Therapy for Insomnia with Chronic Obstructive Pulmonary Disease: a Randomized Trial of Components

STUDY OBJECTIVES To determine efficacy and mechanisms of cognitive behavioral therapy for insomnia (CBT-I) and COPD education (COPD-ED) on clinical outcomes in adults with concurrent COPD and insomnia. METHODS We conducted a 2 × 2 factorial study to test the impact of CBT-I and COPD-ED delivered alone or in combination on severity of insomnia and fatigue, sleep and dyspnea. Participants were randomized to one of 4 groups. Group1: CBT-I+Attention Control (AC, health videos, N=27). Group 2: COPD-ED+AC, N=28. Group 3: CBT-I+COPD-ED, N=27 and Group 4, AC only, N=27. Participants received 6, 75-minute weekly sessions. Dependent variables included insomnia severity, sleep by actigraphy, fatigue and dyspnea measured at baseline, immediately post-intervention, and at 3-months post-intervention. Presumed mediators of intervention effects included beliefs and attitudes about sleep, self-efficacy for sleep and COPD, and emotional function. RESULTS COPD patients (FEV1% predicted 67±24% (mean ± SD), age 65±8 years, with insomnia participated in the study. Insomnia and sleep improved more in patients who received CBT-I than in those who did not, an effect that was sustained at 3 months post-intervention and mediated by beliefs and attitudes about sleep. CBT-I was associated with clinically important improvements in fatigue and dyspnea. When CBT-I and COPD-ED were concurrently administered, effects on insomnia, fatigue and dyspnea were attenuated. CONCLUSIONS CBT-I produced significant and sustained decreases in insomnia, sleep and clinically important improvement in fatigue and dyspnea. Combination of CBT-I and COPD-ED reduce CBT-I's effectiveness. Further research is needed to understand the mechanisms associated with effects of insomnia therapy on multiple symptoms in COPD. CLINICAL TRIAL REGISTRATION Registry: ClinicalTrials.gov; Title: A Behavioral Therapy for Insomnia Co-existing with COPD; Identifier: NCT01973647.