ADULTS WITH MULTIPLE SCLEROSIS
The Relationships Between Circadian Rhythm, Sleep Quality, Fatigue, and Depressive Symptoms among Adults with Multiple Sclerosis
Multiple sclerosis (MS) is a neurological disease that is common among adults. The disorder affects about 2.3 million individuals globally, hence influencing the quality of life and the overall wellbeing of the affected persons. The symptoms emanate from the demyelination and inflammation, which upset the central nervous system (CNS). As a result of the effect on the brain, fatigue and circadian rhythm are some of the common symptoms of multiple sclerosis. Statistics reveal that up to 90 percent of individuals with the disorder experience fatigue (Barun, 2013). Some of the factors that reveal the symptoms include depression, disordered sleep, and anxiety. Additionally, fatigue and circadian rhythm can emanate from the multiple sclerosis disease process. Circadian rhythm, fatigue, and lack of adequate sleep can elevate the level of depression (Braley & Boudreau, 2016). Although the symptoms are common in patients, interventions such as Actigraphy watch can alleviate such indicators and promote the patient’s quality of life and the general wellbeing.
Patients with multiple sclerosis experience various symptoms that might create challenges in their quality of life and general wellbeing. Fatigue and circadian rhythm are common in people with the disorder, possibly because of the effect of the disease process on the brain. Depression, disordered sleep are possible causes of fatigue in patients. Up to 90 percent of patients experience symptoms that further cause depression and anxiety. Fatigue and poor sleeping habits are common risk factors for depression and challenges in concentration. Besides, lack of quality sleep increases disability and decline cognitive abilities (Kinnucan, Rubin, & Ali, 2013). While these problems are common in individuals with multiple sclerosis, they are often undiagnosed and untreated. Hence, those issues affect the quality of life and the capacity to perform work-related activities adversely.
The negative symptoms of multiple sclerosis often complicate its management and could cause additional clinical challenges for the patient. The symptoms can further affect physical and cognitive functioning, daily task engagements, the capacity to work, and interpersonal connections (Powell, Moss-Morris, Liossi, & Schlotz, 2015). Circadian rhythm, lack of quality sleep, and fatigue are associated with other problems, such as pain perception, increased risk of fall, because of reduced motor skills, accidents, and related injuries. They also affect the immune system’s expression and modulation. Sleep disruption can create an increased risk of proinflammatory, such as intensified cytokines and oxidative stress (Kinnucan, Rubin, & Ali, 2013). Therefore, it would be appropriate to enhance the means of regulating sleep to reduce the risk of Circadian Rhythm, Fatigue, and depression. The intervention is necessary to improve the quality of life and the general wellbeing of the patient.
Application of Actigraphy Watch
Technology plays an essential role in regulating various aspects of multiple sclerosis to improve patient outcomes, including the quality of life and wellbeing. One of the commonly used technologies is actigraphy, a non-invasive mechanism of monitoring a person’s rest or activity cycles. It is an actigraph unit and an actimetry sensor, which a person wears for a particular period to measure gross motor activity. The patient wears the wrist-watch-like package and keeps it for a while to achieve the objective of measuring activity. It continually records the movement that the unit undergoes. Furthermore, it measures light exposure (Leonavicius, & Adomaitiene, 2014). A computer is used to read and analyze the data in real-time or offline. Generally, the actigraphy watch collects data to monitor sleep duration and control the quality of sleep to reduce the adverse outcomes.
Autography watch plays an imperative role in the management of multiple sclerosis. It monitors sleep duration and quality over several nights. Nonetheless, the system averages the data across nights and reports the mean value. Implementers’ interest is to examine intraindividual variability (IIV) or the level of variation of sleep from one night to another. For instance, the patient could sleep for five hours in one night, nine hours on another, and seven hours on the third night. The average duration would be seven hours per night (Leonavicius, & Adomaitiene, 2014). The autography watch is important for the implementer to understand sleep variations patterns and how such variants affect the person’s quality of life. The information can help in managing the quality of sleep and other multiple sclerosis disease outcomes.
Implementation of any technology in healthcare involves significant investment, especially when the technology is applied for the first time. The cost of implementing the system includes the acquisition of the actigraphy watches (sensors) and the computer systems to record and monitor the collected data. It will be a major capital investment because the current setting does not have such systems in place (Rahurkar, Vest, & Menachemi, 2015). The financial aspects should be sufficient to assess the actual impact of the system and informatics intervention targeting patients with multiple sclerosis and related symptoms. However, the system should have more benefits to justify the high-cost investment. It should be beneficial in improving the patient’s quality of life and wellbeing.
