The Link Between COPD and Sleep Disorders
About 50 percent of people with COPD also suffer from sleep disorders, or conditions that prevent a restful sleep. Here are three of the most common sleep disorders associated with COPD, signs and symptoms to watch out for, and possible treatments.
1. Hypoventilation
This is a medical term describing a decreased rate and depth of breathing. Reduced breathing activity is normal during sleep, but generally causes no problems. Even if oxygen levels drop slightly, they remain at safe levels. However, people with lung disease may already have chronically decreased oxygen levels, so relaxed breathing activity may result in oxygen levels becoming dangerously low.
Complicating this is the COPD disease process itself. Some have chronically elevated carbon dioxide levels. Some use accessory muslces to breathe, and these muscles are paralyzed while sleeping. Both of these processes may cause hypoventilation and unsafe oxygen levels while sleeping.
Signs and Symptoms. This may result in disturbances in sleep quality at night, resulting in feelings of sleepiness and fatigue during the day. It also increases the risk of bronchospasm or COPD flare ups at night. It also increases the risk of dying at night.
Treatment. The simplest treatment is to wear oxygen while sleeping. Usually this is accomplished with a low flow of oxygen through a nasal cannula. Some studies have proven that nighttime oxygen may increase life expectancy in patients with COPD.
2. Obstructive Sleep Apnea
Complicating this is the COPD disease process itself. Some have chronically elevated carbon dioxide levels. Some use accessory muslces to breathe, and these muscles are paralyzed while sleeping. Both of these processes may cause hypoventilation and unsafe oxygen levels while sleeping.
Signs and Symptoms. This may result in disturbances in sleep quality at night, resulting in feelings of sleepiness and fatigue during the day. It also increases the risk of bronchospasm or COPD flare ups at night. It also increases the risk of dying at night.
Treatment. The simplest treatment is to wear oxygen while sleeping. Usually this is accomplished with a low flow of oxygen through a nasal cannula. Some studies have proven that nighttime oxygen may increase life expectancy in patients with COPD.
2. Obstructive Sleep Apnea
About 4 percent of men and 2 percent of women have this, and the risk is the same among the COPD population as the general population. This is a medical condition that causes a person to stop breathing for a few seconds to a minute while sleeping. It's caused when tissues in the upper airway become too relaxed, thus blocking the airway. These episodes are ended by the person waking up slightly to an audible grunt or snore. A typical person may have 30 or more such episodes each night.
During episodes oxygen levels drop, although will usually rise back to normal levels. Since COPD may result in chronically lowered oxygen levels, these may drop to critical levels while sleeping. Lower oxygen levels then cause blood vessels to constrict, and the heart rate to work harder to pump blood through the lungs in search of more oxygen that is not there. Over time, this may cause heart failure or even death.
Signs and Symptoms. While most patients are unaware of these episodes, a bed partner may recognize them, along with the grunts and snores. Daytime symptoms may include trouble staying awake, trouble concentrating, morning headaches and depression.
Treatment. Some patients may benefit from wearing an oral appliance to keep the airway open at night. Others may benefit from CPAP at night. This involves wearing a mask that supplies pressures during exhalation to keep the airway open. If these treatments don’t work, surgery is another option.
3. Insomnia
Anxiety due to the disease process itself may result in trouble sleeping. Bronchodilators, including theophylline and albuterol, may act as stimulants and cause trouble sleeping, especially when taken in higher doses. Corticosteroids may also make it difficult to sleep.
Signs and Symptoms. Lack of quality sleep may result in the feeling of not being well rested. It may also result in daytime headaches, irritability, anxiety and depression. It may also result in poor concentration, and an increased risk of making errors at work.
Treatment. The simplest treatment for this may be a medicine to help induce sleep at night. However, a physician will want to be careful here, as some sleep medicines may relax breathing and further complicate the problem. The medicine should ideally be short acting and low dose.
The bottom line
Seek Help. It's bad enough having a lung disease, let alone a sleeping disorder to go along with it. If you recognize any of these symptoms, it's time to seek help. If a loved one is concerned about pauses and snoring while you are sleeping, it's time to seek help. Getting proper treatment should help you live better with COPD. It may also help you live longer.
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