Management of Insomnia in Chronic Lung Diseases

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. 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.