Research

Mary Kapella , PhD, RN, Funded Projects

Feasibility of Cognitive Behavioral Therapy for People with COPD and Insomnia

Funding Source: Center for Reducing Risks in Vulnerable Populations (CRRVP)

Co-Investigator: David Carley

Dates: 05/01/07– 04/30/08

Abstract: People with chronic obstructive pulmonary disease (COPD) often go into a downward spiral of decreased activity and deconditioning. Two commonly reported symptoms that interfere with daily activities in people with COPD are dyspnea and subjective fatigue and previous research suggests that poor sleep quality may lead to subjective in people with this disease. In our sample of 130 people with moderate to severe COPD the most frequently reported sleep disturbances on the Pittsburgh Sleep Quality Index were not getting to sleep within 30 minutes and waking up in the middle of the night or early morning. Although there is a substantial body of research in obstructive respiratory disease focusing on sleep apnea and nocturnal hypoxia little research is focused on older people with chronic illnesses and insomnia. The purpose of this study is to examine the feasibility of a classroom-based cognitive behavioral therapy (CBT) intervention for insomnia in people with COPD and preliminary effects of the intervention on sleep quality, fatigue, functional performance, and mood. Specific aims of the study are to: 1. Refine a multistep screening process to identify people with moderate to severe COPD who have insomnia without other significant sleep disorders. 2. Refine a cognitive behavioral intervention for insomnia for people with moderate to severe COPD. 3. Conduct a preliminary examination of the effect of CBT for insomnia on two primary outcomes: a) sleep quality and b) fatigue and two secondary outcomes: a) functional performance and b) mood (anxious and depressed). This pilot study will use a one-group prospective, repeated measures design to evaluate the feasibility of a cognitive behavioral therapy for people with COPD. The initial classroom-based intervention will continue for six weeks, one 1.5 hour session per week. Primary dependent variables (outcomes) include sleep quality and fatigue. Secondary outcomes include functional performance and mood. These variables will be measured at two time periods: (b) baseline (time 1); (b) At the end of the intervention period (time 2). Data from time 1 will provide baseline information. Data from time 2 will provide information regarding the acceptability of the intervention to the participants, appropriate intervention length and components and changes in the outcome variables after the therapy. The sample will consist of at least five people with moderate to severe COPD and insomnia. This study will provide preliminary data for a larger, two-group, randomized controlled intervention study. The long-term goal for the research is to yield information regarding effective interventions to improve sleep quality and minimize fatigue in people with COPD. Effective interventions could lead to improved ability to perform important and valued daily activities and improved quality of life. It is anticipated that successful demonstration of the feasibility of this intervention will lead to further development and testing of an effective, easy to administer, low cost and portable insomnia program that can be available to health care providers and used for the prevention and treatment of chronic insomnia in people with COPD.

Nurse Managed Cognitive Behavioral Therapy for Insomnia in People with COPD

Funding Source: National Institute of Nursing Research

Co-Investigator: David Carley

Dates: 06/15/08– 05/31/11

Abstract: The aim of this Mentored Research Scientist Development Award (K01) is to provide the applicant with the skills and knowledge necessary to develop and test cognitive behavioral therapy interventions to promote symptom management and optimal function in people with chronic obstructive pulmonary disease (COPD). Specific career objectives are to: (1) study sleep-related physiology, insomnia and sleep-related behavioral theories; (2) gain an understanding of basic sleep-related monitoring procedures, diagnostic tests and biobehavioral outcomes, including polysomnography, actigraphy and sleep logs; and (3) develop expertise in cognitive behavioral therapy for insomnia and conduct a preliminary study of cognitive behavioral therapy in people with COPD. A two-phase research study is proposed. In Phase 1 of the study, the cognitive behavioral therapy intervention for insomnia will be implemented in a small (n = 5) group of people with moderate to severe COPD and insomnia. The intervention will be pilot-tested to determine feasibility and acceptability, and the intervention will be refined as needed. In Phase 2 of the study, a two-group randomized controlled study (n = 20) will be conducted to test the effects of the cognitive behavioral therapy for insomnia intervention on the primary outcomes of sleep quality and fatigue and the secondary outcomes of mood and functional performance. It is hypothesized that people with COPD receiving cognitive behavioral therapy for insomnia will demonstrate significant improvements in sleep quality, fatigue, mood and functional performance as compared to people with COPD who receive a wellness program. This research will yield valuable information regarding effective interventions aimed at mitigating problems such as poor sleep quality, fatigue and reduced ability to perform valued daily activities. This information will be used to increase the likelihood of long-term successful outcomes such as the ability to maintain productive roles in society for people with COPD.