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

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Girdwood, 1981). This effect of poor sleep may be occurring in people with chronic pain, although these effects need further exploration in humans. The Development and Maintenance of Sleep Difficulties in Chronic Pain The emerging evidence suggests that there is a reciprocal relationship between sleep and pain and that a number of factors may influence this relationship. Psychological models have been proposed to try to explain how these factors may influence pain and sleep quality. The models are all based on the concept that the link between sleep and pain is bi-directional and that a vicious cycle of poor sleep, pain and fatigue develops, resulting in the chronicity of symptoms. In their conceptual model of the psychological development of sleep problems in people experiencing chronic pain, Currie et al (2000) proposed that although pain may be a major factor leading to sleep difficulties, the ways people respond to their pain and initial sleep difficulties can either assist in the resolution or exacerbation of their sleep difficulties. For example, reducing physical activity levels during the day, worrying about the consequences that a poor nights sleep may have on their ability to function the next day and using medication, may all lead to chronic sleep disturbance (see Figure 4, p. 34). 33
Figure 4. Conceptual model of the development of sleep difficulties in chronic pain (Currie et al., 2000) Chronic pain Insomnia secondary to chronic pain Pre-Chronic pain No insomnia Acute pain Acute insomnia Masi et al (2002) have criticised this model by highlighting that other factors have been found to affect sleep quality, such as anxiety and depression, are not incorporated into the conceptual model. However, the model has been effectively used to inform treatment of insomnia for people with chronic pain, based on cognitive behavioural techniques which support the use of adaptive coping strategies in response to pain and sleep difficulties (Currie et al., 2000). Chronic pain Continuing sleep problems Attempts to cope with sleeping problems -excessive time in bed -irregular sleep routine -napping and low activity -worrying in bed -pain and sleep medication Onset of pain - trauma from injury or illness More than 6 months in pain -emotional distress -functional impairment -reduced activity -medication reliance Despite the wealth of evidence suggesting a bi-directional relationship between sleep and pain, there is little research exploring the potential physiological mechanisms underlying the link. In a review of the sleep and chronic pain literature, Smith and Haythornthwaite (2004) highlighted that areas of the brain involved in the onset and maintenance of sleep (such as the mesencephalic periaqueductal gray and the thalamus), are also involved in the modulation of pain. Neurotransmitters such as acetylcholine are also involved in both sleep and pain regulation, suggesting that a neurological dysfunction may underlie both chronic pain severity and sleep disturbance (Lautenbacher et al., 2006). Incorporating theses physiological processes in their conceptual framework of sleep and pain, Call-Schmidt and Richardson (2003) propose 34
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 and 46: pain). Lentz et al (1999) revealed
Page 47 and 48: These results have also been suppor
Page 49: (McCracken & Iverson, 2002) which s
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
Page 101 and 102:
For both groups, participants were
Page 103 and 104:
with and without chronic medical co
Page 105 and 106:
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
Page 111 and 112:
Table 6. Participant characteristic
Page 113 and 114:
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
Page 123 and 124:
interventions. With this in mind, t
Page 125 and 126:
The philosophy of phenomenology was
Page 127 and 128:
Methods Participants were given a w
Page 129 and 130:
Table 11. Interview schedule for th
Page 131 and 132:
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
Page 145 and 146:
conducted at several time points, w
Page 147 and 148:
Chapter Seven. Investigating the Ef
Page 149 and 150:
activities because they no longer f
Page 151 and 152:
Therefore as this was a feasibility
Page 153 and 154:
Self-reported sleep quality was ass
Page 155 and 156:
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 (
Page 177 and 178:
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)
Page 201 and 202:
Yunus, M. B., Masi, A. T., & Aldag,
Page 203 and 204:
Appendices Appendix A: Search Strat
Page 205 and 206:
Sleep and Fibromyalgia Syndrome Con
Page 207 and 208:
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
Page 215 and 216:
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
Page 227 and 228:
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
Page 235 and 236:
218
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220
Page 239 and 240:
222
Page 241 and 242:
Appendix K. Information Sheet and C
Page 243 and 244:
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
Page 249 and 250:
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
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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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