Information technology in health has significant benefits in terms of cost-effectiveness, efficiency, quality, and safety. Implementation of the new system follows the trend in the realized benefits of information technology and informatics in healthcare settings (Rahurkar, Vest, & Menachemi, 2015). The advantage of actigraphy watches is to manage the symptoms of multiple sclerosis, improve the quality of sleep, and hence prevent fatigue, circadian rhythm, and depressive symptoms. Previous studies reveal that actigraphy watches have been effective in reducing the effect of the disorder and improving the quality of sleep. The technology is linked to various health outcomes in adults, such as lowering stress levels and depressive symptoms and improving cognitive functioning. Other related benefits of the technology include enhancing mobility, balance, and motor skills (Leonavicius, & Adomaitiene, 2014). As a result, the affected person can continue operating normally in daily activities. Thus, the cost of the technology is justified by the positive outcomes among adults with multiple sclerosis.
The technology will be implemented to assist those patients with multiple sclerosis. Therefore, the users of this technology must be diagnosed with the disease. Furthermore, they must have the target symptoms, including circadian rhythm, sleep quality, fatigue, and depressive symptoms. For such individuals, circadian rhythm and fatigue affect the quality of sleep, which create depressive symptoms in the affected individual (Smith et al., 2018). Therefore, the implementation plan will include an assessment of the signs in the target persons. The execution will be conducted in a healthcare setting with multiple sclerosis patients. Notably, to test its effectiveness, it is necessary to use it on some patients to allow implementers to compare the outcomes and determine the effect of the intervention.
The implementation will include an assessment of the technology at two levels, intraindividual variability (IIV) and the level of variation of sleep from one night to another. For example, two patients can be compared in terms of their differences in the quality of sleep. The autography clock will collect data on the duration of time a person sleeps for consecutive nights. For example, a patient sleeps for five hours in one night, nine on another, and seven on the third. Another patient may sleep for seven hours for all three nights. The average duration of sleep for both patients is seven hours per night. Besides reporting the mean, data will be collected to determine variability across the nights (Powell, Moss-Morris, Liossi, & Schlotz, 2015). For instance, an individual could sleep for five hours and another person sleep for eight hours for consecutive nights. The two will not have any variability in sleep. However, the first person will have less optimal sleep because he or she sleeps less than the recommended duration. Therefore, the clock will be used to determine various aspects of sleep quality, including duration and variability.
The health IT project requires adequate investment, while stakeholders demand data on its value to the individuals and the healthcare setting. Therefore, an evaluation is necessary to collect the data to determine the effectiveness of the project in achieving the desired objectives. The assessment will justify the investment in the project. The evaluation will use the Agency for Healthcare Research and Quality (AHRQ) and National Resource Center for Health Information Technology (NRC) Evaluation Toolkit to assess the effectiveness of the technology (Cresswell, Bates, & Sheikh, 2013). The toolkit is a source of systematic direction for the implementer of the actigraphy watch system to evaluate its impact on the management of multiple sclerosis and its problematic symptoms.
The evaluation process begins with a revisit of the objectives of the technology project. The current project was aimed at monitoring and managing sleep patterns to help adults with multiple sclerosis to manage other symptoms such as circadian rhythm, fatigue, and depressive symptoms. Therefore, the evaluator will collect pre- and post-implementation data to test the effectiveness. Data will be obtained using the actigraphy watch, involving intraindividual variability (IIV) and the level of variation of sleep from one night to another. The findings will be compared pre- and post-implementation to reveal whether the technology is effective. Besides, data will be collected from self-report on sleep disturbance, fatigue, and depressive feelings. Similarly, data will be gathered pre- and post-evaluation for comparison (Cresswell, Bates, & Sheikh, 2013). The evaluator will use quantitative methods of data collection, such as a questionnaire. Furthermore, the results from the evaluation will be used for decision-making, concerning the viability of the technology and continued use.
As it is evident from the above analysis, Circadian rhythm, sleep disturbance, fatigue, and depressive symptoms are some of the common challenges among adults with multiple sclerosis. The problem is that most of these symptoms are usually undiagnosed, which creates difficulties for individuals, including adverse effects on their daily work and cognitive functioning. Therefore, it is necessary to implement effective interventions to help adults with multiple sclerosis to manage the symptoms and have a quality life. The project proposes the use of an autography watch to monitor and control the symptoms, especially sleep disturbances. Data from previous projects reveal a high level of effectiveness of the technology in managing sleep disturbances. Therefore, the current plan will potentially be a viable intervention for individuals with multiple sclerosis to live a quality life.