Sick and Tired: Understanding and Managing Sleep Difficulties in Fibromyalgia Syndrome

................................................................................................................................ xv Introduction ............................................................................................................................. 1 Defining Terms Central to the Thesis .................................................................................. 3 Chapter One. The Context of Fibromyalgia Syndrome (FMS) ......................................... 5 Clinical Presentation of FMS ............................................................................................... 5 Diagnosis ............................................................................................................................. 6 Prevalence ............................................................................................................................ 9 Impact of FMS ..................................................................................................................... 9 Current Management Strategies ........................................................................................ 12 Conclusion ......................................................................................................................... 14 Chapter Two. The Role of Sleep ........................................................................................ 15 The Normal Sleep Process ................................................................................................. 15 Measuring Sleep ................................................................................................................ 20 Objective Measures ........................................................................................................... 20 Subjective Measures .......................................................................................................... 22 Affects of Poor Sleep ......................................................................................................... 27 The Links between Sleep and Pain .................................................................................... 27 Nature of Sleep Disturbance in Chronic Pain .................................................................... 29 Factors Affecting Sleep Quality in Chronic Pain .............................................................. 31 The Development and Maintenance of Sleep Difficulties in Chronic Pain ....................... 33 Clinical Implications .......................................................................................................... 36 Chapter Three. Sleep in FMS ............................................................................................. 38 Possible Underlying Physiological Mechanisms of Poor Sleep in FMS ........................... 39 Sleep Disorders in FMS ..................................................................................................... 41 Types of Sleep Difficulties Experienced in FMS .............................................................. 43 Relationships between Sleep and Pain in FMS ................................................................. 44 Managing Sleep Disturbance in FMS ................................................................................ 46 Summary ............................................................................................................................ 47