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

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List of Figures Figure 1. Tender point sites according to the ACR (1990) diagnostic criteria ............................................. 7 Figure 2. The cycle of sleep stages............................................................................................................. 16 Figure 3. The Integrative Model of the interaction between sleep-interfering and sleep-interpreting processes (Lundh & Broman, 2000) .......................................................................................................... 20 Figure 4. Conceptual model of the development of sleep difficulties in chronic pain ............................... 34 Figure 5. Conceptual framework of pain and sleep (Call-Schmidt & Richardson, 2003) .......................... 35 Figure 6. The Self-Regulatory Model (Leventhal, Meyer, & Nerenz, 1980; Leventhal, Nerenz, & Steele, 1984) .......................................................................................................................................................... 50 Figure 7. Scree plot for the exploratory factor analysis of the DBAS-10 .................................................. 90 Figure 8. Scree plot for the exploratory factor analysis of the PSS ............................................................ 92 Figure 9. Flow chart of the study population ........................................................................................... 139 Figure 10. Sleep fragmentation index as measured by actigraphy for the two groups ............................. 142 Figure 11. Original Conceptual Framework of Pain and Sleep adapted from Call-Schmidt and Richardson (2003) ....................................................................................................................................................... 156 Figure 12. Revised Conceptual Framework of Pain and Sleep adapted from Call-Schmidt and Richardson (2003) ....................................................................................................................................................... 157 v
List of Tables Table 1. Participant characteristics and assessment measure scores .......................................................... 62 Table 2. Correlations between demographic and health outcome variables ............................................... 68 Table 3. Final model of variables associated with global sleep quality in the logistic regression.............. 70 Table 4. Factor structure of the DBAS-10 for FMS participants ............................................................... 89 Table 5. Factor structure of the PSS-10 for FMS participants ................................................................... 91 Table 6. Participant characteristics and outcome measure scores .............................................................. 94 Table 7. Measures of central tendency and variability for the individual DBAS-10 items ........................ 96 Table 8. Correlations between psychological factors and sleep quality in healthy control participants..... 97 Table 9. Correlations between psychological factors and sleep quality in FMS participants .................... 98 Table 10. Logistic regression analysis ..................................................................................................... 100 Table 11. Interview schedule for the qualitative interviews ..................................................................... 112 Table 12. Participant characteristics ......................................................................................................... 140 Table 13. Measures of central tendency and variability for the actigraphy data ...................................... 141 Table 14. Measures of central tendency and variability for perceptions of sleep quality......................... 143 Table 15. Correlation between subjective and objective measures of sleep quality ................................. 144 Table 16. Measures of central tendency and variability for the measures of health related quality of life .................................................................................................................................................................. 144 vi
Page 1 and 2: Sick and Tired: Understanding and M
Page 3 and 4: Chapter Four. The Nature and Effect
Page 5: References ........................
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 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 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
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questionnaire 78 (77.2%) of the par
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efficiency, suggesting that partici
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Older age and longer length of illn
Page 85 and 86:
Table 2. Correlations between demog
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Logistic Regression As 97% of the s
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in bed, participants may have devel
Page 91 and 92:
Relationship between Negative Affec
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participants, who may be less likel
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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
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For both groups, participants were
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with and without chronic medical co
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As previously described on page 61,
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Figure 7. Scree plot for the explor
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Figure 8. Scree plot for the explor
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Table 6. Participant characteristic
Page 113 and 114:
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
Page 121 and 122:
It became clear, through the analys
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interventions. With this in mind, t
Page 125 and 126:
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
Page 139 and 140:
Participants also described how the
Page 141 and 142:
“XXXX (name of person) planned a
Page 143 and 144:
A strong theme that emerged in this
Page 145 and 146:
conducted at several time points, w
Page 147 and 148:
Chapter Seven. Investigating the Ef
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activities because they no longer f
Page 151 and 152:
Therefore as this was a feasibility
Page 153 and 154:
Self-reported sleep quality was ass
Page 155 and 156:
The progressive muscle relaxation (
Page 157 and 158:
Exploring the baseline data, there
Page 159 and 160:
Consequently, univariate analysis w
Page 161 and 162:
There was no significant correlatio
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people with FMS (Perlis, Giles, Men
Page 165 and 166:
The aim of this study was to explor
Page 167 and 168:
observed in perceived overall sleep
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elaborated on in Chapter Six, which
Page 171 and 172:
Four) revealed that global sleep qu
Page 173 and 174:
Modifications to the Call-Schmidt a
Page 175 and 176:
MBSR programme in people with FMS (
Page 177 and 178:
diagnostic criteria for these sleep
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comprehensive measures to look at t
Page 181 and 182:
References Abad, V. C., Sarinas, P.
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Brand, S., Gerber, M., Beck, J., Ha
Page 185 and 186:
Crofford, L. J., & Demitrack, M. A.
Page 187 and 188:
Goldenberg, D. L., Kaplan, K. H., N
Page 189 and 190:
Johns, M. W. (2002). Sleep propensi
Page 191 and 192:
Leung, Y. Y., Ho, K. W., Zhu, T. Y.
Page 193 and 194:
Mease, P. J. (2005). Fibromyalgia s
Page 195 and 196:
symptoms in healthy subjects; Corre
Page 197 and 198:
approach with illustration to the h
Page 199 and 200:
Thomas, E. N., & Blotman, F. (2010)
Page 201 and 202:
Yunus, M. B., Masi, A. T., & Aldag,
Page 203 and 204:
Appendices Appendix A: Search Strat
Page 205 and 206:
Sleep and Fibromyalgia Syndrome Con
Page 207 and 208:
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
Page 221 and 222:
204
Page 223 and 224:
206
Page 225 and 226:
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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220
Page 239 and 240:
222
Page 241 and 242:
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
Page 247 and 248:
Appendix M. Letter to GPs for Study
Page 249 and 250:
What are the side effects of any tr
Page 251 and 252:
Appendix O: Poster Advertising Stud
Page 253 and 254:
Appendix Q: Participant Questionnai
Page 255 and 256:
HAD Scale Read each item and place
Page 257 and 258:
During the past month have you had
Page 259 and 260:
Appendix R. Letter from Dr Mark Cro
Page 261 and 262:
PUBLICATIONS Peer Reviewed Journal
Page 263:
and panic-like episodes, Faculty of
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