Vnitr Lek 2026, 72(5):300-305 | DOI: 10.36290/vnl.2026.056

Insomnia in patients with chronic obstructive pulmonary disease: pathophysiology, diagnosis and treatment

Milan Sova, Jaroslav Vejrych, Vladimír Herout, Ondřej Venclíček
Klinika nemocí plicních a TBC, Fakultní nemocnice Brno

Insomnia is an independent sleep-wake disorder that is common in patients with chronic obstructive pulmonary disease (COPD) and may substantially impair daytime functioning, quality of life, and coping with the underlying respiratory disease. Its origin is usually multifactorial. Contributing factors include nocturnal dyspnoea, cough and sputum, sleep-related changes in ventilation, hypoxaemia or hypercapnia, COPD-obstructive sleep apnoea overlap, pain, gastro-oesophageal reflux, nocturia, heart failure, anxiety and depression, medication effects, and perpetuating behavioural patterns. Diagnosis is primarily clinical and should distinguish subjective sleep quality from sleep efficiency, which is a calculated parameter. Assessment should include a structured sleep history, sleep diary, an insomnia severity measure, and targeted screening for other sleep disorders. Cognitive behavioural therapy for insomnia (CBT-I), together with optimisation of COPD and comorbid conditions, is the first-line treatment. Sleep hygiene alone and pulmonary rehabilitation have limited or inconsistent effects on insomnia. Pharmacotherapy should be individualised, time-limited, and regularly reassessed. Benzodiazepines and Z-drugs require particular caution in hypercapnia, untreated sleep apnoea, concomitant opioid use, and frail older adults. Orexin receptor antagonists have reassuring short-term respiratory data in selected COPD populations, but evidence in severe disease remains limited.

Keywords: insomnia, chronic obstructive pulmonary disease, cognitive behavioural therapy for insomnia, hypnotics, sleep efficiency, obstructive sleep apnoea.

Accepted: August 20, 2026; Published: August 27, 2026  Show citation

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Sova M, Vejrych J, Herout V, Venclíček O. Insomnia in patients with chronic obstructive pulmonary disease: pathophysiology, diagnosis and treatment. Vnitr Lek. 2026;72(5):300-305. doi: 10.36290/vnl.2026.056.
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