Fibromyalgia: the role of sleep in affect and in negative event reactivity and recovery.

Department of Psychology, University of Kansas, USA.
Health Psychology (Impact Factor: 3.95). 07/2008; 27(4):490-7. DOI: 10.1037/0278-6133.27.4.490
Source: PubMed

ABSTRACT Fibromyalgia (FM) syndrome is a chronic pain condition characterized by diffuse muscle pain, increased negative mood, and sleep disturbance. Until recently, sleep disturbance in persons with FM has been modeled as the result of the disease process or its associated pain. The current study examined sleep disturbance (i.e., sleep duration and sleep quality) as a predictor of daily affect, stress reactivity, and stress recovery.
A hybrid of daily diary and ecological momentary assessment methodology was used to evaluate the psychosocial functioning of 89 women with FM. Participants recorded numeric ratings of pain, fatigue, and positive and negative affect 3 times throughout the day for 30 consecutive days. At the end of each day, participants completed daily diary records of positive and negative life events. In addition, participants reported on their sleep duration and sleep quality each morning.
After accounting for the effects of positive events, negative events, and pain on daily affect scores, it was found that sleep duration and quality were prospectively related to affect and fatigue. Furthermore, the effects of inadequate sleep on negative affect were cumulative. In addition, an inadequate amount of sleep prevented affective recovery from days with a high number of negative events.
These results lend support to the hypothesis that sleep is a component of allostatic load and has an upstream role in daily functioning.

  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Objective: This study compared the impact of cognitive-behavioral therapy for pain (CBT-P), mindful awareness and acceptance treatment (M), and arthritis education (E) on day-to-day pain- and stress-related changes in cognitions, symptoms, and affect among adults with rheumatoid arthritis (RA). Method: One hundred forty-three RA patients were randomized to 1 of the 3 treatment conditions. CBT-P targeted pain-coping skills; M targeted awareness and acceptance of current experience to enhance coping with a range of aversive experiences; E provided information regarding RA pain and its management. At pre- and posttreatment, participants completed 30 consecutive evening diaries assessing that day's pain, fatigue, pain-related catastrophizing and perceived control, morning disability, and serene and anxious affects. Results: Multilevel models compared groups in the magnitude of within-person change in daily pain and stress reactivity from pre- to posttreatment. M yielded greater reductions than did CBT-P and E in daily pain-related catastrophizing, morning disability, and fatigue and greater reductions in daily stress-related anxious affect. CBT-P yielded less pronounced declines in daily pain-related perceived control than did M and E. Conclusions: For individuals with RA, M produces the broadest improvements in daily pain and stress reactivity relative to CBT-P and E. These findings also highlight the utility of a diary-based approach to evaluating the treatment-related changes in responses to daily life. (PsycINFO Database Record (c) 2014 APA, all rights reserved).
    Journal of Consulting and Clinical Psychology 11/2014; 83(1). DOI:10.1037/a0038200 · 4.85 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Fibromyalgia (FM) is a chronic pain condition often resulting in functional impairments. Nonrestorative sleep is a prominent symptom of FM that is related to disability, but the day-to-day mechanisms relating the prior night's sleep quality to next-day reports of disability have not been examined. This study examined the within-day relations among early-morning reports of sleep quality last night, late-morning reports of pain and positive and negative affect, and end-of-day reports of activity interference. Specifically, we tested whether pain, positive affect, and negative affect mediated the association between sleep quality and subsequent activity interference. Data were drawn from electronic diary reports collected from 220 patients with FM for 21 consecutive days. The direct and mediated effects at the within-person level were estimated with multilevel structural equation modeling. Results showed that pain and positive affect mediated the relation between sleep quality and activity interference. Early-morning reports of poor sleep quality last night predicted elevated levels of pain and lower levels of positive affect at late-morning, which, in turn, predicted elevated end-of-day activity interference. Of note, positive affect was a stronger mediator than pain and negative affect was not a significant mediator. In summary, the findings identify 2 parallel mechanisms, pain and positive affect, through which the prior night's sleep quality predicts disability the next day in patients with FM. Furthermore, results highlight the potential utility of boosting positive affect after a poor night's sleep as one means of preserving daily function in FM.
    Pain 03/2015; 156(3):540-546. DOI:10.1097/01.j.pain.0000460324.18138.0a · 5.84 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: This study aimed to evaluate the efficacy of cognitive-behavioral therapy for insomnia (CBT-I) on polysomnographic parameters in patients with fibromyalgia (FM). Twenty-six women with FM participated in the study and were randomly assigned to a CBT-I (n = 13) group or sleep hygiene (SH) condition (n = 13). The evaluation consisted in two interview sessions and domiciliary polysomnography study before and after treatment. The results show that time-in-bed and wake percentage diminish after CBT-I. Improvements were also observed in sleep efficiency, which was close to normal levels. The percentage of NREM stage 1 sleep decreased and NREM stages 3 sleep and 4 increased. Similarly, light sleep (stages 1 and 2) diminished and deep sleep increased (stages 3 and 4) after CBT-I. No improvements were observed in any of these parameters in the individuals undergoing SH therapy. This randomized controlled trial provides new evidence that the use of CBT-I in FM patients can significantly improve objective sleep parameters. KEYWORDS. Fibromyalgia. Insomnia. Cognitive-behavioral therapy. Domiciliary polisomnography. Randomized controlled trial.
    International Journal of Clinical and Health Psychology 01/2012; 12(1):39-53. · 2.79 Impact Factor

Full-text (2 Sources)

Available from
Jun 2, 2014