Sick and Tired: Understanding and Managing Sleep Difficulties in ...
Sick and Tired: Understanding and Managing Sleep Difficulties in ...
Sick and Tired: Understanding and Managing Sleep Difficulties in ...
Create successful ePaper yourself
Turn your PDF publications into a flip-book with our unique Google optimized e-Paper software.
(McCracken & Iverson, 2002) which showed that few (only 16%) participants reported<br />
napp<strong>in</strong>g dur<strong>in</strong>g the daytime.<br />
Depression <strong>and</strong> anxiety have been consistently found to be higher <strong>in</strong> people with<br />
chronic pa<strong>in</strong>, possibly due to the dem<strong>and</strong>s of liv<strong>in</strong>g with a chronic condition (Fishba<strong>in</strong>,<br />
Cutler, Rosomoff, & Rosomoff, 1997), <strong>and</strong> there is evidence that mood may also have<br />
an <strong>in</strong>fluential role <strong>in</strong> people‟s perceptions of sleep quality. In a sample of 51 participants<br />
with chronic low back pa<strong>in</strong>, Atk<strong>in</strong>son et al (1988) revealed that perceived poor sleep<br />
quality was more highly correlated with depression than disease severity. This f<strong>in</strong>d<strong>in</strong>g<br />
was supported by the objective polysmonographic evidence recorded for a sub-sample<br />
of the participants, which <strong>in</strong>dicated that mood has an important role <strong>in</strong> the experience of<br />
sleep. In people with chronic non-malignant pa<strong>in</strong> conditions (<strong>in</strong>clud<strong>in</strong>g headache, back<br />
ache <strong>and</strong> neck ache), Sayar et al (2002) revealed that depression was the most<br />
significant factor associated with poor sleep quality <strong>in</strong> the regression analysis. However,<br />
this f<strong>in</strong>d<strong>in</strong>g was not supported <strong>in</strong> a sample of patients seek<strong>in</strong>g outpatient treatment for a<br />
range of chronic pa<strong>in</strong> conditions <strong>in</strong> the study conducted by Mor<strong>in</strong> et al (1998) which<br />
found that there was no significant difference <strong>in</strong> mood between participants classified as<br />
good or poor sleepers, as def<strong>in</strong>ed by the participants themselves. The validity of these<br />
f<strong>in</strong>d<strong>in</strong>gs may be questioned as the study did not utilise st<strong>and</strong>ardised measures of sleep<br />
or mood. The role of mood <strong>and</strong> sleep disturbance therefore warrants further<br />
<strong>in</strong>vestigation, to explore if the <strong>in</strong>consistent f<strong>in</strong>d<strong>in</strong>gs may just be a reflection that the<br />
difference <strong>in</strong> study f<strong>in</strong>d<strong>in</strong>gs is due to different pa<strong>in</strong> populations <strong>in</strong>vestigated.<br />
Medications to relieve the symptoms of chronic pa<strong>in</strong> or antidepressants can alter the<br />
underly<strong>in</strong>g sleep architecture. Increased night-time awaken<strong>in</strong>gs <strong>and</strong> levels of nocturnal<br />
arousal <strong>and</strong> <strong>in</strong>somnia can be side effects of tak<strong>in</strong>g such medication (McCrae &<br />
Lichste<strong>in</strong>, 2001). Indeed McCraken <strong>and</strong> Iverson (2002) revealed that poor sleep quality<br />
was significantly associated with use of anti-depressants, although it is unclear whether<br />
this was directly related to the medication itself or to the underly<strong>in</strong>g depression.<br />
Evidence from studies of rats have also revealed that sleep disturbance (particularly<br />
disturbance to REM sleep), may <strong>in</strong>terfere with opiod analgesic medication by <strong>in</strong>hibit<strong>in</strong>g<br />
opiod prote<strong>in</strong> synthesis <strong>and</strong> opiod receptors, <strong>and</strong> reduc<strong>in</strong>g the ability of the seroton<strong>in</strong><br />
system to <strong>in</strong>hibit pa<strong>in</strong> (Lautenbacher, Kundermann, & Krieg, 2006; Shapiro &<br />
32