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Published in: Current Pulmonology Reports 3/2020

01-09-2020 | Insomnia | Sleeping and Breathing (A Abreu, Section Editor)

Management of Insomnia in Chronic Lung Diseases

Authors: Kori Ascher, Alexandre R. Abreu, Alejandro D. Chediak

Published in: Current Pulmonology Reports | Issue 3/2020

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Abstract

Purpose of Review

Review the treatment of insomnia in those with chronic lung diseases.

Recent Findings

Cognitive behavioral therapy for insomnia and positive airway pressure, the latter for those with sleep disordered breathing, are effective and safe alternatives to hypnotic therapy. Some new hypnotics improve sleep via mechanisms that theoretically render them safe to use in those afflicted with both insomnia and chronic lung disease.

Summary

Treatment for insomnia may include cognitive behavioral therapy, positive airway pressure, and pharmacotherapy. Computerized cognitive behavioral therapy is a safe and effective treatment alternative for insomnia. Insomnia comorbid with obstructive sleep apnea can respond favorably to positive airway pressure therapy. Prescription hypnotics that affect sleep via modulation of melatonin, histamine, and orexin pathways are theoretically well suited for treatment of insomnia in those with chronic lung diseases. We offer the reader an algorithm to manage a patient with insomnia and chronic lung disease.
Literature
1.
go back to reference Dodge R, Cline MG, Quan SF. The natural history of insomnia and its relationship to respiratory symptoms. Arch Intern Med. 1995;155(16):1797–800.PubMedCrossRef Dodge R, Cline MG, Quan SF. The natural history of insomnia and its relationship to respiratory symptoms. Arch Intern Med. 1995;155(16):1797–800.PubMedCrossRef
4.
go back to reference Bonnet MH, Arand DL. Hyperarousal and insomnia: state of the science. Sleep Med Rev. 2010;14(1):9–15.PubMedCrossRef Bonnet MH, Arand DL. Hyperarousal and insomnia: state of the science. Sleep Med Rev. 2010;14(1):9–15.PubMedCrossRef
5.
go back to reference Grima NA, Bei B, Mansfield D. Insomnia theory and assessment. Aust J Gen Pract. 2019;48(4):193–7.PubMedCrossRef Grima NA, Bei B, Mansfield D. Insomnia theory and assessment. Aust J Gen Pract. 2019;48(4):193–7.PubMedCrossRef
6.
go back to reference Budhiraja R, Siddiqi TA, Quan SF. Sleep disorders in chronic obstructive pulmonary disease: etiology, impact, and management. J Clin Sleep Med. 2015;11(3):259–70.PubMedPubMedCentralCrossRef Budhiraja R, Siddiqi TA, Quan SF. Sleep disorders in chronic obstructive pulmonary disease: etiology, impact, and management. J Clin Sleep Med. 2015;11(3):259–70.PubMedPubMedCentralCrossRef
7.
go back to reference Batal O, Khatib OF, Bair N, Aboussouan LS, Minai OA. Sleep quality, depression, and quality of life in patients with pulmonary hypertension. Lung. 2011;189(2):141–9.PubMedCrossRef Batal O, Khatib OF, Bair N, Aboussouan LS, Minai OA. Sleep quality, depression, and quality of life in patients with pulmonary hypertension. Lung. 2011;189(2):141–9.PubMedCrossRef
8.
go back to reference Tomaszek L, Cepuch G, Pawlik L. Evaluation of selected insomnia predictors in adolescents and young adults with cystic fibrosis. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2018;162(3):212–8.PubMedCrossRef Tomaszek L, Cepuch G, Pawlik L. Evaluation of selected insomnia predictors in adolescents and young adults with cystic fibrosis. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2018;162(3):212–8.PubMedCrossRef
9.
go back to reference •• Seda G, Tsai S, Lee-Chiong T. Medication effects on sleep and breathing. Clin Chest Med. 2014;35(3):557–69 This paper reports the normal physiological changes in repiration during sleep and the impact of select medications on repirations during sleep.PubMedCrossRef •• Seda G, Tsai S, Lee-Chiong T. Medication effects on sleep and breathing. Clin Chest Med. 2014;35(3):557–69 This paper reports the normal physiological changes in repiration during sleep and the impact of select medications on repirations during sleep.PubMedCrossRef
