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Journal of Behavioral Medicine

, Volume 27, Issue 6, pp 581–605 | Cite as

Sleep Quality and Psychological Adjustment in Chronic Fatigue Syndrome

  • Myrtis Fossey
  • Eva Libman
  • Sally Bailes
  • Marc Baltzan
  • Ronald Schondorf
  • Rhonda Amsel
  • Catherine S. Fichten
Article

Abstract

Without specific etiology or effective treatment, chronic fatigue syndrome (CFS) remains a contentious diagnosis. Individuals with CFS complain of fatigue and poor sleep—symptoms that are often attributed to psychological disturbance. To assess the nature and prevalence of sleep disturbance in CFS and to investigate the widely presumed presence of psychological maladjustment we examined sleep quality, sleep disorders, physical health, daytime sleepiness, fatigue, and psychological adjustment in three samples: individuals with CFS; a healthy control group; and individuals with a definite medical diagnosis: narcolepsy. Outcome measures included physiological evaluation (polysomnography), medical diagnosis, structured interview, and self-report measures. Results indicate that the CFS sample had a very high incidence (58%) of previously undiagnosed primary sleep disorder such as sleep apnea/hypopnea syndrome and restless legs/periodic limb movement disorder. They also had very high rates of self-reported insomnia and nonrestorative sleep. Narcolepsy and CFS participants were very similar on psychological adjustment: both these groups had more psychological maladjustment than did control group participants. Our data suggest that primary sleep disorders in individuals with CFS are underdiagnosed in primary care settings and that the psychological disturbances seen in CFS may well be the result of living with a chronic illness that is poorly recognized or understood.

insomnia nonrestorative sleep chronic fatigue syndrome (CFS) narcolepsy primary sleep disorder sleep apnea/hypopnea syndrome restless legs/periodic limb movement disorder psychological adjustment psychopathology health 

