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

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Types of Sleep Difficulties Experienced in FMS Baseline analysis of participants with FMS in a clinical trial of hydrotherapy revealed that participants (N=50) reported sleeping for a total of five hours per night. This is comparable to patients with insomnia, less than participants with chronic pain and significantly worse than the general population as described in Chapter Two (Vitorino, Carvalho, & Prado, 2006). A key study published during the completion of this thesis, explored the nature of perceived sleep disturbances in patients with FMS using the PSQI. Findings revealed that participants with FMS perceived their overall sleep quality to be poor, with over 90% of participants obtaining a PSQI global score >10 (Osorio et al., 2006). As described in Chapter Two, PSQI global scores of >5 are considered to be indicative of poor sleep quality in need of treatment, however for this study the authors set the cut-off score as 10 for reasons that were unspecified. This change in scoring makes comparisons to other studies about the extent of sleep difficulties based on the PSQI scores problematic. Despite these limitations, on exploring the components of sleep quality within this sample, it was revealed that people with FMS reported significantly more night-time awakenings, difficulties falling asleep and reduced daytime dysfunction, in comparison to matched healthy controls. This suggests that the reduction in total sleep time observed by Vitorino et al (2006) may be caused by difficulties both with sleep onset and sleep maintenance. The findings of the study by Vitorino et al (2006) were also limited by its ability to generalize to the FMS population due to its small sample size (N=30) and because of sampling participants solely from a rheumatology clinic (which may not be representative of the whole FMS population). The study did not explore the influence of sleep quality on illness outcome. Consequently further research is needed to explore people‟s perceptions of sleep quality in FMS and how poor sleep may impact on their illness experience and daily living in people with FMS. 43
Relationships between Sleep and Pain in FMS Comparable to the findings from research into chronic pain, sleep, pain and mood have been found to be significantly correlated in FMS. The initial study exploring perceived sleep quality in FMS assessed sleep quality using the PSQI and found that poor sleep quality, sleep efficiency, increased night-time awakenings and poor overall scores of sleep quality as assessed by the PSQI global score, were all associated with increased sensitivity to pain, as assessed by dolorimetry (Agargun et al., 1999). However, this study did not explore the effect of poor sleep on other symptoms of the condition. Nicassio et al (2002) asked participants to complete a questionnaire exploring levels of pain, fatigue, depression and sleep quality for the period of one week. Analysis of the baseline data revealed that as expected, high levels of pain were associated with high levels of depression and fatigue, and that there was a negative association with sleep quality. The data collected over the course of the week was then aggregated to explore the effect of pain on subsequent sleep quality and fatigue. It was revealed that the prior day‟s pain was associated with poor sleep quality and increased fatigue. Interestingly, sleep quality appeared to mediate the relationship between pain and the following day‟s fatigue. This suggests that interventions to improve sleep quality, that have been effective in improving symptomology in other chronic conditions (Lobbezoo, Tanguay, Thon, & Lavigne, 1996), may improve the experience of FMS symptoms. The measures used in this study however, have limitations. For example, sleep was measured using only one item from the sleep subscale of the FIA questionnaire (Mason, Silverman, Weaver, & Simms, 1992) which focused on feelings on awakening from sleep, rather than asking directly about perceived sleep quality. It would be expected that feelings on awakening are very likely to be associated with perceived pain, mood and fatigue that day. In addition, completing the assessments on a daily basis did not enable the above studies to account for how symptoms may vary over the course of day, therefore the role of sleep on subsequent symptoms remains unclear. In contrast to the research conducted by Nicassio et al (2002), which found that pain impacts on subsequent sleep quality, studies that have been conducted over longer periods of time have revealed different relationships between pain and sleep. In a daily diary study using palm top computers to record mood, sleep and fatigue over 30 consecutive days by 89 women with FMS, it was revealed that perceived total sleep 44
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Sick and Tired: Understanding and M
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Chapter Four. The Nature and Effect
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References ........................
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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 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: pauses in breathing indicative of s
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
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Page 97 and 98: eactions are most likely to be detr
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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,
Page 107 and 108: Figure 7. 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
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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
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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
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References Abad, V. C., Sarinas, P.
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Brand, S., Gerber, M., Beck, J., Ha
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Crofford, L. J., & Demitrack, M. A.
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Goldenberg, D. L., Kaplan, K. H., N
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Johns, M. W. (2002). Sleep propensi
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Leung, Y. Y., Ho, K. W., Zhu, T. Y.
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Mease, P. J. (2005). Fibromyalgia s
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symptoms in healthy subjects; Corre
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approach with illustration to the h
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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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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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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
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PUBLICATIONS Peer Reviewed Journal
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and panic-like episodes, Faculty of
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