CCTS Pilot Grant Awardee Makes Advances in COPD-Insomnia Intervention
Mary Kapella, PhD, RN is making advances in Chronic Obstructive Pulmonary Disease (COPD) management and insomnia interventions at the University of Illinois at Chicago. Her research is helping COPD patients better manage their disease and learn techniques to gain longer, more sound sleep.
COPD refers to a group of lung diseases that block airflow and make breathing difficult. This includes conditions like emphysema and chronic bronchitis. A nurse for more than 30 years, Kapella’s interest in COPD began when she worked in an intensive care unit taking care of people with severe COPD. Her interest in insomnia began while studying fatigue during her doctoral dissertation.
“We knew from observation that people with COPD experience fatigue along with breathing difficulties, but we didn’t know what other symptoms were associated with it and how it impacted day-to-day life,” she explained.
Kapella found that in people with moderate to severe COPD, insomnia was common and likely a key factor in their exhaustion. Patients with COPD may use bronchodilators and other medications during “flare-ups,” times when they have increased breathing difficulties. Insomnia is a common side effect of these medications. While Kapella wanted to learn more, she knew little about insomnia or sleep disorders. At the encouragement of then-dean of the College of Nursing, Joan Shaver, Kapella began applying for career development grants –K awards– to receive training in the area of sleep and sleep disorders.
Kapella received her first K award through UIC’s Center for Clinical and Translational Science’s Pilot Grant program in 2007. CCTS funds helped enable Kapella to recruit study participants for her pilot study as well as form a mentorship team.
“The pilot grant offered 75 percent protected time for research. It also allowed me to develop a mentor team, including Dr. David Carley, an expert on sleep neurobiology, and Dr. Michael Perlis, a psychologist known for his work in behavioral therapy for insomnia,” said Kapella.
Shortly after receiving the CCTS pilot award, Kapella accepted an NIH K01 grant. With new knowledge of insomnia, she began her pilot study using cognitive behavioral therapy techniques for insomnia (CBT-I) to a small group of study volunteers with moderate to severe COPD. For several weeks, patients were asked to wear sleep monitors to bed and keep a sleep diary. Kapella would review this information with the patient during the CBT-I session and develop a “sleep prescription” designed to optimize actual sleep time compared to time spent in bed. She then evaluated how the therapy influenced the patients’ insomnia and fatigue levels, as well as other factors like anxiety, depression, and the ability to perform daily activities.
“Many people were so dissatisfied with their sleep in the beginning. They really wanted this intervention to work,” said Kapella.
The quality of sleep experienced by those with insomnia can differ between individuals. While one person may sleep for 7 hours and feel fatigued, another may sleep the same amount of time and feel rested. For this reason, sleep diaries were important in supporting the patients’ sleep monitor data.
As part of the KO1 grant, a randomized study compared participants receiving the CBT-I intervention to a control group receiving COPD wellness education.
“The education piece was designed to help patients understand and cope with the problems and symptoms associated with the disease,” said Kapella. “Our pilot study found significant improvements in both groups. Those receiving CBT-I reported improvement in their insomnia and fatigue, while those receiving COPD education reported less depression.”
Throughout her project, the CCTS continued to support Kapella via her mentoring team and biostatisticians who helped analyze research data.
Results of the pilot study led Kapella to consider incorporating the COPD education component to the insomnia intervention in order to optimize therapeutic outcomes. The current NIH funded study is determining the effectiveness of both CBT-I and wellness education in people with COPD.
“In our current study, we are looking at the mediating effects between the intervention components and the outcomes,” said Kapella. “Is CBT-I helping patients develop skills for managing their sleep? Is COPD education instilling confidence in the ability to manage COPD and thereby lessening depression and fatigue?”
Now an assistant professor in the Department of Biobehavioral Health Science, Kapella hopes that in the future health care providers will incorporate her study findings into their care when treating chronically ill patients experiencing insomnia.
“I would like to see healthcare providers partner with sleep centers to offer insomnia interventions administered by clinicians trained in behavioral sleep medicine. Effectively treating and preventing insomnia is likely to lead to longer, higher quality and more productive lives for people with chronic illnesses.”