10.
go back to reference Genta PR, Eckert DJ, Gregorio MG, et al. Critical closing pressure during midazolam-induced sleep. J Appl Physiol (1985). 2011;111(5):1315–22.CrossRef Genta PR, Eckert DJ, Gregorio MG, et al. Critical closing pressure during midazolam-induced sleep. J Appl Physiol (1985). 2011;111(5):1315–22.CrossRef
11.
go back to reference Coyle MA, Mendelson WB, Derchak PA, James SP, Wilson MG. Ventilatory safety of zaleplon during sleep in patients with obstructive sleep apnea on continuous positive airway pressure. J Clin Sleep Med. 2005;1(1):97.PubMedCrossRef Coyle MA, Mendelson WB, Derchak PA, James SP, Wilson MG. Ventilatory safety of zaleplon during sleep in patients with obstructive sleep apnea on continuous positive airway pressure. J Clin Sleep Med. 2005;1(1):97.PubMedCrossRef
12.
go back to reference Rosenberg R, Roach JM, Scharf M, Amato DA. A pilot study evaluating acute use of eszopiclone in patients with mild to moderate obstructive sleep apnea syndrome. Sleep Med. 2007;8(5):464–70.PubMedCrossRef Rosenberg R, Roach JM, Scharf M, Amato DA. A pilot study evaluating acute use of eszopiclone in patients with mild to moderate obstructive sleep apnea syndrome. Sleep Med. 2007;8(5):464–70.PubMedCrossRef
13.
go back to reference Kryger M, Roth T, Wang-Weigand S, Zhang J. The effects of ramelteon on respiration during sleep in subjects with moderate to severe chronic obstructive pulmonary disease. Sleep Breath. 2009;13(1):79–84.PubMedCrossRef Kryger M, Roth T, Wang-Weigand S, Zhang J. The effects of ramelteon on respiration during sleep in subjects with moderate to severe chronic obstructive pulmonary disease. Sleep Breath. 2009;13(1):79–84.PubMedCrossRef
14.
go back to reference Herring WJ, Snyder E, Budd K, Hutzelmann J, Snavely D, Liu K, et al. Orexin receptor antagonism for treatment of insomnia: a randomized clinical trial of suvorexant. Neurology. 2012;79(23):2265–74.PubMedCrossRef Herring WJ, Snyder E, Budd K, Hutzelmann J, Snavely D, Liu K, et al. Orexin receptor antagonism for treatment of insomnia: a randomized clinical trial of suvorexant. Neurology. 2012;79(23):2265–74.PubMedCrossRef
15.
go back to reference Michelson D, Snyder E, Paradis E, Chengan-Liu M, Snavely DB, Hutzelmann J, et al. Safety and efficacy of suvorexant during 1-year treatment of insomnia with subsequent abrupt treatment discontinuation: a phase 3 randomised, double-blind, placebo-controlled trial. Lancet Neurol. 2014;13(5):461–71.PubMedCrossRef Michelson D, Snyder E, Paradis E, Chengan-Liu M, Snavely DB, Hutzelmann J, et al. Safety and efficacy of suvorexant during 1-year treatment of insomnia with subsequent abrupt treatment discontinuation: a phase 3 randomised, double-blind, placebo-controlled trial. Lancet Neurol. 2014;13(5):461–71.PubMedCrossRef
16.
go back to reference Sun H, Palcza J, Rosenberg R, Kryger M, Siringhaus T, Rowe J, et al. Effects of suvorexant, an orexin receptor antagonist, on breathing during sleep in patients with chronic obstructive pulmonary disease. Respir Med. 2015;109(3):416–26.PubMedCrossRef Sun H, Palcza J, Rosenberg R, Kryger M, Siringhaus T, Rowe J, et al. Effects of suvorexant, an orexin receptor antagonist, on breathing during sleep in patients with chronic obstructive pulmonary disease. Respir Med. 2015;109(3):416–26.PubMedCrossRef
17.
go back to reference Douglas NJ, White DP, Weil JV, et al. Hypoxic ventilatory response decreases during sleep in normal men. Am Rev Respir Dis. 1982;125(3):286–9.PubMed Douglas NJ, White DP, Weil JV, et al. Hypoxic ventilatory response decreases during sleep in normal men. Am Rev Respir Dis. 1982;125(3):286–9.PubMed
18.
go back to reference Douglas NJ, White DP, Weil JV, Pickett CK, Zwillich CW. Hypercapnic ventilatory response in sleeping adults. Am Rev Respir Dis. 1982;126(5):758–62.PubMed Douglas NJ, White DP, Weil JV, Pickett CK, Zwillich CW. Hypercapnic ventilatory response in sleeping adults. Am Rev Respir Dis. 1982;126(5):758–62.PubMed
20.
