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

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particularly some pain relieving medications that contain high levels of caffeine. As a stimulant, caffeine can lead to poor sleep quality particularly if ingested close to bedtime. Even moderate amounts of caffeine can affect sleep. For example in one study, adult men were given a 200mg single dose of caffeine (equivalent to one to two cups of regular coffee) or a non active placebo before 7.30 in the morning and were asked not to consume any further caffeine products for the remainder of the day. The results revealed that on the day participants were given the caffeine, they experienced reduced sleep efficiency (total sleep time/time in bed x 100), total sleep time, and increased latency to stage two sleep (Landolt, Werth, Borbely, & Dijk, 1995). This suggests that even a relatively small dose of caffeine can have a considerable effect on sleep. Bootzin and Nicassio (1978) highlighted the importance of behaviours on sleep quality in their stimulus control theory. They proposed that over time the sleeping environment (e.g. the bedroom) becomes associated with wakefulness and other activities un- associated with sleep. For example, people may also use their bedroom for watching television, working or using a computer or reading, making the bedroom a stimulating environment and therefore increasing arousal. If people experience difficulty sleeping they may also begin to associate being in bed with feeling agitated and frustrated about not being able to sleep and these associations may therefore prevent sleep onset or further disrupt sleep. Amalgamating the research evidence on the factors affecting sleep quality in people with insomnia, Lundh and Broman (2000) proposed the integrative model of the interaction between sleep-interfering and sleep-interpreting processes. The four boxes at the top of Figure 3 (p. 20) represent the sleep interfering processes and the three boxes at the bottom of Figure 3 highlight the sleep interpretation processes that impact on sleep quality. As shown by the model, these processes are likely to influence each other with beliefs about sleep also directly influencing behaviour and cognitive coping strategies. 19
Figure 3. The Integrative Model of the interaction between sleep-interfering and sleep-interpreting processes (Lundh & Broman, 2000) AROUSABILITY (emotional sensitivity, slow habituation) Consequently, as highlighted by the model, people‟s behaviours, thoughts, environment and physical health all have an important influence on sleep quality. Maintaining the sleep equilibrium can therefore be difficult and it has been estimated that up to 45% of the adult population may experience some form of sleep disturbance (Lugaresi, Zucconi, & Bixler, 1987). The role of these factors on sleep in FMS will be discussed in more detail in Chapters Three, Four and Five. Measuring Sleep ATTRIBUTIONS of poor sleep and daytime functioning Objective Measures STIMULUS - AROUSAL ASSOCIATIONS AROUSAL physiological, emotional, cognitive SLEEP APPRAISAL of sleep and daytime functioning BEHAVIOURAL AND COGNITIVE STRATEGIES with regard to the sleep situation PERFECTIONISM high personal standard concerning sleep and daytime functioning INTERPERSONAL RELATIONS (conflicts, emotional involvements) SLEEP COMPLAINT = INSOMNIA BELIEFS about sleep need, consequence of poor sleep etc. Polysomnography provides a comprehensive and objective measure of sleep quality. Electrodes are placed onto the scalp and skin before sleep onset, which monitor and record brain activity. Sensors are also used to monitor air flow (nasal or oral), respiratory effort, oxygen saturation, heart rate and eye movements, muscle tension and 20
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 and 32: also likely to depend on a number o
Page 33 and 34: deep sleep (stages three and four)
Page 35: Although sleep moves through the sl
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
Page 83 and 84: Older age and longer length of illn
Page 85 and 86: Table 2. Correlations between demog
Page 87 and 88:
Logistic Regression As 97% of the s
Page 89 and 90:
in bed, participants may have devel
Page 91 and 92:
Relationship between Negative Affec
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participants, who may be less likel
Page 95 and 96:
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
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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
Page 141 and 142:
“XXXX (name of person) planned a
Page 143 and 144:
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 (
Page 157 and 158:
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
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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
Page 239 and 240:
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
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Appendix O: Poster Advertising Stud
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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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