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

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the mediational role of coping in the relationship between illness representation and health outcomes is weak (Carlisle, John, Fife-Schaw, & Lloyd, 2005). Due to the unique demands of different medical conditions, the effectiveness of coping strategies may be dependent on their appropriateness for the situation or illness. Indeed, research focusing on coping and FMS specifically, has revealed that higher use of active coping strategies is associated with increased disability, pain and poor physical functioning. Nicassio et al (1995) explored the use of coping at baseline and 3 months later using the Pain Coping Strategies Questionnaire (CSQ, Rosenstiel & Keefe, 1983) to explore the effect of coping on pain in FMS. In the regression analysis they revealed that higher use of active coping strategies were associated with higher levels of pain and lower quality of well-being. Their study also found that higher use of passive coping strategies was associated with increased levels of depression. This was partially supported by a study conducted by Martin et al (1996) looking at the use of coping attempts (rather than active or passive coping). Martin et al (1996) revealed that coping attempts and catastrophizing were both related to higher disability, and coping attempts were associated with psychosocial disability. Therefore, it appears that in contrast to other chronic pain conditions, such as arthritis, active coping may be detrimental in FMS (Nicassio et al., 1995). Although both of the aforementioned studies used the CSQ, different underlying factors of the CSQ were revealed. In the Nicassio et al (1995) study there were two underlying factors: „coping attempts‟ and „pain control and rational thinking‟; whereas Martin et al (1996) also found two factors but these were: „coping attempts‟ and „catastrophizing‟. Differences in the underlying factors of the CSQ may reflect differences in the methods of the two studies, a longitudinal study by Nicassio et al (1995) and a cross-sectional study by Martin et al (1996) and differences between the two study populations (one recruiting through rheumatology clinics, the other recruiting through the community and patient support groups.) The inconsistent findings may also reflect that coping is a more complex phenomenon than these measures suggest. There is evidence that the use of coping strategies is not stable and may change over time. For example, in a review of the literature on coping and chronic pain, Jensen et al (1991) stated that “some coping strategies in the CSQ are related to adjustment, only in patients reporting low levels of pain severity” (p. 277). It should also be noted that these studies by Martin et al (1996) 51
and Nicassio et al (1995) only explored the use of coping strategies specifically in response to pain. It may also be the case that different coping measures explore the use of different types or aspects of coping. For example, the CSQ explores coping specifically in relation to pain, whereas other measures explore the application of more generic, trait coping strategies, such as the COPE scale (Carver, Scheier, & Weintraub, 1989). Therefore using different coping measures may reveal different results. Thus caution is needed when comparing the findings from studies using different assessments of coping. As FMS and coping are complex phenomena it may be necessary to explore the use of more generic coping strategies using a different measure of coping, such as the COPE, on a range of outcomes in addition to pain, to understand the effect of coping in FMS. Coping has been found to have links with sleep in the general population. For example, Harvey (2002) suggested that behaviours, such as reducing physical activity, can be an exacerbating factor in the maintenance of sleep difficulties. (Sadeh, Keinan, & Daon, 2004) suggested that a passive coping approach (such as using disengagement), may be related to increased sleep, as a way of escaping the stressor. They also propose that some strategies (such as cognitive rumination) may lead to increased arousal, preventing sleep onset and therefore poor sleep may be indicative of the use of less effective coping strategies (Sadeh et al., 2004). It should be noted however that this finding was not statistically significant. Active coping strategies such as seeking information may be a useful strategy to reduce stress and improve mood (Felton, Revenson, & Hinrichsen, 1984), however, the use of information seeking has also been associated with increased physiological arousal preventing sleep onset and insomnia (Sadeh et al., 2004; Voss, Kolling, & Heidenreich, 2006). Another factor that may be linked with sleep, coping and health outcomes in FMS (although not specified in the models of sleep and pain) is mood, such as depression and negative affect. As described in Chapter Two, sleep and mood are highly correlated (Haythornthwaite, Hegel, & Kerns, 1991; Wells, Day, Carney, Freedland, & Duntley, 2004) and mood has been related to a wide range of physical and psychological problems in FMS (Burckhardt et al., 1992; Thieme, Turk, & Flor, 2004). Indeed in a cross-sectional study of people with FMS, Nicassio et al (2002) revealed that depression was linked to pain, fatigue and sleep in FMS. However, it is unclear if depression (often 52
Page 1 and 2:
Sick and Tired: Understanding and M
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Chapter Four. The Nature and Effect
Page 5 and 6:
References ........................
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List of Tables Table 1. Participant
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Co-authored Works Although the stud
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Acknowledgments This thesis would n
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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 and 60: pauses in breathing indicative of s
Page 61 and 62: Relationships between Sleep and Pai
Page 63 and 64: Managing Sleep Disturbance in FMS D
Page 65 and 66: may be possible to help patients im
Page 67: person to initiate an action (such
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
Page 93 and 94: participants, who may be less likel
Page 95 and 96: emotional problems, increased pain
Page 97 and 98: eactions are most likely to be detr
Page 99 and 100: It has been suggested that the auto
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
Page 109 and 110: Figure 8. Scree plot for the explor
Page 111 and 112: Table 6. Participant characteristic
Page 113 and 114: Table 7. Measures of central tenden
Page 115 and 116: CON = DBAS-10 Dysfunctional beliefs
Page 117 and 118: 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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202
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204
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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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218
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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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