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REFERENCES

  1. American Psychiatric Association (1994). Diagnostic and Statistical Manual of Mental Disorders, 4th ed., American Psychiatric Association, Washington, DC.Google Scholar
  2. Atlas Task Force of the American Sleep Disorders Association (1993). Recording and scoring leg movements. Sleep 16: 749.Google Scholar
  3. Bailes, S., Baltzan, M., Alapin, I., Fichten, C. S., and Libman, E. (2003). Different but Equal: Symptom Presentation in Women and Men With Sleep Apnea, Manuscript submitted for publication.Google Scholar
  4. Bailes, S., Baltzan, M., Alapin, I., Schondorf, R., Fossey, M., Fichten, C. S., and Libman, E. (2001, May). Sleep Quality and Psychological Adjustment in Chronic Fatigue, Presentation at the Canadian Sleep Society convention, Ottawa, Canada (Summary in 2001 Canadian Sleep Odyssey Conference Program, p. 46).Google Scholar
  5. Beck, A., Steer, R., and Brown, G. (1996). BDI-II: Beck Depression Inventory Manual, 2nd ed., The Psychological Corporation, San Antonio, TX.Google Scholar
  6. Bootzin, R. R., and Nicassio, P. M. (1978). Behavioral treatments for insomnia. In Hersen, M., Eisler, R., and Miller, P. (Eds.), Progress in Behavior Modification, Vol. 6, Academic Press, New York, pp. 1–45.Google Scholar
  7. Burns, D. D. (1980). Feeling Good: The New Mood Therapy, Avon Books, New York, pp. 22–23.Google Scholar
  8. Caplan, C. (1998). Chronic fatigue syndrome or just plain tired? Can. Med. Assoc. J. 159: 519.Google Scholar
  9. Chalder, T., Berelowitz, G., Pawlikowska, T., Watts, L., Wessely, S., Wright, D., and Wallace, E. P. (1993). Development of a fatigue scale. J. Psychosom. Res. 37(2): 147–153.PubMedGoogle Scholar
  10. Cleare, A. J. (2003). The neuroendocrinology of chronic fatigue syndrome. Endocrine Reviews 24: 236–252.PubMedGoogle Scholar
  11. Cohen, J. (1988). Statistical Power Analysis for the Behavioral Sciences, 2nd ed., Erlbaum, Hillsdale, NJ.Google Scholar
  12. Creti, L., Libman, E., Bailes, S., Fichten, C. S., Jastremsky, M., Morin, N., Baltzan, M., Schondorf, R., Amsel, R., and Spector, I. (2003, November). Treatment of Sleep Disor-ders in Chronic Fatigue Syndrome: Cbt, Medical Treatment or Both? Presented at the Association for Advancement of Behavior Therapy (AABT), Boston.Google Scholar
  13. Dattore, P. J., Shontz, F. C., and Coyne, L. (1980). Premorbid personality differentiation of cancer and noncancer groups: A test of the hypothesis of cancer proneness. J. Consult. Clin. Psychol. 48: 388–394.PubMedGoogle Scholar
  14. David, A. S., Wessely, S., and Pelosi, A. J. (1988). Myalgic encephalomyelitis or what? Lancet 2: 100–101.Google Scholar
  15. Derogatis, L. R. (1977). The Psychopathology Rating Scale: A Brief Description. Unpublished manuscript.Google Scholar
  16. Derogatis, L. R., Rickels, K., and Rock, A. F. (1976). The SCL-90 and the MMPI: A step in the validation of a new self-report scale. Br. J. Psychiatry 128: 280–289.PubMedGoogle Scholar
  17. Diagnostic Classification Steering Committee (1990). ICSD –International Classification of Sleep Disorders: Diagnostic and Coding Manual, American Sleep Disorders Association, Rochester, MI.Google Scholar
  18. Digman, J. M. (1990). Personality structure: Emergence of the 5-Factor model. Ann. Rev. Psy-chol. 41: 417–440.Google Scholar
  19. Eysenck, H. J. (1952). The Scientific Study of Personality, Routledge & Kenan Paul, London.Google Scholar
  20. Eysenck, H. J., and Eysenck, S. B. G. (1968). Manual: Eysenck Personality Inventory, Educational and Industrial Testing Service, San Diego, CA.Google Scholar
  21. Eysenck, H. J., and Eysenck, S. B. G. (1991). Manual of the Eysenck personality Scales (EPS Adult), Hodder & Stoughton, London.Google Scholar
  22. Fichten, C. S., Creti, L., Amsel, R., Brender, W., Weinstein, N., and Libman, E. (1995). Poor sleepers who do not complain of insomnia: Myths and realities about psychologi-cal and lifestyle characteristics of older good and poor sleepers. J. Behav. Med. 18(2): 189–223.PubMedGoogle Scholar
  23. Fichten, C. S., Libman, E., Bailes, S., and Alapin, I. (2000). Characteristics of older adults with insomnia. In Lichstein, K. L., and Morin, C. M. (Eds.), Treatment of Late Life Insomnia, Sage, New York, pp. 37–80.Google Scholar
  24. Fichten, C. S., Libman, E., Creti, L., Amsel, R., Tagalakis, V., and Brender, W. (1998). Thoughts during awake times in older good and poor sleepers – The Self-Statement Test: 60 +. Cogn. Ther. Res. 22(1): 1–20.Google Scholar
