For about 40 percent of patients with chronic obstructive pulmonary disease, getting a good night’s sleep can be a challenge. That’s according to a 2002 survey in the European Respiratory Journal that asked more than 3,200 COPD patients in eight countries about their condition. COPD is an umbrella term encompassing both emphysema and chronic bronchitis, two progressive and incurable lung diseases that make it difficult to breathe.
And it’s this difficulty in getting enough oxygen into the body that is the likely culprit for sleep disturbances among COPD patients who report not sleeping well. Dr. Loutfi Aboussouan, a pulmonologist at Cleveland Clinic, says there are potentially four different reasons why some patients have trouble sleeping.
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What Disrupts Sleep?
“One is that patients with COPD may be very vulnerable to drops in oxygen levels at night, especially while they are dreaming. This is in part because they might be using more accessory muscles during the day to help their breathing, and those accessory muscles tend to be paralyzed in sleep,” Aboussouan says.
These accessory muscles assist in breathing but are not the primary breathing muscles in the body, and they tend to be more engaged when we’re breathing hard than when we’re at rest. They become paralyzed during REM sleep — that’s the dreaming phase that cycles through about every 60 to 90 minutes — as part of a natural process to prevent us from physically acting out our dreams. In most people, this isn’t a problem, but in some COPD patients, this disabling of the accessory muscles makes getting enough oxygen into the body more difficult. It can result in a drop in oxygen that can disrupt sleep.
Secondly, caffeine, alcohol and cigarette smoking could be disrupting sleep or compounding a pre-existing sleep issue. Patients “may be getting bad sleep and then they’re very tired during the daytime, so they end up taking too much caffeine” to stay awake, Aboussouan says. “Or they may try taking alcohol at night because that helps them fall asleep. But once it wears off, the alcohol can act as a stimulant and wake them up.” Smoking can also act as a stimulant, “which is part of why it’s so addictive, so that may be three things to look at,” he says. In addition, some medications could also have sleep disruptions as a side effect.
Third, anxiety and depression are common among COPD patients, and these conditions can impact sleep patterns negatively. “It’s very common that people with depression end up waking up at night, usually very early in the morning. So I think it’s very important to look at these things in anybody who has COPD,” Aboussouan says.
Lastly, some COPD patients have a condition called overlap syndrome, meaning they have a combination of COPD and sleep apnea. The National Heart, Lung and Blood Institute reports that sleep apnea “is a common disorder in which you have one or more pauses in breathing or shallow breaths while you sleep.” These pauses can last a few seconds or a few minutes and can occur 30 times or more each hour. “Typically, normal breathing then starts again, sometimes with a loud snort or choking sound.” But it disrupts sleep and is the leading cause of excessive daytime sleepiness, the NHLBI reports. People with sleep apnea may have no knowledge that they have the condition or that they’re being woken up multiple times per night.
“At least 10 percent of people with COPD also have sleep apnea,” Aboussouan says. “And that’s a bad combination, because it duplicates the effect of each disease and it heightens it. The drops in oxygen are much more severe when you have this combination than if you have each alone.” Patients who are overweight are more likely to have sleep apnea overlap syndrome.
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How to Sleep Better
Although there are several potential causes for disrupted sleep among COPD patients, there are also quite a few ways of addressing the issue. Aboussouan says some inhalers prescribed to manage COPD can help control your oxygen levels, and “they might increase the total sleep time and quality or reduce the number of sleep symptoms.” Some inhalers can help patients breathe easier for 12 or 24 hours, which may help “prevent waking up because of sudden shortness of breath.”
Aboussouan also suggests that undergoing a sleep study may help pinpoint the exact issue and better direct treatment of the problem. If sleep issues are because of the accessory muscle issue or sleep apnea, “then treating that with a CPAP device might be a great opportunity to improve sleep quality. I think if there’s one thing that might improve things really dramatically, it’s treating sleep apnea with CPAP,” Aboussouan says. The American Sleep Association reports that CPAP stands for continuous positive airway pressure, and the device “uses air pressure generated by a machine, delivered through a tube into a mask that fits over the nose or mouth.”
In some cases, another device, called a BiPAP machine, might offer the right solution. “BiPAP refers to bi-level or two-level positive airway pressure. Like CPAP, air is sent through a tube into a mask that fits over the nose,” the ASA reports. A BiPAP machine assists the wearer with both inhale- and exhale-pressure, so it may be useful for some patients with “more severe COPD who have a high carbon dioxide level,” Aboussouan says. The problem for these patients is that they “can’t get rid of the carbon dioxide, so it builds up in the bloodstream,” he says. This buildup can act like a narcotic, causing patients to wake up with headaches and feel very sleepy during the day. “In that case, we might consider something that blows the carbon dioxide out during sleep,” which is what the BiPap device does.
Both the CPAP and BiPAP devices are worn at night and could improve sleep quality, but in both cases, patients would need to undergo a formal sleep study first to determine whether either is the right intervention.
For patients who are suffering from insomnia or sleep disturbances related to anxiety or depression, seeking treatment for these mental health issues can help promote better sleep. Your doctor may prescribe medications — either a sleeping pill or an anti-depressant or anti-anxiety drug — or counseling depending on your particular needs.
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Increasing your levels of physical activity and eating right can also help with depression, anxiety and ultimately sleep issues. Aboussouan says completing a formal pulmonary rehabilitation program — a combination of exercise and counseling that most patients are prescribed upon diagnosis — is a great start, but that “the benefits of rehab last only as long as the exercise is ongoing.” Therefore, he recommends finding and sticking with an ongoing maintenance program.
Lastly, Aboussouan says avoiding smoking and limiting your intake of caffeine and alcohol are simple yet very effective ways of improving sleep quality.
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How Can I Sleep Better With COPD? originally appeared on usnews.com
