Assessment of sleep by self-report in chronic pain patients

Abstract

Insomnia, pain and psychological distress are three common symptoms in many chronic pain patients. Of these symptoms, sleep problems have not been adequately assessed in this population. The purpose of this study was to assess sleep by self-report measures in order to explore the relationship between sleep, pain and psychological distress. Sleep difficulties were evaluated in 52 chronic pain patients by a single administration of an Intake Pain and Sleep Questionnaire based on a modified version of the Stanford Sleep Questionnaire & Assessment of Wakefulness (SQAW) Questions dealt with the Disorders of Initiating and Maintaining Sleep. An additional measure, the Daily Pain and Sleep Log, which contained the same questions as the Intake Questionnaire, was added for additional confirming information. A sleep efficiency rating (SE = (Total sleep time/time in bed) * 100) was calculated from both the Intake Questionnaire and the Daily Log data. Psychological distress was measured by the Derogatis Brief Symptom Inventory. All measures, plus a general Patient Pain Questionnaire, were sent to the patient before the initial doctor's consultation.;Results showed that 69% of the chronic pain patients had low sleep efficiency, according to the Intake Questionnaire, and 79%, according to the Daily Log. Of the patients who did not report insomnia, 1/2 of these actually had low sleep efficiency.;The important results of this study were that all pain variables as well as many sleep variables were significantly overestimated on the Intake Questionnaire compared to the Daily Log data. Only Sleep Latency was significantly underestimated. The major predictor of low sleep efficiency proved to be elevated psychological distress, according to the Global Severity Index of the BSI.;Results show that insomnia as well as pain and psychological distress are significant problems for many chronic pain patients. The use of daily logs in sleep and pain assessment in conjunction with an Intake Questionnaire have proven to be a revealing source of data not obtainable from a single self-report questionnaire.