go back to reference Smith DRL-C Jr, T. Respiratory physiology during sleep. Sleep Med Clin. 2008;3:497–502.CrossRef Smith DRL-C Jr, T. Respiratory physiology during sleep. Sleep Med Clin. 2008;3:497–502.CrossRef
21.
go back to reference Gothe B, Altose MD, Goldman MD, Cherniack NS. Effect of quiet sleep on resting and CO2-stimulated breathing in humans. J Appl Physiol Respir Environ Exerc Physiol. 1981;50(4):724–30.PubMed Gothe B, Altose MD, Goldman MD, Cherniack NS. Effect of quiet sleep on resting and CO2-stimulated breathing in humans. J Appl Physiol Respir Environ Exerc Physiol. 1981;50(4):724–30.PubMed
24.
go back to reference Krachman SL, Criner GJ, Chatila W. Cor pulmonale and sleep-disordered breathing in patients with restrictive lung disease and neuromuscular disorders. Semin Respir Crit Care Med. 2003;24(3):297–306.PubMedCrossRef Krachman SL, Criner GJ, Chatila W. Cor pulmonale and sleep-disordered breathing in patients with restrictive lung disease and neuromuscular disorders. Semin Respir Crit Care Med. 2003;24(3):297–306.PubMedCrossRef
26.
go back to reference van Manen JG, Bindels PJ, IJzermans CJ, van der Zee JS, Bottema BJ, Schade E. Prevalence of comorbidity in patients with a chronic airway obstruction and controls over the age of 40. J Clin Epidemiol. 2001;54(3):287–93.PubMedCrossRef van Manen JG, Bindels PJ, IJzermans CJ, van der Zee JS, Bottema BJ, Schade E. Prevalence of comorbidity in patients with a chronic airway obstruction and controls over the age of 40. J Clin Epidemiol. 2001;54(3):287–93.PubMedCrossRef
27.
go back to reference •• Mason M, Cates CJ, Smith I. Effects of opioid, hypnotic and sedating medications on sleep-disordered breathing in adults with obstructive sleep apnoea. Cochrane Database Syst Rev. 2015;7:CD011090 This review paper summarizes 14 different studies involving patients with OSA comparing placebo to either hypnotics, sedatives, or opioids. •• Mason M, Cates CJ, Smith I. Effects of opioid, hypnotic and sedating medications on sleep-disordered breathing in adults with obstructive sleep apnoea. Cochrane Database Syst Rev. 2015;7:CD011090 This review paper summarizes 14 different studies involving patients with OSA comparing placebo to either hypnotics, sedatives, or opioids.
28.
go back to reference Zinchuk AV, Gentry MJ, Concato J, Yaggi HK. Phenotypes in obstructive sleep apnea: a definition, examples and evolution of approaches. Sleep Med Rev. 2017;35:113–23.PubMedCrossRef Zinchuk AV, Gentry MJ, Concato J, Yaggi HK. Phenotypes in obstructive sleep apnea: a definition, examples and evolution of approaches. Sleep Med Rev. 2017;35:113–23.PubMedCrossRef
29.
go back to reference Stege G, Vos PJ, van den Elshout FJ, Richard Dekhuijzen PN, van de Ven MJ, Heijdra YF. Sleep, hypnotics and chronic obstructive pulmonary disease. Respir Med. 2008;102(6):801–14.PubMedCrossRef Stege G, Vos PJ, van den Elshout FJ, Richard Dekhuijzen PN, van de Ven MJ, Heijdra YF. Sleep, hypnotics and chronic obstructive pulmonary disease. Respir Med. 2008;102(6):801–14.PubMedCrossRef
30.
go back to reference Kryger M, Wang-Weigand S, Zhang J, Roth T. Effect of ramelteon, a selective MT(1)/MT (2)-receptor agonist, on respiration during sleep in mild to moderate COPD. Sleep Breath. 2008;12(3):243–50.PubMedCrossRef Kryger M, Wang-Weigand S, Zhang J, Roth T. Effect of ramelteon, a selective MT(1)/MT (2)-receptor agonist, on respiration during sleep in mild to moderate COPD. Sleep Breath. 2008;12(3):243–50.PubMedCrossRef
31.
go back to reference Cohn MA. Effects of zolpidem, codeine phosphate and placebo on respiration. A double-blind, crossover study in volunteers. Drug Saf. 1993;9(4):312–9.PubMedCrossRef Cohn MA. Effects of zolpidem, codeine phosphate and placebo on respiration. A double-blind, crossover study in volunteers. Drug Saf. 1993;9(4):312–9.PubMedCrossRef
32.
go back to reference Cummiskey J, Guilleminault C, Del Rio G, Silvestri R. The effects of flurazepam on sleep studies in patients with chronic obstructive pulmonary disease. Chest. 1983;84(2):143–7.PubMed Cummiskey J, Guilleminault C, Del Rio G, Silvestri R. The effects of flurazepam on sleep studies in patients with chronic obstructive pulmonary disease. Chest. 1983;84(2):143–7.PubMed
