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

These people may be different to people with primary insomnia due to the different
demands their medical condition places on their lives. As poor sleep quality is a
significant problem for people with FMS, the role of cognitive factors on sleep quality
in this population needs further exploration, particularly as treatments addressing
dysfunctional beliefs has been found to significantly improve sleep quality (Ellis et al.,
2007).
Stress
Many studies have revealed that stress is also linked to poor sleep quality. High levels
of stress have been associated with increased physiological and psychological arousal
preventing sleep onset. Even minor daily stresses have been found to have a negative
impact on subsequent sleep quality in people with insomnia (Rubman et al., 1990). It is
likely that appraisals of potential stressors are affected by a number of factors such as
past experience, mood, perceived coping ability and the effect of other stressful
circumstances coinciding at the same time. Assessments exploring perceptions of
overall stress have been found to be more highly correlated with mood and physical
symptoms, than an assessment of the experience of life events (Pbert, Doerfler, &
DeCosimo, 1992). Healey et al (1981) revealed that the most frequent stressful events
reported by people with poor sleep were related to illness, and loss. It may be that
ruminating about daily stressors or symptoms of pain may delay sleep onset or lead to
disrupted sleep. This concept was supported by Smith et al (2001) who revealed that
ruminating about pain was significantly predictive of longer sleep onset latency and
total duration of night-time awakenings in chronic pain patients. This may also be the
case in people with FMS. Studies have found that stress responses appear to be elevated
in FMS in comparison to healthy controls, and evidence suggests that patients with
FMS have difficulty adapting to stress. Evidence has also revealed that symptoms of
FMS are exacerbated by stress (Crofford & Demitrack, 1996), therefore stress may have
an important role to play in the sleep quality of patients with FMS (Thieme et al., 2006).
In addition, poor sleep may also have a direct negative impact on a person‟s ability to
utilise adaptive coping strategies in response to stressful situation, therefore preventing
recovery from stress, due to excessive daytime sleepiness and creating a vicious cycle
(Moldofsky, 2010).
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