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

expensive to apply in clinical practice. Promising findings have also been revealed for
other non-pharmacological approaches. For example, a pilot study revealed that Ai Chi
(water based exercises aimed at strengthening and toning the body and promoting
relaxation) significantly improved sleep quality in participants with FMS (Calandre et
al., 2009). These findings suggest that non-pharmacological therapies have the potential
to help improve sleep quality for people with FMS and exploration of other more cost
effective approaches is warranted.
Summary
As highlighted in Chapter Two, the implications of poor sleep quality for healthy people
are profound, with poor sleep linked to increased morbidity, risk of accidents,
absenteeism from work, increased health care costs and mortality (Gander et al., 2005;
Kripke et al., 2002). For people with FMS the effects of poor sleep may be even more
extreme through the exacerbation of symptoms such as pain, fatigue, cognitive
impairment and difficulties in maintaining social relationships and engaging in
rehabilitation (Fictenberg, Putnam, Mann, Zafonte, & Millard, 2001).
The evidence described within this chapter highlights that poor sleep quality has been
found to take on primary significance in the course of FMS (Mease, Arnold et al., 2008)
and that if left untreated, sleep disturbance may persist for many years. Specific
interventions to improve poor sleep quality should therefore form a core part of the
management of FMS. The importance of sleep quality in FMS has recently been
recognised by the international Outcome Measures in Rheumatology Clinical Trials
Working Group (OMERACT) who proposed that sleep should be one of the key
outcome variables in clinical trials in FMS and recommend that sleep disturbance
should be a core criteria for the diagnosis of FMS (Mease et al., 2009).
The research completed as part of this thesis aims to address some of the limitations of
previous research in the area of FMS and to extend the current knowledge base by
exploring the nature of sleep difficulties experienced in this population, the
psychological aspects that may contribute to the maintenance of sleep difficulties and
investigate the potential efficacy of a non-pharmacological intervention for people with
FMS. Sleep disturbances have largely been an underestimated and neglected aspect of
FMS. With a greater understanding of the effect of sleep on health outcomes in FMS, it
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