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

& Penzien, 2003), although alpha wave intrusions may contribute to increased arousals
during the night and exacerbate existing sleep difficulties (Perlis, Giles, Bootzin et al.,
1997).
Other studies using polysomnography have identified other potential differences in the
sleep architecture of people with FMS. For example, Branco et al (1994) revealed that
participants with FMS spent less time in deep sleep (stages three and four) and spent
more time awake than controls. The authors proposed that reduced time spent in these
stages of sleep (believed to be involved in helping the body to restore and repair itself),
may contribute to the exacerbation of symptoms in FMS (Branco et al., 1994). This
finding was supported by Sergi et al (1999) who observed that people with FMS spent
increased time in stage one (light) sleep, in comparison to controls. Indeed, this increase
in stage one sleep, in people with FMS, has been the most consistent polysomnographic
finding across studies (Cote & Moldofksy, 1997; Landis et al., 2004; Shaver et al.,
1997). Additional research suggests that the increase in light sleep may be linked to an
observed increase in nocturnal arousals and sleep fragmentation throughout the night
(Jennum, Drewes, Andreasen, & Nielsen, 1993; Sergi et al., 1999; Shah, Feinberg, &
Krishnan, 2006; Shaver et al., 1997).
The findings from studies using polysomnography have also been supported through the
use of actigraphy in people with FMS. One study exploring activity levels over the
course of the day and through the night over five consecutive days, revealed that people
with FMS displayed more activity during the night (despite equivalent levels of daytime
activity) in comparison to controls (Korszun et al., 2002). Korszun et al (2002) also
revealed that people with FMS experienced significantly more nocturnal awakenings
during the night than controls. These findings are suggestive that people with FMS
experienced increased time in the lighter stages of sleep (Kop et al., 2005; Korszun et
al., 2002) and have a greater number of nocturnal awakenings supportive of the
polysomnographic findings. However, the findings were not supported in a study by
Landis et al (2003), although this study only explored actigraphy recordings taken over
three consecutive days and therefore may not have accounted for the variability in sleep
quality over time. The control group used within this study was also not matched for
age and gender making direct comparisons difficult. In addition, as previously
highlighted, studies using polsysomnography and actigraphy have been limited by small
sample sizes and the inconsistent findings may therefore reflect methodological issues
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