Abstract
IntroductionPrimary Sjögren’s syndrome is the third most common systemic autoimmune rheumatic disease, following rheumatoid arthritis and systemic lupus erythematosus, and results in dryness, fatigue, discomfort and sleep disturbances. Sleep is relatively unexplored in primary Sjögren’s syndrome. We investigated the experiences of sleep disturbances from the viewpoint of primary Sjögren’s syndrome patients and their partners and explored the acceptability of cognitive behavioural therapy for insomnia.MethodWe used focus groups to collect qualitative data from 10 patients with primary Sjögren’s syndrome and three partners of patients. The data were recorded, transcribed verbatim and analysed using thematic analysis.ResultsFive themes emerged from the data: (a) Experience of sleep disturbances; (b) variation and inconsistency in sleep disturbances; (c) the domino effect of primary Sjögren’s syndrome symptoms; (d) strategies to manage sleep; (e) acceptability of evidence-based techniques. Sleep disturbances were problematic for all patients, but specific disturbances varied between participants. These included prolonged sleep onset time and frequent night awakenings and were aggravated by pain and discomfort. Patients deployed a range of strategies to try and self-manage. Cognitive behavioural therapy for insomnia was seen as an acceptable intervention, as long as a rationale for its use is given and it is tailored for primary Sjögren’s syndrome.ConclusionPrimary Sjögren’s syndrome patients described a range of sleep disturbances. Applying tailored, evidence-based sleep therapy interventions may improve sleep, severity of other primary Sjögren’s syndrome symptoms and functional ability.
Highlights
Primary Sjogren’s syndrome is the third most common systemic autoimmune rheumatic disease, following rheumatoid arthritis and systemic lupus erythematosus, and results in dryness, fatigue, discomfort and sleep disturbances
The groups are coded according to the session number; for example, FG1A is the first half of focus group 1 and FG3B is the second half of the third focus group
Sleep disturbances are seen in a range of chronic diseases (Kamath et al, 2015) and there are broad similarities between the sleep difficulties experienced in Primary Sjogren’s syndrome (PSS) and in other conditions, such as primary insomnia (Reynolds et al, 1991) and chronic pain (Tang et al, 2015)
Summary
Primary Sjogren’s syndrome is the third most common systemic autoimmune rheumatic disease, following rheumatoid arthritis and systemic lupus erythematosus, and results in dryness, fatigue, discomfort and sleep disturbances. We investigated the experiences of sleep disturbances from the viewpoint of primary Sjogren’s syndrome patients and their partners and explored the acceptability of cognitive behavioural therapy for insomnia. Primary Sjogren’s syndrome (PSS) is the third most common systemic autoimmune rheumatic disease, following rheumatoid arthritis and systemic lupus erythematosus (Yu et al, 2013). It is a connective tissue disease usually diagnosed and treated by rheumatologists. Other known features of PSS include chronic fatigue (Ng and Bowman, 2010) and chronic widespread pain (Segal et al, 2013)
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