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

Mary C Kapella, James J Herdegen, Michael L Perlis, Joan L Shaver, Janet L Larson, Julie A Law, David W Carley, Mary C Kapella, James J Herdegen, Michael L Perlis, Joan L Shaver, Janet L Larson, Julie A Law, David W Carley

Abstract

Background: 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.

Methods: 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.

Results: 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).

Conclusion: 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.

Keywords: CBT-I; chronic bronchitis; emphysema; sleep disturbance.

Figures

Figure 1
Figure 1
Flow diagram of the study enrollment. Note: aThree participants were excluded by more than one criterion. Abbreviations: AHI, apnea/hypopnea index; CBT-I, cognitive behavioral therapy for insomnia; PFT, pulmonary function testing; PLM, periodic limb movement; PSG, programmable sound generator; WE, wellness education.
Figure 2
Figure 2
Acceptability of treatments (CBT-I and WE). Abbreviations: CBT-I, cognitive-behavioral therapy for insomnia; WE, wellness education.

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