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

Chapter Four. The Nature and Effect of Sleep Difficulties on Quality of Life in
FMS
Previous studies exploring sleep and FMS have revealed a high prevalence of sleep
disturbances, and that poor sleep quality is significantly associated with increased pain
in patients with this condition. As discussed in Chapter Two, in order to establish a
comprehensive understanding of the role of sleep and its effect on quality of life in
FMS, it is important to fully explore patients‟ perceptions and experiences of sleep
quality. As outlined in Chapter Three, studies into perceptions of sleep quality
undertaken to date have rarely been based on standardised assessment measures,
explored the separate components of sleep quality or the effect of sleep disturbance on
other health outcomes in FMS. Therefore our understanding on the effect of sleep on
people‟s perceptions of sleep quality is limited.
As proposed by the conceptual model of the development of sleep difficulties (Currie et
al., 2000) and the conceptual framework of pain and sleep (Call-Schmidt & Richardson,
2003) as described in Chapter Two, there are many factors that are likely to influence
the link between sleep quality and pain severity, and a greater understanding of these
factors is needed to understand the role of sleep in FMS. One factor identified in the
models of pain and sleep, that may influence sleep and pain in FMS, is people‟s ability
to cope with chronic pain and sleep difficulties. Poor sleep may reduce patients‟ ability
to successfully use cognitive coping strategies in response to pain so that individuals
become more attentive to the pain (Lawson, Reesor, Keefe, & Turner, 1990) and it is
likely that mechanisms regulating attention to pain may also be disrupted by poor sleep
(Affleck, Urrows, Tennen, Higgins, & Abeles, 1996).
Coping has been defined as “purposeful efforts to manage the negative impact of stress”
(Jensen, Turner, Romano, & Karoly, 1991, p. 250). Managing a chronic condition can
be stressful and therefore coping strategies are used by people to manage the everyday
demands of living with a chronic illness, such as managing chronic pain. Coping
strategies are often classified as either „problem focused‟ (where the person confronts
the problem directly, such as coming up with a strategy to resolve the problem), or
„emotion focused‟ (where the person focuses on controlling their emotional reactions,
such as talking to family and friends) (Folkman & Lazarus, 1988). However, other
researchers prefer to classify coping in terms of „active‟ styles of coping which require a
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