Access Type

Open Access Dissertation

Date of Award

January 2014

Degree Type


Degree Name




First Advisor

Mark A. Lumley


Fibromyalgia (FM) impacts millions of individuals around the world and is characterized by widespread chronic pain and tenderness as well as nonrestorative sleep, fatigue, and stiffness (Wolfe et al., 1990; Wolfe et al., 2010). Poor sleep quality is reported by more than 90% of individuals with FM, suggesting that sleep disturbance may be a contributing factor to the pain experience (Moldofsky, 2008). Recent reviews of the literature have established the connection between sleep and pain, although the direction of this relationship remains unclear (Finan et al., 2013; Moldofsky, 2001). This dissertation sought to examine the daily relationship between sleep and pain in a large population of chronic pain patients with fibromyalgia (FM), as well as the factors that may explain individual differences in this relationship. Ninety adults with FM completed baseline self-report measures of depression, negative affect, pain, sleep disturbance, and pain catastrophizing. Participants also wore an actiwatch, an objective measurement of sleep, for two weeks while completing daily diaries about their sleep and pain. Hierarchical linear modeling (HLM) was utilized to examine the intraindividual variability in daily sleep and pain among participants, as well as the baseline factors that explain individual differences in this relationship.

Results of this study suggest that there is a bidirectional relationship between sleep and pain, with daily refreshing quality of sleep predicting next day's pain, and one day's pain predicting the next night's self-reported sleep onset latency. Average objective wake after sleep onset also predicted daily pain, and daily pain predicted average objective wake after sleep onset. In addition to the daily sleep and pain findings, several factors that explained individual differences in the sleep and pain relationship including depression, negative affect, age, and pain catastrophizing were assessed as moderators. Age, depression, and pain catastrophizing all exhibited bidirectional moderation of the sleep and pain relationship, and individuals who were older as well as those who reported higher levels of baseline depression and pain catastrophizing demonstrated the expected results of poorer sleep being associated with increased pain. The similar relationships among these moderator variables suggest a consistent effect. These findings provide more support for the temporal relationship of daily sleep and pain and indicate that there are individual factors that should be considered in evaluating this relationship.