Perspectives on the management of insomnia in patients with chronic respiratory disorders

Complaints of poor sleep are very common in people with chronic respiratory disorders. In patients with chronic obstructive pulmonary disease (COPD), poor sleep may be due to many causes, including cough, excess mucous produc tion, and frequent arousals from sleep caused by hypercapnia, as well as se condary to medications used to manage the lung disease. Patients with obstr uctive sleep apnea (OSA) also complain of excessive daytime sleepiness and fatigue due to poor-quality sleep, although the mechanism of sleep disrupti on is somewhat different from that in patients with COPD. Although benzodia zepines are often the drugs of choice for the management of insomnia, cauti on is suggested with the use of these agents in patients with chronic obstr uctive respiratory disease due to the reduction in upper airway muscle tone and blunting of the arousal response to hypercapnia. However, controlled t rials with short-acting benzodiazepine receptor antagonists, including tria zolam, zolpidem, and zaleplon, suggest that these agents may be safely used in selected patients who have mild to moderate COPD without daytime hyperc apnia. Less data are available on the use of these agents for patients with OSA, but a preliminary trial using zaleplon suggests that respiratory func tion is not adversely affected in patients with mild to moderate OSA. Studi es are needed to further define the benefit-risk ratio of the use of benzod iazepine receptor agonists for the management of insomnia in patients with chronic obstructive lung disease.