COPD and Difficulty Breathing
This content was created by the National Sleep Foundation
Chronic obstructive pulmonary disease (COPD) is a term used for lung disorders such as emphysema, chronic bronchitis, and in some cases chronic asthma. People with COPD may have difficulty breathing, chronic cough, fatigue, and chest tightening. COPD can also result in reduced blood oxygen levels, causing fatigue and leading to adverse health conditions. Sleep problems and sleepiness are common in COPD patients, partly due to symptoms but also because of the medications used to treat COPD. In addition, changes in breathing patterns that occur during normal sleep that do not affect healthy people may lead to more severe consequences in people with COPD, which may worsen and complicate COPD since they reduce blood oxygen. Even COPD patients without obstructive sleep apnea (OSA) may experience a drop in oxygen during sleep.
COPD develops slowly and is rare in people under the age of 40. It is progressive, meaning that it does not go away and may worsen over time, depending on when treatment is initiated. According to COPD International, 12 million Americans currently have COPD and an estimated 12 million more are undiagnosed. Smoking is the main cause of COPD but it is also linked with exposure to second hand smoke and/or other environmental pollutants. COPD is the fourth leading cause of death in the United States, according to a report by the Centers for Disease Control and Prevention.
For people with COPD, symptoms such as coughing, chest pain, and frequent nighttime urination may profoundly impact sleep. In addition, medications used to treat COPD may cause insomnia or daytime sleepiness. Simply having to wake up and take prescriptions on schedule may also disturb sleep.
Overlap syndrome is a term used for patients with both COPD and OSA. Overlap syndrome, which research suggests occurs in 10-15% of COPD patients, is associated with a reduction of blood oxygen levels during sleep, which may cause extreme fatigue and other health problems. If you have COPD and suspect that you may also suffer from OSA, talk to your physician about treatment options, including continuous positive airway pressure (CPAP). Research suggests that treatment of overlap syndrome with CPAP improves lung function. Another study suggests that it may improve erectile dysfunction in men with overlap syndrome.
COPD is linked with heart disease. Specifically, COPD is one of the most common causes of “cor pulmonale,” an enlargement in the right ventricle which leads to failure of the right side of the heart, according to a recent study. When COPD is combined with OSA, the prevalence of cor pulmonale can be as high as 80%, according to one analysis, which also found that less than a third of COPD patients with cor pulmonale survive longer than five years.
COPD is a life-threatening disease that requires major medical intervention and may result in early death. Unfortunately, COPD is often diagnosed once it has progressed from mild to severe and there is little opportunity for stopping or reversing its course. If you feel you may suffer from COPD, see a physician about your symptoms as soon as possible. If you have already been diagnosed with COPD, follow your treatment plan as directed and be vigilant about eating healthy and sleeping well.
Morning cough is often the earliest sign of the disease, followed by noisy breathing, chest pain, and breathlessness. People with COPD sometimes develop a barrel-shaped chest due to an enlargement of the lungs. Other symptoms include:
- Difficulty breathing
- Chronic cough that produces sputum
- Wheezing, whistling, or hissing sound with breathing
- Chest pain or tightening
- Skin discolorations
- Erectile dysfunction
- Frequent nighttime urination
- Weight loss
- Daytime sleepiness
There is no cure for COPD, but there are treatments for its symptoms, including drug therapies, and behavioral remedies, and – rarely – surgery. In some cases, it is possible to alleviate symptoms by quitting smoking or avoiding environmental pollutants. Medications and rehabilitation therapies may also minimize or eliminate symptoms. In rare cases, surgery to reduce lung volume or lung transplantation is recommended, but these procedures carry severe risks. Supplemental oxygen is commonly prescribed for COPD patient and has been shown to increase the quality and quantity of patients’ lives.
Getting adequate sleep is essential to maintaining health in COPD patients. If you have symptoms of insomnia such as difficulty falling asleep, staying asleep, or waking up unrefreshed, talk to your doctor about treatment options. Keep in mind that certain store-purchased and prescription sleep aids may impair breathing in COPD patients. One exception is ramelteon, which was studied in mild and moderate COPD patients and found to not harm their breathing.
In addition to spending enough time sleeping, sleep quality is also important. Conditions such as overlap syndrome – having both COPD and OSA – can seriously undermine health. If you have COPD as well as symptoms of OSA, talk to your physician about treatment options, including the use of continuous positive airway pressure (CPAP).
In addition to quitting smoking and the other self-directed therapies mentioned under “treatment,” getting adequate sleep is essential to feeling well and maintaining overall health. This can be challenging for COPD patients. Here are some tips for getting the sleep you need:
- Maintain a regular sleep and wake schedule
- Establish a regular relaxing bedtime routine
- Use your bed only for sleep and sex, not for other stimulating activities
- Create a sleep environment that is cool, dark, and comfortable
- Avoid caffeine in the hours before bedtime
In addition to healthy sleep, try these tips for coping with COPD:
- Conserve energy by limiting activities and getting adequate sleep
- Develop an exercise plan in consultation with your physician
- Keep your home free of smoke and airborne irritants
- Join a respiration rehabilitation group
- Take naps as needed, but not close to bedtime
- Eat healthy high-protein foods
- Seek support from family and friends
NSF’s 2003 Sleep in America poll found that untreated sleep problems may interfere with the ability to cope with chronic medical conditions. In addition, NSF’s 2005 Sleep in America poll found that 26% of American adults are at high risk for OSA.