33.
34.
go back to reference Gatti RC, Burke PR, Otuyama LJ, Almeida DR, Tufik S, Poyares D. Effects of zolpidem CR on sleep and nocturnal ventilation in patients with heart failure. Sleep. 2016;39(8):1501–5.PubMedPubMedCentralCrossRef Gatti RC, Burke PR, Otuyama LJ, Almeida DR, Tufik S, Poyares D. Effects of zolpidem CR on sleep and nocturnal ventilation in patients with heart failure. Sleep. 2016;39(8):1501–5.PubMedPubMedCentralCrossRef
36.
go back to reference Light RW, Merrill EJ, Despars J, Gordon GH, Mutalipassi LR. Doxepin treatment of depressed patients with chronic obstructive pulmonary disease. Arch Intern Med. 1986;146(7):1377–80.PubMedCrossRef Light RW, Merrill EJ, Despars J, Gordon GH, Mutalipassi LR. Doxepin treatment of depressed patients with chronic obstructive pulmonary disease. Arch Intern Med. 1986;146(7):1377–80.PubMedCrossRef
37.
go back to reference Trauer JM, Qian MY, Doyle JS, Rajaratnam SM, Cunnington D. Cognitive behavioral therapy for chronic insomnia: a systematic review and meta-analysis. Ann Intern Med. 2015;163(3):191–204.PubMedCrossRef Trauer JM, Qian MY, Doyle JS, Rajaratnam SM, Cunnington D. Cognitive behavioral therapy for chronic insomnia: a systematic review and meta-analysis. Ann Intern Med. 2015;163(3):191–204.PubMedCrossRef
38.
go back to reference •• Zachariae R, Lyby MS, Ritterband LM, O’Toole MS. Efficacy of internet-delivered cognitive-behavioral therapy for insomnia - a systematic review and meta-analysis of randomized controlled trials. Sleep Med Rev. 2016;30:1–10 This meta anaylsis serves as evidence to support the use of computerized CBT-I across several patient populations.PubMedCrossRef •• Zachariae R, Lyby MS, Ritterband LM, O’Toole MS. Efficacy of internet-delivered cognitive-behavioral therapy for insomnia - a systematic review and meta-analysis of randomized controlled trials. Sleep Med Rev. 2016;30:1–10 This meta anaylsis serves as evidence to support the use of computerized CBT-I across several patient populations.PubMedCrossRef
39.
go back to reference Ye L, Pien GW, Ratcliffe SJ, Björnsdottir E, Arnardottir ES, Pack AI, et al. The different clinical faces of obstructive sleep apnoea: a cluster analysis. Eur Respir J. 2014;44(6):1600–7.PubMedPubMedCentralCrossRef Ye L, Pien GW, Ratcliffe SJ, Björnsdottir E, Arnardottir ES, Pack AI, et al. The different clinical faces of obstructive sleep apnoea: a cluster analysis. Eur Respir J. 2014;44(6):1600–7.PubMedPubMedCentralCrossRef
40.
go back to reference Bjornsdottir E, Janson C, Sigurdsson JF, et al. Symptoms of insomnia among patients with obstructive sleep apnea before and after two years of positive airway pressure treatment. Sleep. 2013;36(12):1901–9.PubMedPubMedCentralCrossRef Bjornsdottir E, Janson C, Sigurdsson JF, et al. Symptoms of insomnia among patients with obstructive sleep apnea before and after two years of positive airway pressure treatment. Sleep. 2013;36(12):1901–9.PubMedPubMedCentralCrossRef
41.
go back to reference •• Nguyen XL, Rakotonanahary D, Chaskalovic J, Fleury B. Insomnia related to sleep apnoea: effect of long-term auto-adjusting positive airway pressure treatment. Eur Respir J. 2013;41(3):593–600 This manuscript describes the relationship of sleep apnea to insomnia and the effect of positive pressure therapy on insomnia.PubMedCrossRef •• Nguyen XL, Rakotonanahary D, Chaskalovic J, Fleury B. Insomnia related to sleep apnoea: effect of long-term auto-adjusting positive airway pressure treatment. Eur Respir J. 2013;41(3):593–600 This manuscript describes the relationship of sleep apnea to insomnia and the effect of positive pressure therapy on insomnia.PubMedCrossRef
Metadata
Title
Management of Insomnia in Chronic Lung Diseases
Authors
Kori Ascher
Alexandre R. Abreu
Alejandro D. Chediak
Publication date
01-09-2020
Publisher
Springer US
Published in
Current Pulmonology Reports / Issue 3/2020
Electronic ISSN: 2199-2428
DOI
https://doi.org/10.1007/s13665-020-00253-z

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