A Behavioral Therapy for Insomnia Co-existing With COPD

University of Illinois

Status: Completed

Conditions: Chronic Obstructive Pulmonary Disease; Insomnia; COPD; Fatigue

Treatments: Behavioral: Cognitive Behavioral Therapy for Insomnia; Behavioral: COPD Education; Behavioral: Attention Control

Study type: Interventional

Funder types: Other

Identifiers

NCT01973647

2013-0626

Details and patient eligibility

About

Difficulty falling asleep, staying asleep or poor quality sleep (insomnia) is common in people with chronic obstructive pulmonary disease. Insomnia is related to greater mortality, with four times the risk of mortality for sleep times < 300 minutes. Insomnia is also related to greater morbidity, with 75% greater health care costs than people without insomnia. However, insomnia medications are used with caution in COPD due to potential adverse effects. Common features of COPD such as dyspnea, chronic inflammation, anxiety and depression also affect insomnia and can interfere with therapy outcomes. While cognitive behavioral therapy for insomnia (CBT-I), a therapy that provides guidance on changing unhelpful sleep-related beliefs and behavior, is effective for people with primary insomnia and people with other chronic illnesses, the efficacy and mechanisms of action of such a therapy are yet unclear in people with both insomnia and COPD. The objective in this application is to rigorously test efficacy of two components of insomnia therapy - CBT-I and COPD education (COPD-ED) - in people with coexisting insomnia and COPD, and to identify mechanisms responsible for therapy outcomes. The central hypothesis is that both CBT-I and COPD-ED will have positive, lasting effects on objectively and subjectively measured insomnia and fatigue. The rationale for the proposed study is that once the efficacy and mechanisms of CBT-I and COPD-ED are known, new and innovative approaches for insomnia coexisting with COPD can be developed, thereby leading to longer, higher quality and more productive lives for people with COPD, and reduced societal cost due to the effects of insomnia. The investigators plan to test our central hypothesis by completing a randomized controlled comparison of CBT-I, COPD-ED and non-COPD, non-sleep health education attention control (AC) using a highly efficient 4-group design. Arm 1 comprises 6 weekly sessions of CBT-I+AC; Arm 2=6 sessions of COPD-ED+AC; Arm 3=CBT-I+COPD-ED; and Arm 4=AC. This design will allow completion of the following Specific Aims: 1. Determine the efficacy of individual treatment components, CBT-I and COPD-ED, on insomnia and fatigue. 2. Define mechanistic contributors to the outcomes after CBT-I and COPD-ED. The research proposed in this application is innovative because it represents a new and substantive departure from the usual insomnia therapy, namely by testing traditional CBT-I with education to enhance outcomes.

Full description

The investigators plan to test our central hypothesis by completing a randomized controlled comparison of CBT-I, COPD-ED and non-COPD, non-sleep health education attention control (AC) using a highly efficient 4-group design. Arm 1 comprises 6 weekly sessions of CBT-I+AC; Arm 2=6 sessions of COPD-ED+AC; Arm 3=CBT-I+COPD-ED; and Arm 4=AC. This design will allow completion of the following Specific Aims: 1. Determine the efficacy of individual treatment components, CBT-I and COPD-ED, on insomnia and fatigue. 2. Define mechanistic contributors to the outcomes after CBT-I and COPD-ED.

Enrollment: 109 patients

Sex: All

Ages: 45+ years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• mild to very severe COPD.
• age ≥ 45 years of age with no other major healthproblems.
• clinically stable at the time of enrollment into the study.
• insomnia.

Exclusion criteria

• evidence of restrictive lung disease or asthma.
• pulse oximetry reading of < 90% at rest or < 85% at night for > 5 min.
• evidence of a major sleep disorder other than insomnia.
• hypnotic use.
• acute respiratory infection within the previous 2 months.
• 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.

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Single Blind

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109 participants in 4 patient groups, including a placebo group

Cognitive Behavioral Therapy (CBT-I)

Experimental group

Description:

Six weekly sessions of Cognitive Behavioral Therapy for Insomnia

Treatment:

Behavioral: Cognitive Behavioral Therapy for Insomnia

CBT-I + COPD-ED

Experimental group

Description:

Six weekly sessions of Cognitive Behavioral Therapy for Insomnia plus COPD Education

Treatment:

Behavioral: Cognitive Behavioral Therapy for Insomnia

Behavioral: COPD Education

COPD Education (COPD-ED)

Experimental group

Description:

Six weekly sessions of COPD education

Treatment:

Behavioral: COPD Education

Attention Control (AC)

Placebo Comparator group

Description:

Six weekly sessions of non-sleep, non-COPD health education

Treatment:

Behavioral: Attention Control