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Sleeping with COPD: What You Need to Know

SCOFA-Sleeping-with-COPD-What-You-Need-to-Know-1

 
Medically reviewed by
Dacelin St Martin, MD
Triple board-certified in Sleep Medicine,
Internal Medicine, and Pediatrics.

 
 

What is COPD? | How Does COPD Affect Sleep? | Sleep Disorders and COPD | Differentiating Between the Two Disorders | How to Improve Your Sleep with COPD | Bridging the Gap Between Disorders

 

Overview

Getting a decent night’s sleep is hard enough, but when attempting to hit the hay while living with a respiratory condition, such as chronic obstructive pulmonary disease, or COPD, the concept of good sleep seems more out of reach. 

With COPD affecting over 16 million people in the United States, and being amongst the country’s top three causes of death, focusing on its far-reaching consequences on sleep becomes more of a necessity.[1]

 

What is COPD?

As per its name, COPD is a chronic or longstanding lung disorder characterized by inflammation in the airways that limits airflow and causes the individual to suffer from repeated episodes of shortness of breath.[2] 

COPD is primarily caused by smoking, including inhaling second-hand smoke and other environmental pollutants that may irritate the respiratory tract.[3] 

Though treatable, COPD is difficult to reverse and, when unmanaged, can exacerbate various respiratory infections and prolonged respiratory symptoms that interfere with sleep.[4]

 

How Does COPD Affect Sleep?

Some of the most prominent characteristics of COPD are the breathing difficulties attributed to the disease, which can be more pronounced during the night or when lying down.[5] 

These breathing difficulties can lead to hypoxemia (reduced oxygen levels in the blood) which may impact rapid eye movement (REM) sleep by causing the individual to be more prone to awakening throughout the night.[6]

Though COPD is manageable, certain medicines used to treat COPD, such as theophylline, can result in significant disturbances in sleep, thus bringing one back to square one.[7] Likewise, those with relatively severe COPD who experience frequent COPD exacerbations may be prescribed repeated courses of steroids to help manage the respiratory inflammation.[8] 

However, one significant side effect of steroids is their tendency to cause mood swings, hallucinations, delirium, and nightmares, making sleep more difficult.[9]

When people with COPD have symptoms so severe that they start to impact sleep, they become sleep deprived. Combined with the preexisting burden which COPD has on an individual, the added lack of sleep can lead to mood swings, inability to focus, and the increased risk of developing both psychological and physiological conditions.[10]

 

Sleep Disorders and COPD

Due to the potential for sharing symptoms, differentiating between sleep disorders and COPD can be difficult, meaning that those with COPD may be unaware of a preexisting sleep disorder they may be affected by, which is making their symptoms worse.[11]

In saying that, studies suggest that sleep disorders, such as sleep apnea and COPD co-exist rather commonly, causing a complex cluster of symptoms termed under the umbrella of “overlap syndrome.”[11]

 

SCOFA-Sleeping-with-COPD-What-You-Need-to-Know-2
 

 

Differentiating Between the Two Disorders

The undeniable similarity between sleep-disordered breathing and COPD warrants the need for multidisciplinary input from pulmonary specialists, primary care physicians, and sleep specialists to distinguish the conditions.[11] 

Guidelines suggest that those potentially having overlap syndrome should undergo various tests, such as polysomnography and spirometry so that the degree of COPD can be evaluated and the cause of sleep-disordered breathing can be determined.[11]


 

How to Improve Your Sleep with COPD

As people with COPD experience disrupted sleep with the added consequence of poor gaseous exchange, managing sleep while having COPD should consider all aspects of the disease.[12]

1) Oxygen Therapy

One of the most serious consequences of COPD and other sleep disorders is the inability to regulate oxygen levels.[12] Oxygen therapy, often provided as continuous positive airway pressure therapy (CPAP), can help correct hypoxemia, improve symptoms, and enhance sleep quality.[13] You should contact a sleep specialist for guidance to determine your eligibility for CPAP therapy. 

 

2) Sleep Hygiene

As people with COPD often face additional barriers to getting a good night’s rest, stricter adherence to sleep hygiene is required to increase the likelihood of sufficient sleep. Practicing sleep-friendly measures such as avoiding caffeine 6 hours before bedtime, limiting usage of blue-light emitting devices before bed, and regularly exercising can help you maximize your sleep quality and improve your overall quality of life.

