Management of Insomnia in Chronic Lung Diseases
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SLEEPING AND BREATHING (A ABREU, SECTION EDITOR)
Management of Insomnia in Chronic Lung Diseases Kori Ascher 1 & Alexandre R. Abreu 1 & Alejandro D. Chediak 1 Published online: 13 July 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
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. Keywords Insomnia . Treatment . Sleep apnea . Lung disease . Pulmonary
Introduction Nearly one-third of the general population is affected by insomnia [1], of which approximately 10% have chronic insomnia. Similarly, the American Lung Association reports that 10% of Americans have chronic lung disease [2]. Untreated insomnia causes measurable physiologic stress on cortisol levels, metabolic activity, neuroimmunological function, and blood pressure [3], [4]. Long-term health outcomes of untreated insomnia have been studied and associated with increased risk for hypertension, coronary heart disease, heart failure, impaired cognitive function, and self-reported decreased quality of life [5]. The mechanism is thought to be associated with dysregulation of the hypothalamic-pituitary axis, increased sympathetic tone, and inflammation [5]. Treatment of insomnia typically involves behavioral modification and prescription hypnotic agents. Some hypnotics have significant adverse effect on respiratory and nonThis article is part of the Topical Collection on Sleeping and Breathing * Kori Ascher [email protected] 1
Division of Pulmonary, Allergy, Critical Care & Sleep Medicine, Department of Medicine, University of Miami Leonard M. Miller School of Medicine, Miami, FL, USA
respiratory systems. Effective pharmacological treatment for insomnia, therefore, must be handled with great care for insomniacs with coexisting chronic lung disease (CLD). Additionally, many hypnotics approved by the US Food and Drug Administration (FDA) for the treatment of insomnia can lead to tolerance and habituation requiring additional consideration. This review serves to summarize current science, expert opinion, and trends in the treatment of insomni
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