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

associated with chronic illness conditions), influences coping and health outcome, or if
it is the result of living with a chronic illness. Negative affect is thought to influence the
relationship between self-reports of stressors and strain (Brett, Brief, Burke, George, &
Webster, 1990; Griffith, Steptoe, & Cropley, 1999; Stansfeld, North, White, & Marmot,
1995). Indeed, one study has revealed that patients with FMS find it more difficult to
sustain positive affect in response to stressful situations (Zautra et al., 2005). Therefore
both positive and negative affect need to be controlled for when exploring coping in
patients with FMS.
It was revealed in the literature review of sleep, coping and health outcomes (Chapters
One, Two and Three) that there is a need to explore the nature of the sleep difficulties
and factors that may contribute to poor sleep quality in FMS. In order to explore the
nature and frequency of perceived sleep difficulties in FMS, a number of different
methodologies were considered to inform the design of this study. A retrospective
cohort study design was considered as this would offer the most cost-effective, yet
reasonably robust approach, to determine the incidence of sleep difficulties within the
population and enable to the exploration of potential risk factors. However, due to low
awareness and common misdiagnosis of FMS (as discussed in Chapter One) and low
recognition and treatment of sleep difficulties in health care services, a retrospective
study using health care databases would incur difficulties in ensuring the reliability of
FMS diagnosis and would be likely to underestimate the extent of sleep difficulties in
this population. A prospective cohort study would not have been feasible due to
financial constraints and difficulties in accessing a population of people with FMS. This
is because some people with FMS self manage their condition, while others are
managed in primary care or are treated by specialist hospital services. To address these
weaknesses a cross-sectional design was chosen for this study. This study design
offered the opportunity to use a standardised measure to assess the components of sleep
quality, as well as enabling the advantage of accessing a wider population of FMS
patients, encompassing the spectrum of symptom severity and including those treated
both in the community and in secondary care services within a short timeframe.
To ascertain the extent and nature of sleep difficulties in FMS, and the role of sleep in
FMS, this study aimed to explore the components of sleep quality and relationships
between sleep, mood, coping and health outcomes in FMS. Based on the review of the
previous literature it was hypothesised that:
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