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

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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). 81
It has been suggested that the autonomic nervous system (part of the body‟s stress response system) may not be working effectively in people with FMS. Several researchers (Martinez-Lavin, 2007; Zurowski & Shapiro, 2004) have also suggested that living with FMS and sleep difficulties may cause increased stress as a result of dealing with the increased demands of managing a chronic pain condition. In addition, polysomnographic evidence has revealed increased frontal cognitive activity during sleep in people with FMS in comparison to controls (Horne & Shackell, 1991). Indeed, participants with FMS have described finding it difficult to calm their mind before sleep, suggesting that cognitive factors may have an affect on sleep quality in people with FMS. Therefore stress is likely to influence sleep quality in FMS. Given the evidence that stress and beliefs about sleep may affect sleep quality, there is a need to investigate the role of these factors on sleep quality in FMS and to identify the factors that may influence the onset and maintenance of sleep disturbances. The present study aimed to explore whether levels of perceived stress and dysfunctional beliefs about sleep are different between people with FMS and healthy controls, and to explore the relationships between stress, dysfunctional beliefs about sleep, sleep quality and health related quality of life in FMS. Based on the research literature it is hypothesised that people with FMS will have significantly higher dysfunctional beliefs about sleep and greater levels of stress than healthy controls. Moreover, it is expected, that high dysfunctional beliefs about sleep and levels of stress will be significantly associated with poorer sleep quality and health related quality of life. Methods In order to identify whether perceived levels of stress and dysfunctional beliefs about sleep are important to perceived sleep quality in FMS, this study employed a case- control design. Case-control studies provide stronger evidence of cause-effect associations compared with studies only exploring the population of interest, as they can be used to identify factors that may contribute to a medical condition by comparing people who have a certain condition (cases), with patients who are similar but do not have the condition (controls) (Bland, 2000). 82
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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
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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 and 96: emotional problems, increased pain
Page 97: eactions are most likely to be detr
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
Page 147 and 148: 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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202
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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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218
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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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