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

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(Tabachnick & Fidell, 2007). Therefore further analysis of the data set was not completed. Discussion This exploratory study aimed to investigate the extent and nature of sleep difficulties in FMS and to explore the effects of self-reported sleep and coping on health outcomes. A high percentage of the sample (97%) were found to have sleep quality above the level indicative of significant sleep disturbance in need of treatment, a level higher than indicated in previous research. This suggests that sleep difficulties are an important issue for people with FMS (Osorio et al., 2006; Rao & Bennett, 2003). This study found that global sleep quality was significantly associated with physical functioning, role limitations due to emotional difficulties, fatigue, well-being, social functioning, and levels of pain. The most prominent sleep difficulties related to overall poor sleep quality and frequent night-time awakenings, which were significantly correlated with poorer health outcomes in FMS. The Nature of Sleep Difficulties in FMS As discussed in Chapter Two, identifying the specific sleep difficulties that people experience is crucial to inform suitable treatment interventions. In this study, the main difficulties people with FMS experienced were perceptions of overall poor sleep quality, frequent awakenings during the night and difficulties being able to return to sleep afterwards. This contrasts with previous research findings for people with chronic pain who reported that their main difficulties related to initial sleep onset, total time spent asleep and sleep efficiency as described in Chapter Three (Wittig et al., 1982). These findings did not support the hypothesis for this study. The frequent experience of night-time awakenings in FMS may be due to cognitive factors such as worrying about sleep or feeling stressed. These cognitive factors may also have an important influence on sleep quality in FMS. In the general population difficulties returning to sleep after awakening are often increased by worrying or ruminating about daily events (Sadeh et al., 2004). As a high proportion of FMS participants in this study reported low enjoyment of sleep, while spending a lot of time 71
in bed, participants may have developed negative associations with going to bed, dysfunctional beliefs about their sleep or started to engage in sleep catastrophising (Morin, Stone, Trinkle, Mercer, & Remsberg, 1993). The wide variability in the duration of night-time awakenings found in this study, suggests that this may be an important distinction in our understanding of the role of night-time awakenings in FMS. Objective measures of sleep have shown higher frequencies of night-time awakenings than subjective reports which may occur as people could experience brief awakenings that they may not be fully conscious of at night (Lockley, Skene, & Arendt, 1999). Consequently, it may be the case that nocturnal awakenings of several minutes may have less of an impact on FMS symptoms, than awakenings of several hours and this was not explored within this study. Physiological factors such as increased pain due to a period of inactivity may prevent sleep onset after awakening or awakenings may be due to abnormal levels hormones and neurotransmitter activity as described in Chapter One. Therefore, further investigation of the causes of night-time awakenings in FMS is necessary. The Effect of Sleep on Health Outcomes in FMS The results of this study support previous findings that components of poor sleep quality are significantly associated with pain, poorer physical functioning and higher levels of negative affect in FMS (Affleck et al., 1996; Agargun et al., 1999; Nicassio et al., 2002). Previous studies of sleep in FMS have explored self-reported sleep using global measures of sleep quality such as single VAS scales. However, in line with the proposals of Pilcher et al (1997), the role of sleep on health outcomes became clearer when the individual components of the PSQI were used in the analysis. For example, in this study it appeared that the number of night-time awakenings and overall sleep quality were more related to health outcomes in FMS than sleep quantity, sleep onset latency or sleep efficiency, and it was interesting to note that the global PSQI score was not significantly correlated with general health. As only night-time awakenings and perceived sleep quality were the components of sleep quality that were significantly correlated with health outcomes, in this study, this would suggest that reducing night- time awakenings and perceived sleep quality should be the focus of interventions to improve health related quality of life in FMS. 72
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Sick and Tired: Understanding and M
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Chapter Four. The Nature and Effect
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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
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Confidential Material No participan
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The role of sleep in FMS appears to
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little information was available as
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Psychophysiologic insomnia which is
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and are less able to inhibit the pa
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widely applied in clinical practice
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of fewer tender points; usually bet
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Current Management Strategies The t
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also likely to depend on a number o
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deep sleep (stages three and four)
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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
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: Logistic Regression As 97% of the s
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
Page 119 and 120: has explored the use of napping on
Page 121 and 122: It became clear, through the analys
Page 123 and 124: interventions. With this in mind, t
Page 125 and 126: The philosophy of phenomenology was
Page 127 and 128: Methods Participants were given a w
Page 129 and 130: Table 11. Interview schedule for th
Page 131 and 132: Rigour The interview transcripts we
Page 133 and 134: “The main symptom is this overwhe
Page 135 and 136: Theme Two. Inter-relationship betwe
Page 137 and 138: 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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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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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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