Insomnia disorder is characterised by difficulties with initiating and/or maintaining sleep. Similar to most psychiatric and mental health conditions, insomnia is defined according to subjective complaint, and achieves disorder ‘status’ when associated daytime functioning impairment is present. Yet, ironically, it is these two cornerstones of insomnia disorder, combined, that have achieved relatively minimal attention in the literature. That is, perhaps surprisingly, the subjective experience, and impact of insomnia, at least from the patient (‘expert’) perspective, has been under-researched. Night-time symptoms and sleep parameters have typically been the target of both treatment and non-treatment (clinical, epidemiological, mechanistic) research. In this thesis, a multi-method, multi-level approach is adopted to better understand the daytime experience of those with chronically disturbed sleep. First, a brief overview (chapter one) of insomnia is provided to familiarise the reader with the ‘problem of insomnia’. A narrative review (chapter two) then sets the scene in relation to the assessment and measurement of health-related quality of life (HRQoL) and daytime functioning. This work reveals several inadequacies and limitations of existing work, and outlines a prospective research agenda. Chapter three describes the first ever phenomenological study carried out in primary insomnia patients. Here, two qualitative methodologies, focus groups and audio-diaries, are combined to help better understand the proximal and distal impairments attributed to chronic sleep disturbance. Chapter four builds on this work by describing the creation of two new clinical scales, developed to quantify, in both valid and novel ways, the impact of poor sleep on aspects of daytime functioning and insomnia-related quality of life. Chapter five combines the aforementioned qualitative and questionnaire approaches to explore the experience of an effective behavioural intervention for insomnia, sleep restriction therapy (SRT). The application of these refined methods provided insight into the effects of SRT on both sleep and daytime functioning, but also permitted exploration of treatment-related issues - such as adherence, side-effects, and mechanisms of action - that have otherwise been difficult to probe using traditional quantitative methodologies. Chapter six tackles the issue of objective daytime impairment, typically assessed using computerised reaction time tasks. Through ‘mining’ an existing brain and behavioural database, and applying an algorithm to select poor and normal sleepers, it was possible to investigate cognitive functioning at two broad stages of processing – event-related potentials generated from the scalp-recorded electroencephalogram (EEG), and performance output using neuropsychological testing. The results provide some interesting hypotheses concerning possible cognition-arousal and -effort interactions. Importantly, as a by-product of this work, a methodological template for the future standardized assessment of brain and behavioural function in insomnia is considered. Finally, chapter seven synthesises the results of each preceding experimental chapter, with particular emphasis on how this work will advance research, measurement and understanding of insomnia-related functioning. Immediate clinical implications and relevance to other areas of insomnia research are also briefly considered.
| Identifer | oai:union.ndltd.org:bl.uk/oai:ethos.bl.uk:575952 |
| Date | January 2010 |
| Creators | Kyle, Simon David |
| Publisher | University of Glasgow |
| Source Sets | Ethos UK |
| Detected Language | English |
| Type | Electronic Thesis or Dissertation |
| Source | http://theses.gla.ac.uk/1971/ |
Page generated in 0.0587 seconds