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

Clinical Implications
Despite the profound implications of poor sleep on health and daily functioning, people
rarely seek advice from clinicians for their poor sleep (Tubtimtes, Sukying, &
Prueksaritanond, 2009) and if suspected or reported, poor sleep is often not specifically
treated, even with hypnotic medication (National Institute of Health, 2005). However,
as the models and research evidence suggests, there is a reciprocal relationship between
sleep and pain. Treating only the pain may help to improve sleep quality but may not
fully resolve chronic sleep difficulties which will continue to affect levels of pain.
Studies exploring the course of sleep problems in chronic illness have revealed that in
88% of cases, if left untreated, sleep difficulties can persist for up to two years (Ganguli,
Reynolds, & Gilby, 1996; Katz & McHorney, 1998). This suggests that sleep
difficulties need to be specifically addressed in treatment for chronic pain (Roehrs,
2009).
In instances where a sleep disturbance is identified in clinical practice, hypnotic
medications are the most frequent treatment, despite little evidence to support the
continued efficacy of hypnotic medication with prolonged use, and as expected, any
positive effects of the medication only continue for as long as the medication is taken
(Morin, Belanger, Bastien, & Vallieres, 2005). Hypnotics have been associated with
increased mortality and long term use of the medication is not recommended (Mallon,
Broman, & Hetta, 2009). In addition, medications do not address the psychological and
behavioural factors that have been found to be important in the development and
maintenance of chronic sleep difficulties.
Non-pharmacological interventions, comprising of cognitive and behavioural therapy
strategies designed for the treatment of primary insomnia (insomnia occurring without
the existence of a co-morbid medical condition), have demonstrated consistent
improvements in sleep quality (Morin, Culbert, & Schwartz, 1994; Murtagh &
Greenwood, 1995), with 70-80% of participants experiencing beneficial effects from
treatment (Morin & Wooten, 1996) and with significant improvements still evident after
several years (Backhaus, Hohagen, Voderholzer, & Riemann, 2001). However, access
to full programmes of cognitive behavioural interventions delivered by sleep specialists
is expensive and highly limited in current clinical practice. Therefore alternative
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