is some evidence that these preferences may be heritable (Hur, 2007) and are influenced by the person‟s underlying circadian rhythm (Duffy, Rimmer, & Czeisler, 2001). Circadian rhythms involve natural variations in core body temperature, secretion of melatonin and hormones, appetite and alertness over the course of the day. Changes in these physiological processes prepare the body for the onset of sleep or wakefulness (Morin, 1993). Levels of melatonin increase before sleep onset which increases feelings of drowsiness and has a role in reducing the body temperature to facilitate sleep onset. 16
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 and 30: Current Management Strategies The t
Page 31: also likely to depend on a number o
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
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
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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
Page 147 and 148:
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
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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.
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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
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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
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204
Page 223 and 224:
206
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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
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222
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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
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PUBLICATIONS Peer Reviewed Journal
Page 263:
and panic-like episodes, Faculty of
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