Additionally, and arguably most importantly, those with COPD are encouraged to quit smoking. Inhaling smoke inflames your airways, making it more difficult to breathe. Contact your doctor or local pharmacist to see which smoking cessation programs suit your schedule best.[14]

 

3) Medicines

Many prescription-only treatments are available for both COPD and sleep-disordered breathing that can help your sleep quality get as close to ‘normal’ as possible. These medicines are rather complex and are often only initiated by primary care physicians and specialists.

 

Bridging the Gap Between Disorders

The relationship between COPD and sleep is complex, proving to be anything but symbiotic. The unique challenges in sleep faced by those suffering from COPD should be approached with care so that disease management can be optimized and sleep quality can be improved. 

If you have COPD and are simultaneously experiencing a continuum of sleepless nights, then reach out for help. Let’s not let the nuances of overlap syndrome hold back the high-quality sleep you so deserve.

 

References: 

  1. COPD National Action Plan | NHLBI, NIH. (n.d.). NHLBI, NIH. https://www.nhlbi.nih.gov/health-topics/education-and-awareness/COPD-national-action-plan
  2. Agarwal, A. K. (2022, August 8). Chronic Obstructive Pulmonary Disease. StatPearls – NCBI Bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK559281/
  3. Barnes, P. J., Burney, P., Silverman, E. K., Celli, B. R., Vestbo, J., Wedzicha, J. A., & Wouters, E. F. (2015). Chronic obstructive pulmonary disease. Nature Reviews Disease Primers, 1(1). https://doi.org/10.1038/nrdp.2015.76
  4. Hanania, N. A., Celli, B. R., Donohue, J. F., & Martin, U. J. (2011). Bronchodilator reversibility in COPD. Chest, 140(4), 1055–1063. https://doi.org/10.1378/chest.10-2974
  5. Braghiroli, A., Braido, F., Piraino, A., Rogliani, P., Santus, P., & Scichilone, N. (2020). Day and Night Control of COPD and Role of Pharmacotherapy: A Review</p> International Journal of Chronic Obstructive Pulmonary Disease, Volume 15, 1269–1285. https://doi.org/10.2147/copd.s240033
  6. Marrone, O., Salvaggio, A., & Insalaco, G. (2006). Respiratory disorders during sleep in chronic obstructive pulmonary disease. International Journal of Chronic Obstructive Pulmonary Disease, 1(4), 363–372. https://doi.org/10.2147/copd.2006.1.4.363
  7. Kaplan, J., Fredrickson, P. A., Renaux, S. A., & O’Brien, P.C. (1993). Theophylline Effect on Sleep in Normal Subjects. Chest, 103(1), 193–195. https://doi.org/10.1378/chest.103.1.193
  8. Woods, J. A., Wheeler, J. O., Finch, C. K., & Pinner, N. A. (2014). Corticosteroids in the treatment of acute exacerbations of chronic obstructive pulmonary disease. International Journal of Chronic Obstructive Pulmonary Disease, 421. https://doi.org/10.2147/copd.s51012
  9. Cole J. L. (2020). Steroid-Induced Sleep Disturbance and Delirium: A Focused Review for Critically Ill Patients. Federal practitioner : for the health care professionals of the VA, DoD, and PHS, 37(6), 260–267.
  10. What Are Sleep Deprivation and Deficiency? | NHLBI, NIH. (2022, March 24). NHLBI, NIH. https://www.nhlbi.nih.gov/health/sleep-deprivation
  11. Owens, R. L., & Malhotra, A. (2010). Sleep-disordered breathing and COPD: the overlap syndrome. Respiratory care, 55(10), 1333–1346.
  12. McNicholas, W. T., Verbraecken, J., & Marin, J. J. (2013). Sleep disorders in COPD: the forgotten dimension. European Respiratory Review, 22(129), 365–375. https://doi.org/10.1183/09059180.00003213
  13. Sterling, K. L., Pépin, J., Linde-Zwirble, W. T., Chen, J., Benjafield, A., Cistulli, P. A., Cole, K. V., Emami, H., Woodford, C., Armitstead, J., Nunez, C., Wedzicha, J. A., & Malhotra, A. (2022). Impact of Positive Airway Pressure Therapy Adherence on Outcomes inPatients with Obstructive Sleep Apnea and Chronic Obstructive Pulmonary Disease. American Journal of Respiratory and Critical Care Medicine, 206(2), 197–205. https://doi.org/10.1164/rccm.202109-2035oc
  14. Andreas, S., Hering, T., Mühlig, S., Nowak, D., Raupach, T., & Worth, H. (2009). Smoking Cessation in Chronic Obstructive Pulmonary Disease. Deutsches Arzteblatt International. https://doi.org/10.3238/arztebl.2009.0276
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