  25. Fukuda, K., Strauss, S. E., Hickie, I., Sharpe, M. C., Dobbins, J. G., and Komaroff, A. L. (1994). The chronic fatigue syndrome: Acomprehensive approach to its definition and study. Ann. Intern. Med. 121: 953–959.PubMedGoogle Scholar
  26. Hardt, J., Buchwald, D., Wilks, D., Sharpe, M., Nix, W. A., and Egle, U. T. (2001). Health-related quality of life in patients with chronic fatigue syndrome. An international study. J. Psychosom. Res. 51(2): 431–434.PubMedGoogle Scholar
  27. Hoddes, E., Zarcone, V., Smythe, H., Phillips, K., and Dement, W. C. (1973). Quantification of sleepiness: A new approach. Psychophysiology 10: 431–437.PubMedGoogle Scholar
  28. Honma, K., Hashimoto, S., Nakao, M., and Honma, S. (2003). Period and phase adjustments of human circadian rhythms in the real world. J. Biol. Rhythms 18(3): 261–270.PubMedGoogle Scholar
  29. Johns, M. W. (1991). Anew method for measuring daytime sleepiness: The Epworth Sleepiness Scale. Sleep 14(6): 540–545.PubMedGoogle Scholar
  30. Kapsimalis, F., and Kryger, M. H. (2002). Gender and obstructive sleep apnea syndrome: Part 1: Clinical features. Sleep 25(4): 412–419.PubMedGoogle Scholar
  31. Kirmayer, L. J., and Robbins, J. M. (1991). Three forms of somatization in primary care: Preva-lence, co-occurrence, and sociodemographic characteristics. J. Nerv. Ment. Dis. 179(11): 647–655.PubMedGoogle Scholar
  32. Kok, S. W., Roelfsema, F., Overseem, S., Lammers, G. J., Strijers, R. L., Frolich, M., Meinders, A. E., and Pijl, H. (2002). Dynamics of the pituitary–adrenal ensemble in hypocretin-deficient narcoleptic humans: Blunted basal adrenocorticotropin release and evidence for normal time-keeping by the master pacemaker. J. Clin. Endocrinol. Metab. 87(11): 5085–5091.PubMedGoogle Scholar
  33. Komaroff, A. L. (1990). Minor illness symptoms: The magnitude of their burden and of our ignorance. Arch. Intern. Med. 150: 1586–1687.PubMedGoogle Scholar
  34. Komaroff, A. L., and Fagioli, L. (1996). Medical assessment of fatigue and chronic fatigue syndrome. In Demitrack, M. A., and Abbey, S. E. (Eds.), Chronic Fatigue Syndrome – An Integrative Approach to Evaluate and Treatment, Guilford, New York.Google Scholar
  35. Krupp, L. B., LaRocca, N. G., Muir-Nash, J., and Sternberg, A. D. (1989). The Fatigue Severity Scale: Application to patients with multiple sclerosis and systemic lupus erythemasis. Arch. Neurol. 46: 1121–1123.PubMedGoogle Scholar
  36. Lacks, P. (1987). Daily sleep diary. In Lacks, P. (Ed.), Behavioral Treatment for Persistent Insomnia, Pergamon, New York, p. 165.Google Scholar
  37. Le Bon, O., Fischler, B., Hoffman, G., Murphy, J. R., De Meirleir, K., Cluydts, R., and Pelc, I. (2000). How significant are primary sleep disorders in the chronic fatigue syndrome? Sleep Res. Online 3(2): 43–48.PubMedGoogle Scholar
  38. Leese, G., Chattington, P., Fraser, W., Vora, J., Edwards, R., and Williams, G. (1996). Short-term night-shift working mimics the pituitary–adrenocortical dysfunction in chronic fatigue syndrome. J. Clin. Endocrinol. Metab. 81: 1867–1870.PubMedGoogle Scholar
  39. Libman, E., Creti, L., Amsel, R., Brender, W., and Fichten, C. S. (1997a). What do older good and poor sleepers do during periods of nocturnal wakefulness? The Sleep Behaviors Scale: 60 +. Psychol. Aging 12(1): 170–182.PubMedGoogle Scholar
  40. Libman, E., Creti, L., Levy, R. D., Brender, W., and Fichten, C. S. (1997b). A comparison of reported and recorded sleep in older poor sleepers. J. Clin. Geropsychol. 3(3): 199–211.Google Scholar
  41. Libman, E., Fichten, C. S., Bailes, S., and Amsel, R. (2000). Sleep questionnaire vs. sleep diary: Which measure is better? Int. J. Rehabil. Health 5(3): 205–209.Google Scholar
  42. Lichstein, K. L., Durrence, H. H., Reidel, B. W., and Bayen, U. J. (2001). Primary versus secondary insomnia in older adults: Subjective sleep and daytime functioning. Psychol. Aging 16(2): 264–271.PubMedGoogle Scholar
  43. Lichstein, K. L., Durrence, H. H., Taylor, D. J., Bush, A. J., and Reidel, B. W. (2003). Quantitative criteria for insomnia. Behav. Res. Ther. 41: 427–445.PubMedGoogle Scholar
  44. Lichstein, K. L., Wilson, N. M., Noe, S. L., Aguillard, R. N., and Bellur, S. N. (1994). Daytime sleepiness in insomnia: Behavioral, biological and subjective indices. Sleep 17(8): 693–702.PubMedGoogle Scholar
  45. Mastin, D. F. (1999). The psychosocial impact of sleepiness in a large African-American family with several narcoleptic members (Doctoral dissertation, The University of Southern Mississippi, 1999). Diss. Abstr. Int., Sect. B: Sci. Eng. 59(7B): 3703.Google Scholar
