title: Cognitive behavioral therapy for insomnia comorbid with COPD is feasible with preliminary evidence of positive sleep and fatigue effects.
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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Center for Narcolepsy, Sleep and Health Research, Department of Biobehavioral Science, College of Nursing, University of Illinois at Chicago, Chicago, IL 60612-7350, USA. mkapel1@uic.edu
authors.forename: Mary C
authors.initials: MC
authors.lastname: Kapella
authors.forename: James J
authors.initials: JJ
authors.lastname: Herdegen
authors.forename: Michael L
authors.initials: ML
authors.lastname: Perlis
authors.forename: Joan L
authors.initials: JL
authors.lastname: Shaver
authors.forename: Janet L
authors.initials: JL
authors.lastname: Larson
authors.forename: Julie A
authors.initials: JA
authors.lastname: Law
authors.forename: David W
authors.initials: DW
authors.lastname: Carley
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000704:Analysis of Variance; D001521:Behavior Therapy; D005221:Fatigue / Q000209:etiology; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019964:Mood Disorders / Q000209:etiology; D017286:Polysomnography; D011446:Prospective Studies; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications* / Q000503:physiopathology; D012129:Respiratory Function Tests; D012720:Severity of Illness Index; D007319:Sleep Initiation and Maintenance Disorders / Q000209:etiology* / Q000523:psychology* / Q000628:therapy*; D016896:Treatment Outcome