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

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Chapter Five. Investigation of the Factors that may Influence Sleep Quality in FMS The previous chapter revealed that sleep disturbance is a common difficulty experienced by people with FMS, with up to 97% of patients reporting poor sleep quality. As discussed in Chapter Two, the literature on insomnia has revealed that psychological factors have been found to be central to the maintenance of sleep disturbance. To extend the findings from Study One on the nature and frequency of sleep disturbances in this population, this study aimed to explore if any psychological factors may influence poor sleep quality specifically for people with FMS. Dysfunctional Beliefs about Sleep As discussed in Chapter Two, models of insomnia and the development of sleep difficulties in chronic pain, suggest that cognitive factors are likely to have a significant impact on insomnia (Call-Schmidt & Richardson, 2003; Currie et al., 2000; Lundh & Broman, 2000) and sleep quality in people with chronic pain (Call-Schmidt & Richardson, 2003; Currie et al., 2000). Elaborating on the role of cognitive factors within poor sleep quality, Harvey (2002) developed the Cognitive Model of Insomnia and proposes that some people become anxious and worry excessively about their sleep quality and the consequences of not getting enough sleep. These worries stem from the establishment of dysfunctional beliefs about sleep (people‟s inaccurate expectations of the amount and quality of sleep that they need, and the consequences that poor sleep will have on their daily functioning). Worrying about sleep may increase attention to the problem and sensitivity to symptoms (Masi et al., 2002). This increased cognitive activity may lead to an increase in brain activity, basal and central nervous system metabolic rate and body temperature, which have all been associated with increased arousal thereby delaying sleep onset and increasing the risk of people experiencing sleeping difficulties (Harvey, 2002; Lichstein & Rosenthal, 1980; Ohayon, Caulet, & Guilleminault, 1997). Research evidence has provided support for links between beliefs and expectations about sleep and sleep quality. For example, people experiencing insomnia describe high levels of worry, planning, thinking about daily events and difficulties calming their mind before sleep onset (Lichstein & Rosenthal, 1980; Ohayon et al., 1997). Exploring these cognitions in more detail, it has been revealed that thoughts eliciting emotional 79
eactions are most likely to be detrimental to sleep quality (Morin et al., 1993). High levels of pre-sleep cognitive arousal have been found to be associated with delayed sleep onset latency and the total amount of time spent asleep in people with insomnia (Broman & Hetta, 1994; Gross & Borkovec, 1982). This suggests that cognitions may influence the experience of sleep, although research exploring the role of cognitions on sleep quality in FMS is lacking. Beliefs and expectations about sleep are most commonly assessed using the Dysfunctional Beliefs and Attitudes Scale (DBAS) (Morin, 1993). The DBAS was initially developed as a 30 item scale, however the DBAS is also available in shorter 16 item and 10 item versions, which have revealed more robust psychometric properties. Research utilising the DBAS has revealed that although both good and poor sleepers may hold dysfunctional beliefs about sleep to some extent (as not all dysfunctional beliefs discriminate between insomniacs and normal sleepers) (Carney & Edinger, 2006; Ellis, Hampson, & Cropley, 2007), poor sleepers have stronger and more rigid dysfunctional beliefs and attitudes towards sleep. Ellis et al (2007) identified that 8 of the 10 items from the DBAS-10 discriminated between good and poor sleepers. The two items that did not discriminate were: „When I don‟t get the proper amount of sleep on a given night, I need to catch up on the next day by napping or on the next night by sleeping longer‟ and „When I have trouble getting to sleep, I should stay in bed and try harder‟ (Ellis et al., 2007). As highlighted by Morin (1993), it is important to identify the beliefs that discriminate between good and poor sleepers to inform treatment. Indeed, cognitive behavioural therapy has been found to significantly reduce dysfunctional beliefs about sleep resulting in improved sleep efficiency for people with insomnia (Carney & Edinger, 2006; Sato, Yamadera, Matsushima, Itoh, & Nakayama, 2010). Despite the evidence suggesting that cognitive factors have a key role on sleep quality, little research has explored the role of beliefs about sleep on sleep quality in chronic pain. One recent study using the DBAS-16 in a sample of patients with chronic benign pain (pain which has persisted despite medical intervention), revealed that high dysfunctional beliefs about sleep, depression and night-time levels of pain, significantly contributed to the model of pain, explaining 51% of the variance in poor sleep quality (Ashworth, Davidson, & Espie, 2009). However, this study did not explore which beliefs discriminated between good and poor sleepers in people with chronic pain. 80
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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
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Figure 3. The Integrative Model of
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However, conducting a blood test is
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As sleep is a complex process invol
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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 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: emotional problems, increased pain
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
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
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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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