The management of insomnia in people with Chronic Obstructive Pulmonary Disease (COPD) – assessment of pharmacological and non-pharmacological interventions.

<p>Background: Chronic Obstructive Pulmonary Disease (COPD) is a common, preventable and treatable disease that is characterised by persistent respiratory symptoms and airway limitation. More than half of people with COPD also live with insomnia which includes finding it difficult to fall asleep or stay asleep or acknowledge having poor-quality sleep.Aim(s): The overarching aim of this thesis was to provide the necessary foundation for the development of an intervention to manage insomnia in COPD. The thesis reports a systematic review that aimed to evaluate the effectiveness of pharmacological and non-pharmacological interventions for COPD patients with insomnia. The thesis also reports an interview study that aimed to explore the lived experiences, opinions and views of COPD patients living with Insomnia.Results: The search strategy for the systematic review identified 6116 records. After removal of duplicates, 3616 records were screened, of which 3090 records were excluded based on title and abstract. Full-texts were obtained for the remaining 64 records. Five studies met the eligibility criteria. The trials assessed a range of interventions including progressive muscle relaxation, melatonin, cognitive behavioural therapy, temazepam and zolpidem or triazolam. The limited number of trials and range of interventions meant that meta-analyses of available data for primary outcomes (e.g. Pittsburgh Sleep Quality Index, sleep latency, total sleep time, sleep duration, sleep efficiency, sleep quality, daytime dysfunction, awakening, and sleep disturbance) and secondary outcomes (e.g disease specific measures of health-related quality of life) was not possible. The interview study generated five main themes and sixteen sub-themes that reflected participants’ lived experience of living with COPD and insomnia. The five key themes comprised of lifestyle impact, emotional and mental health, relaxation and distraction to alleviate sleep, reluctance to seek help and medication, and respiratory symptoms.Conclusion: The symptoms for sleep disturbance in COPD is associated with overall decreased sleep efficiency, longer latency to sleep onset, frequent arousals, and recurrent awakening. The findings of this thesis provide preliminary evidence of the safety of pharmacological interventions available, to manage insomnia, in COPD but further data are required to confirm this which would offer re-assurance for concerns of such treatments that were reported by patients in this thesis. Non-pharmacological interventions are usually preferred over pharmacological treatment in insomnia. Further trials are required of these complex psychological interventions to determine their potential to target key treatment areas of insomnia identified in this thesis including emotional and mental health as well as relaxation and distraction to alleviate sleep. Several unresolved questions prevail in insomnia and COPD including clinical efficacy, mechanisms and patients’ experience of interventions.</p>