Cognitive Behavioral Therapy for Insomnia in People With Chronic Obstructive Pulmonary Disease(COPD)

Inclusion Criteria:

• Subjects will have moderate to severe COPD. Severity of COPD will be defined according to the new GOLD standards (moderate IIA (moderate), 50% < FEV1 < 80% predicted; moderate IIB (severe) 30% < FEV1 < 50%). 58
• Insomnia. Insomnia will be defined as difficulty initiating or maintaining sleep, waking up too early or poor quality sleep. 59
• Subjects must be > 45 years of age with no other major health problems
• Subjects must be clinically stable at the time of enrollment into the study without major exacerbation of COPD within the previous two months.

Exclusion Criteria:

• Evidence of restrictive lung disease or asthma.
• Evidence of a major sleep disorder other than insomnia (sleep apnea evidenced by apnea/hypopnea index of > 10, periodic limb movement disorder, narcolepsy).
• Hypnotic, sedative, anxiolytic or antidepressant use.
• Pulse oximetry (SaO2) reading of < 90% at rest.
• Pulse oximetry (SaO2) reading of < 85% at night for > 5 minutes.
• Significant sleep apnea (apnea/hypopnea index ≥ 10).
• .Acute respiratory infection within the previous 2 months.
• Class > 2 functional status according to the New York Heart Association.
• The presence of a potentially debilitating disease such as cancer, congestive heart failure, kidney disease, liver failure or cirrhosis; evidence of alcohol or drug abuse, musculoskeletal or degenerative nerve disease.
• A self-reported current diagnosis of major depression or psychiatric disease or a Hospital Anxiety and Depression Scale (HADS) depression score of > 11.
• Currently participating in pulmonary rehabilitation.