Cognitive behavioral therapy for insomnia comorbid with COPD is feasible with preliminary evidence of positive sleep and fatigue effects

• Published in: International journal of chronic obstructive pulmonary disease Vol. 6; no. default; pp. 625 - 635
• Main Authors: Kapella, Mary C, Herdegen, James J, Perlis, Michael L, Shaver, Joan L, Larson, Janet L, Law, Julie A, Carley, David W
• Format: Journal Article
• Language: English
• Published: New Zealand Dove Medical Press 01-01-2011
• Subjects: Activities of Daily Living; Aged; Analysis of Variance; Behavior Therapy; Fatigue - etiology; Feasibility Studies; Female; Humans; Male; Middle Aged; Mood Disorders - etiology; Original Research; Polysomnography; Prospective Studies; Pulmonary Disease, Chronic Obstructive - complications; Pulmonary Disease, Chronic Obstructive - physiopathology; Respiratory Function Tests; Severity of Illness Index; Sleep Initiation and Maintenance Disorders - etiology; Sleep Initiation and Maintenance Disorders - psychology; Sleep Initiation and Maintenance Disorders - therapy; Treatment Outcome; chronic bronchitis; sleep disturbance; CBT-I; emphysema
• ISSN: 1178-2005; 1176-9106; 1178-2005
• DOI: 10.2147/COPD.S24858

Many people with COPD report difficulties falling asleep or staying asleep, insufficient sleep duration, or nonrestorative sleep. Cognitive behavioral therapy for insomnia (CBT-I) has proved effective not only in people with primary insomnia but also in people with insomnia comorbid with psychiatric and medical illness (eg, depression, cancer, and chronic pain). However, CBT-I has rarely been tested in those with COPD who have disease-related features that interfere with sleep and may lessen the effectiveness of such therapies. The purpose of this study was to determine the feasibility of applying a CBT-I intervention for people with COPD and to assess the impact of CBT-I on insomnia severity and sleep-related outcomes, fatigue, mood, and daytime functioning.
The study had two phases. In Phase 1, a 6-weekly session CBT-I intervention protocol in participants with COPD was assessed to examine feasibility and acceptability. Phase 2 was a small trial utilizing a prospective two-group pre- and post-test design with random assignment to the six-session CBT-I or a six-session wellness education (WE) program to determine the effects of each intervention, with both interventions being provided by a nurse behavioral sleep medicine specialist.
Fourteen participants (five in Phase 1 and nine in Phase 2) completed six sessions of CBT-I and nine participants completed six sessions of WE. Participants indicated that both interventions were acceptable. Significant positive treatment-related effects of the CBT-I intervention were noted for insomnia severity (P = 0.000), global sleep quality (P = 0.002), wake after sleep onset (P = 0.03), sleep efficiency (P = 0.02), fatigue (P = 0.005), and beliefs and attitudes about sleep (P = 0.000). Significant positive effects were noted for depressed mood after WE (P = 0.005).
Results suggest that using CBT-I in COPD is feasible and the outcomes compare favorably with those obtained in older adults with insomnia in the context of other chronic illnesses.