# Enhancing pulmonary rehabilitation in veterans with chronic obstructive pulmonary disease through internet-based cognitive-behavioral treatment for insomnia

> **NIH VA I01** · VETERANS HEALTH ADMINISTRATION · 2022 · —

## Abstract

Chronic obstructive pulmonary disease (COPD) is a progressive lung disease that is highly prevalent among
veterans. Pulmonary rehabilitation which incorporates exercise training and self-management education is
recommended as standard management for COPD and aims to increase daily activity and quality of life through
improvement in symptoms and exercise tolerance and prompting health behavior change. Although insomnia is
common is veterans with COPD, the self-management education component of pulmonary rehabilitation does
not address sleep, thus potentially explaining the lack of improvement in sleep following pulmonary
rehabilitation. Insomnia can substantially impact the intended treatment goals of pulmonary rehabilitation as it
has been found to be associated with limitations in activities of daily living (ADL), lower levels of physical activity,
poor quality of life, greater COPD symptoms, and reduced exercise performance. Given that sleep is not
addressed as part of pulmonary rehabilitation, untreated insomnia may partly account for the declines in quality
of life and exercise capacity and absence of increased daily activity often reported following pulmonary
rehabilitation. Implementing an insomnia-specific treatment in COPD patients undergoing pulmonary
rehabilitation is likely to lead to improvements in sleep that could facilitate maintenance of gains in quality of
life and exercise capacity and enhance daily activity levels following pulmonary rehabilitation. Cognitive-
behavioral therapy for insomnia (CBT-I) not only improves sleep-specific symptoms of insomnia but also
improves quality of life, reduces ADL limitations, and improves condition-specific symptoms. We postulate that
CBT-I as an adjunct to home-based pulmonary rehabilitation for COPD patients with insomnia will lead to
improvement in sleep quality that will facilitate achievement of optimal and enduring functional outcomes
following pulmonary rehabilitation. To test this hypothesis, we will conduct a randomized controlled trial of
veterans with COPD and insomnia enrolled in home-based pulmonary rehabilitation assessed pre-pulmonary
rehabilitation, post-pulmonary rehabilitation and at 6-month follow-up to test the impact of Internet-based CBT-
I during home-based pulmonary rehabilitation on sleep and health-related functioning relative to home-based
pulmonary rehabilitation only. We also examine whether sleep mediates the effects of treatment on health-
related functioning.

## Key facts

- **NIH application ID:** 10378588
- **Project number:** 5I01RX003513-02
- **Recipient organization:** VETERANS HEALTH ADMINISTRATION
- **Principal Investigator:** Faith S Luyster
- **Activity code:** I01 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2022
- **Award amount:** —
- **Award type:** 5
- **Project period:** 2021-04-01 → 2025-03-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10378588

## Citation

> US National Institutes of Health, RePORTER application 10378588, Enhancing pulmonary rehabilitation in veterans with chronic obstructive pulmonary disease through internet-based cognitive-behavioral treatment for insomnia (5I01RX003513-02). Retrieved via AI Analytics 2026-05-26 from https://api.ai-analytics.org/grant/nih/10378588. Licensed CC0.

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