COPD and Sleep: A Delicate Balance
Living with COPD is difficult, but can be harder when your blood oxygen levels drop during sleep. Learn why this happens and what to do.

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Picture of young doctor COPD and Sleep: A Delicate Balance

If you have chronic obstructive pulmonary disease (COPD), you may know all about chronic coughing, fatigue, and wheezing. These problems are hard enough to deal with during the day, but they may get worse at night.

COPD most often refers to the lung disorders emphysema and chronic bronchitis. In COPD, the lungs are damaged and airways are partially blocked, making it hard to breathe. At night, even normal changes in sleep breathing patterns can dangerously lower blood oxygen levels.

Some medications may cause insomnia or daytime sleepiness. Even the act of waking up to take certain prescriptions can disturb sleep.

What happens at night?
Sleep studies in people with COPD often show their sleep quality is poor. The signs include:

  • Changing stages of sleep more frequently. Bouncing between light sleep (stage 2) and deeper stages (3, 4 and "rapid eye movement")
  • Frequent waking
  • Decreased total sleep time

When asleep, the body normally revitalizes itself by delivering oxygen through the bloodstream and removing carbon dioxide. A major cause of COPD death is the breakdown of this process.

During sleep, especially deep sleep, more air stays in the lungs of people with COPD. This may happen because of decreased muscle tone and increased upper airway resistance. In effect, the body reacts more slowly to the presence of more carbon dioxide. This can make the person wake up more. Morning confusion or daytime sleepiness may follow.

Overlap syndrome
Between 10 percent and 15 percent of people with COPD also have obstructive sleep apnea. Having both conditions is known as overlap syndrome. With apnea, people stop breathing for short periods during sleep, often because of excess weight, or extra tissue and/or poor muscle tone in the throat. This leads to lower blood oxygen levels.

People with overlap syndrome may improve their nighttime oxygen levels and lung function with a therapy called continuous positive airway pressure (CPAP). CPAP is given through a special mask worn over the mouth and/or nose at night. The CPAP machine pumps a steady flow of air through a tube. The air pressure acts as a splint to keep the airway open. This way, breathing is not interrupted and sleep is not disturbed.

Better sleep with COPD
Getting enough sleep is essential to maintain your health if you have COPD. For those struggling with COPD and sleep issues, treatments may include:

  • Using oxygen for longer periods of time. Getting continuous oxygen instead of just the standard 12 to 15 hours per day may lead to better sleep in some people with severe COPD. It can also result in lower mortality. Extended oxygen therapy may often be combined with CPAP therapy to treat overlap syndrome. Check with your doctor before you change any part of your treatment plan, including oxygen therapy.
  • Inhaled anticholinergic therapy. Excess mucus can cause nighttime coughing. An inhaler with an anticholinergic medication may keep the mucus under control. It may also result in better blood oxygen and better sleep quality.
  • Respiratory muscle training. Sleep normally involves decreased muscle activity. So, weakened diaphragms in people with COPD can pose added problems. Physical training of the diaphragm may improve muscle strength, breathing, and blood oxygen levels. Your doctor can tell you if this therapy would be helpful for you. It may be a part of a pulmonary rehabilitation program.
  • Avoid certain medicines. Some prescription and over-the-counter sleep aids can decrease muscle tone in the upper airway and increase airway resistance. This can worsen apnea symptoms and lower oxygen levels. Check with your doctor before you take any sleep medication.

If you have COPD and sleep problems, talk with your doctor. He or she can work with you to help diagnosis and treat the problem.

By Louis Neipris, MD, Staff Writer
Created on 07/22/2008
Updated on 06/03/2011
  • American Lung Association. Sleep apnea. Symptoms, diagnosis and treatment.
  • Krachman S, Minai OA, Scharf SM. Sleep abnormalities and treatment in emphysema. Proceedings of the American Thoracic Society. 2008; 5:536-542.
  • National Sleep Foundation. COPD and difficulty breathing.
  • National Heart, Lung, and Blood Institute. What is COPD?
  • Owens RL, Malhotra A. Sleep-disordered breathing and COPD: the overlap syndrome. Respiratory Care. 2010;55(10):1333-1346.
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