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

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a questionnaire exploring perceived sleep quality, pain severity, depression and physical disability, after controlling for pain and depression, sleep disturbance explained 29% of the variance in physical disability, 58% of psychosocial disability, and 31% of physical symptoms. In addition, Stone, Broderick, Porter, & Kaell (1997) revealed that perceptions of pain were significantly correlated with perceptions of sleep quality recorded, using an electronic sleep diary over one week in participants with rheumatoid arthritis. A similar finding has also been revealed in patients with acute pain after a burn injury (Raymond, Nielsen, Lavigne, Manzini, & Choiniere, 2001). Significant associations have also been found between perceptions of pain severity and objective measures of sleep quality (Wilson et al., 1998). These finding suggest that despite the use of different measures, sleep quality has a consistent independent effect on health outcomes in chronic pain conditions. Nature of Sleep Disturbance in Chronic Pain Exploring the types of sleep difficulties that people with chronic pain conditions experience, Smith et al (2000) asked 51 participants receiving treatment for a variety of chronic pain conditions to complete the PSQI (described above), asking about their perceived sleep quality over the previous month. It was revealed that participants slept on average six hours per night, with a mean sleep onset latency of 48 minutes (in comparison to 7-8.5 hours sleep per night and sleep onset latency of
These results have also been supported in studies using objective measures of sleep quality. In a recent case-control study (O'Donoghue, Fox, Heneghan, & Hurley, 2009) 15 participants with chronic low back pain and 15 age and gender matched controls were asked to complete the PSQI and a measure of health related quality of life (Short Form Medical Outcomes Survey SF-36). In addition, participants completed a daily sleep diary and wore an actigraph for three consecutive nights. Findings revealed that participants with chronic back pain had significantly lower sleep efficiency, but that there was no difference in the total sleep time or sleep onset latency between the two groups based on both the subjective and objective measures of sleep quality. However, the sample size in this study was too small to ensure statistical power to detect a significant difference between the two groups. Using polysomnographic recordings, Wittig et al (1982) revealed that patients with a range of chronic pain conditions spent less time asleep, displayed lower sleep efficiency and longer sleep onset latencies, in comparison to a group of patients reporting insomnia, once again highlighting the severity of the sleep disturbance in patients with chronic pain (Wittig et al., 1982). As illustrated by the studies described above, the main issues for patients with chronic pain are difficulties falling asleep, a short time spent asleep and sleep efficiency, although the type of sleep difficulties experienced does vary between studies (Abad, Sarinas, & Guilleminault, 2008). These differences could suggest that sleep quality may be condition specific and future studies could explore sleep quality in specific disease groups, rather than in samples of a variety of chronic pain conditions. The differences may also reflect the different assessment methods and study designs used, making direct comparisons between the study findings difficult. The cross-sectional designs of the studies described also prevent any notion of causality to be determined. Two longitudinal studies exploring pain and sleep, one which followed patients with rheumatoid arthritis at baseline and two years later (N = 242) (Nicassio & Wallston, 1992), and the other which focused on orofacial pain patients and followed them up over eight months (N = 128) (Riley et al., 2001), revealed that sleep quality assessed at baseline, was not independently associated with levels of pain at follow up, suggesting that sleep may not be predictive of pain in the longer term. However, both studies highlighted that baseline levels of pain severity were independently predictive of sleep quality at follow up. These findings suggest that pain may have an important influence on long term sleep quality, and is supported by the 90% of people stating that the start 30
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 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: pain). Lentz et al (1999) revealed
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
Page 93 and 94: 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
Page 99 and 100:
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
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.
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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
Page 199 and 200:
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
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
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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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