Psychological and Pharmacological Strategies to Address Sleep Disturbances in Chronic Illness: A Review

Abstract

Sleep disturbances are a significant and frequently neglected co-morbidity in chronic diseases that has a substantial effect on the course of the disease and patient well-being. This review describes a synthesis of evidence about the neurobiological and inflammatory processes of sleep disruption in such conditions as diabetes, cancer, cardiovascular disease, and neurodegenerative diseases. Central to this pathology is the disruption of a neurohormone system known as the hypothalamic/pituitary/adrenal (HPA), also called the "stress axis" - disruptions of the autonomic nervous system and neurotransmitters defined as gamma-aminobutyric acid (GABA), serotonin, acetylcholine. Chronic inflammation, mediated by inflammation mediators such as IL-6, TNF-α, and CRP, results in direct changes to neural circuits that control sleep-wake cycles, which then becomes a vicious cycle that worsens systemic disease. The review evaluates the available psychological treatments, especially the cognitive-behavioral treatment for insomnia (CBT-I), as well as pharmacological treatments, and their efficiency and defects. It highlights important areas for further research including lack of large-scale trials in specific disease groups, under-representation of elderly and multimorbid patients, and lack of data on longevity. Future directions focus on the concepts of precision medicine, digital therapeutics using AI, and interdisciplinary care models, as well as concentrating on the long-term quality of life outcomes to make sleep management the mainstay rather than an adjunct in chronic disease treatment.