Skip to main content
SpringerLink
Log in

Management of Insomnia in Chronic Lung Diseases

  • Sleeping and Breathing (A Abreu, Section Editor)
  • Published:
Current Pulmonology Reports Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: •• Of major importance

  1. 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.

    Article  CAS  PubMed  Google Scholar 

  2. Association AL. American Lung Association Website. https://www.lung.org/. 2019.

  3. Riemann D. Hyperarousal and insomnia: state of the science. Sleep Med Rev. 2010;14(1):17.

    Article  PubMed  Google Scholar 

  4. Bonnet MH, Arand DL. Hyperarousal and insomnia: state of the science. Sleep Med Rev. 2010;14(1):9–15.

    Article  PubMed  Google Scholar 

  5. Grima NA, Bei B, Mansfield D. Insomnia theory and assessment. Aust J Gen Pract. 2019;48(4):193–7.

    Article  PubMed  Google Scholar 

  6. 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.

    Article  PubMed  PubMed Central  Google Scholar 

  7. 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.

    Article  PubMed  Google Scholar 

  8. 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.

    Article  PubMed  Google Scholar 

  9. •• 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.

    Article  PubMed  Google Scholar 

  10. Genta PR, Eckert DJ, Gregorio MG, et al. Critical closing pressure during midazolam-induced sleep. J Appl Physiol (1985). 2011;111(5):1315–22.

    Article  CAS  Google Scholar 

  11. 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.

    Article  PubMed  Google Scholar 

  12. 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.

    Article  PubMed  Google Scholar 

  13. 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.

    Article  PubMed  Google Scholar 

  14. 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.

    Article  CAS  PubMed  Google Scholar 

  15. 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.

    Article  CAS  PubMed  Google Scholar 

  16. 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.

    Article  PubMed  Google Scholar 

  17. 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.

    CAS  PubMed  Google Scholar 

  18. 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.

    CAS  PubMed  Google Scholar 

  19. Douglas NJ, White DP, Pickett CK, Weil JV, Zwillich CW. Respiration during sleep in normal man. Thorax. 1982;37(11):840–4.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. Smith DRL-C Jr, T. Respiratory physiology during sleep. Sleep Med Clin. 2008;3:497–502.

    Article  Google Scholar 

  21. 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.

    CAS  PubMed  Google Scholar 

  22. Shigemitsu H, Afshar K. Nocturnal asthma. Curr Opin Pulm Med. 2007;13(1):49–55.

    Article  PubMed  Google Scholar 

  23. McNicholas WT. Impact of sleep in COPD. Chest. 2000;117(2 Suppl):48S–53S.

    Article  CAS  PubMed  Google Scholar 

  24. 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.

    Article  PubMed  Google Scholar 

  25. Bhullar S, Phillips B. Sleep in COPD patients. COPD. 2005;2(3):355–61.

    Article  PubMed  Google Scholar 

  26. 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.

    Article  PubMed  Google Scholar 

  27. •• 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.

    Google Scholar 

  28. 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.

    Article  PubMed  Google Scholar 

  29. 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.

    Article  PubMed  Google Scholar 

  30. 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.

    Article  PubMed  Google Scholar 

  31. 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.

    Article  CAS  PubMed  Google Scholar 

  32. 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.

    CAS  PubMed  Google Scholar 

  33. Guilleminault C. Benzodiazepines, breathing, and sleep. Am J Med. 1990;88(3A):25S–8S.

    Article  CAS  PubMed  Google Scholar 

  34. 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.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Carberry JC, Fisher LP, Grunstein RR, Gandevia SC, Mckenzie DK, Butler JE, Eckert DJ. Role of common hypnotics on the phenotypic causes of obstructive sleep apnoea: paradoxical effects of zolpidem. Eur Respir J. 2017;50:1701344. https://doi.org/10.1183/13993003.01344-2017].

  36. 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.

    Article  CAS  PubMed  Google Scholar 

  37. 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.

    Article  PubMed  Google Scholar 

  38. •• 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.

    Article  PubMed  Google Scholar 

  39. 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.

    Article  PubMed  PubMed Central  Google Scholar 

  40. 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.

    Article  PubMed  PubMed Central  Google Scholar 

  41. •• 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.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Pulmonary, Allergy, Critical Care & Sleep Medicine, Department of Medicine, University of Miami Leonard M. Miller School of Medicine, Miami, FL, USA

    Kori Ascher, Alexandre R. Abreu & Alejandro D. Chediak

Authors
  1. Kori Ascher
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Alexandre R. Abreu
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Alejandro D. Chediak
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Kori Ascher.

Ethics declarations

Conflict of Interest

Kori Ascher, Alexandre R Abreu and Alejandro D. Chediak declare no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

This article is part of the Topical Collection on Sleeping and Breathing

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ascher, K., Abreu, A.R. & Chediak, A.D. Management of Insomnia in Chronic Lung Diseases. Curr Pulmonol Rep 9, 102–109 (2020). https://doi.org/10.1007/s13665-020-00253-z

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s13665-020-00253-z

Keywords

Search

Navigation