How do I sleep better and soundly at night with COPD?

A fellow caregiver asked...

How do I sleep better and soundly at night with COPD?

Expert Answer

Loutfi S. Aboussouan is a staff physician for the Cleveland Clinic's Respiratory Institute and Neurological Institute. He is board certified in internal medicine, pulmonary disease, critical care medicine, and sleep medicine and directs the pulmonary curriculum for the second-year class of the Cleveland Clinic Lerner School of Medicine.

There are many reasons why patients with COPD have disrupted sleep and poor sleep quality, including: 1) worsening of breathing during sleep, 2) the effect of medications, caffeine or alcohol, 3) associated conditions such as anxiety, depression or insomnia, 4) other sleep disorders such as sleep apnea,

Normal sleep is associated with a decreased in the depth of breathing in certain sleep stages. This can be well handled without sleep disruption in a person with normal lung function, but can clearly become an issue in someone with COPD. A particularly vulnerable period of sleep in COPD is REM sleep, the stage of sleep usually associated with dreaming, and during which oxygen drops to its lowest level.

This is where it becomes important to have good medical interventions. For example, medications in the anticholinergic class such as ipratropium (which is atrovent), and tiotropium (which is spiriva), can help improve oxygen levels during sleep as well as improve sleep quality. Other commonly used medications in COPD, including combinations of inhaled steroids and long-acting bronchodilators (such as advair, symbicort, dulera) also improve sleep quality. These and other long acting agents may be helpful, particularly if they prevent waking up at night to take an inhaler dose.

Oxygen levels can be measured at night by an easy overnight test which can be done in your home, or with a sleep study. The decision to have a home study or a lab study depends on your symptoms. If sleep apnea is present with COPD, this is a condition called the "overlap syndrome". This can be treated with a device called CPAP, though depending on the severity of your sleep apnea or of your COPD, an alternative device called bilevel positive airway pressure (also called biPAP) can be used. Combined with medications, CPAP or biPAP could also improve your sleep quality.

As far as insomnia is concerned, although there is some concern that sleeping pills and other sleep aids may further impair the breathing of patients with COPD, several of the commonly used insomnia medications can be safely used. There are also other techniques that can improve insomnia without the use of medications.

Lastly, it is important to review other things that may be interfering with sleep quality such as alcohol, caffeine, or the use of medications that may disrupt sleep. Alcohol in particular is tricky since it may help you fall asleep faster, but once your body removes it from your system, it becomes a stimulant which wakes you up in the early morning hours.

I would make sure to discuss these issues with your physician. He may be able to help determine whether disruption of night breathing by COPD can be treated by a change of your medications, whether a sleep study should be obtained, whether additional oxygen should be prescribed, whether depression or anxiety play a role, whether insomnia medications can be prescribe, or whether other medications disrupt your sleep. Depending on your condition, a referral to a sleep specialist may be needed.

I hope these suggestions help you get your zzz's. Good and refreshing sleep is an important component in the management of COPD.