  46. Moldofsky, H. (1986). Sleep and musculoskeletal pain. Am. J. Med. 81: 85–89.Google Scholar
  47. Moldofsky, H., and Scarisbrick, P. (1976). Induction of neurasthenic musculoskeletal pain syndrome by selective sleep stage deprivation. Psychosom. Med. 38: 35–44.PubMedGoogle Scholar
  48. Montplaisir, J., and Godbout, R. (1989). Restless legs syndrome and periodic movements during sleep. In Kryger, M. H., Roth, T., and Dement, W. C. (Eds.), Principles and Practice of Sleep Medicine, Saunders, Philadelphia, PA, pp. 402–409.Google Scholar
  49. Morin, C. M., Rodrigue, S., and Ivers, H. (2003). Role of stress, arousal, and coping skills in primary insomnia. Psychosom. Med. 65: 259–267.PubMedGoogle Scholar
  50. Nicassio, P. M., Schuman, C., Radojevic, V., and Weissman, M. H. (1999). Helplessness as a mediator of health status in fibromyalgia. Cogn. Ther. Res. 23(2): 181–196.Google Scholar
  51. Plioplys, A. V. (2003) Differential diagnosis in medical assessment. In Jason, L. A., Fennell, P. A., and Taylor, R. R. (Eds.), Handbook of Chronic Fatigue Syndrome, Wiley, NJ, pp. 26–41.Google Scholar
  52. Schondorf, R., Benoit, J., Wein, T., and Phaneuf, D. (1999). Orthostatic intolerance in the chronic fatigue syndrome. J. Auton. Nerv. Syst. 75: 192–201.PubMedGoogle Scholar
  53. Schondorf, R., and Freeman, R. (1999). The importance of orthostatic intolerance in the chronic fatigue syndrome. Am. J. Med. Sci. 317: 117–123.PubMedGoogle Scholar
  54. Siegel, J. (2000, Winter). Recent developments in narcolepsy research, an explanation for patients and the general public. Narcolepsy Netw. Newsl. 13: 1–2.Google Scholar
  55. Spath-Schwalbe, E., Scholler, T., Kern, W., Fehm, H. L., and Born, J. (1992). Nocturnal adreno-corticotropin and cortisol secretion depends on sleep duration and decreases in association with spontaneous awakening in the morning. J. Clin. Endocrinol. Metabol. 75: 1431–1435.Google Scholar
  56. Spielberger, C. D., Gorsuch, R. L., Lushene, R., Vagg, P. R., and Jacobs, G. A. (1983). Manual for the State-Trait Anxiety Inventory (Form Y), Consulting Psychologists Press, Palo Alto, CA.Google Scholar
  57. Standards of Practice Committee of the American Sleep Disorders Association (1995). Practice parameters for the use of polysomnography in the evaluation of insomnia. Sleep 18: 55–57.Google Scholar
  58. Steiger, A. (2002). Sleep and the hypothalamo–pituitary–adrenal system. Sleep Med. Rev. 6(2): 125–138.PubMedGoogle Scholar
  59. Taheri, S., Zeitzer, J. M., and Mignot, E. (2002). The role of hypocretins (orexins) in sleep regulation and narcolepsy. Ann. Rev. Neurosci. 25: 283–313.PubMedGoogle Scholar
  60. Taylor, M., and Samson, W. K. (2003). The other side of orexins: Endocrine and metabolic actions. Am. J. Physiol. Endocrinol. Metab. 284: E13–E17.PubMedGoogle Scholar
  61. Van Reeth, O., Weibel, L., Spiegel, K., Leproult, R., Dugovic, C., and Maccari, S. (2000). Interactions between stress and sleep: From basic research to clinical situations. Sleep Med. Rev. 4: 201–219.Google Scholar
  62. Ware, J. E., Snow, K. K., Kosinski, M., and Gandek, B. (2000). SF-36 Health Survey: Manual and Interpretation Guide, Quality Metric Incorporated, Lincoln, RI.Google Scholar
  63. Wessely, S. (1995). Neurasthenia and fatigue syndromes. In Berrios, G., and Porter, R. (Eds.), A History of Clinical Psychiatry, The Athlone Press, London, pp. 509–532.Google Scholar
  64. Williams, G., Pirmohamed, J., Minors, D., Waterhouse, J., Buchan, I., Arendt, J., and Edwards, R. H. T. (1996). Dissociation of body-temperature and melatonin secretion circadian rhythms in patients with chronic fatigue syndorme. Clin. Physiol. 16(4): 327–337.PubMedGoogle Scholar
  65. Yehuda, S., and Mostofsky, D. I. (Eds.). (1997). Chronic Fatigue Syndrome, Plenum, New YorkGoogle Scholar
  66. Young, T., Hutton, R., Finn, L., Badr, S., and Palta, M. (1996). The gender bias in sleep apnea diagnosis. Are women missed because they have different symptoms? Arch. Intern. Med. 156(21): 2445–2451.PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, Inc. 2004

Authors and Affiliations

  • Myrtis Fossey
    • 1
    • 2
  • Eva Libman
    • 1
    • 2
    • 3
  • Sally Bailes
    • 1
  • Marc Baltzan
    • 4
    • 3
  • Ronald Schondorf
    • 1
    • 3
  • Rhonda Amsel
    • 3
  • Catherine S. Fichten
    • 1
    • 5
    • 3
  1. 1.S.M.B.D.-Jewish General HospitalQuebecCanada
  2. 2.Concordia UniversityQuebecCanada
  3. 3.McGill UniversityQuebecCanada
  4. 4.Mount Sinai HospitalQuebecCanada
  5. 5.Dawson CollegeQuebecCanada

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