How to Sleep Better with COPD

How to Sleep Better with COPD

By Nancy Christie, Special to Lifescript

Published December 24, 2010

If you suffer from COPD breathing problems, getting enough sleep is difficult – and related health conditions can make things worse. These doctors’ tips will help you to snag the slumber time…

Chronic obstructive pulmonary disease (COPD) and sleep make poor bedfellows. You take longer to drift into slumber, sleep fewer hours and wake frequently throughout the night.

After all, it’s hard to sleep when you’re coughing and wheezing, have chest pain or tightness, or struggle to breathe. And other conditions that often accompany COPD – such as acid reflux, hormonal fluctuations and sleep apnea – can turn attempts to snooze into a bad dream.

“Patients with COPD often complain of difficulty initiating and maintaining sleep,” says Pittsburgh lung specialist Brian Carlin, M.D., chair of the COPD Alliance, an educational organization for doctors.

That’s because COPD is a condition in which breathing becomes more and more difficult, usually a result of bronchitis (a long-term wet cough) or emphysema (a breakdown of the lungs over time). Its main causes are smoking or exposure to pollution and other lung irritants.

Taken together, COPD and sleep loss can lead to daytime fatigue, depression and memory issues, as well as more serious consequences, such as heart arrhythmia, weight gain, insulin resistance, pulmonary hypertension (high blood pressure within the lungs), and possibly even a heart attack due to extreme stress on the heart.

Although you may not be able to eliminate the COPD symptoms that affect your slumber, there are ways to minimize their impact.

Lifestyle changes are a good start. First, anyone with COPD should stop smoking, and reduce or eliminate exposure to secondhand smoke.Next, a healthy diet with plenty of fruit, vegetables and whole grains may also help you get more sleep, because people with COPD often have low levels of antioxidants and certain minerals (including vitamins A, C and E, potassium, magnesium, selenium and zinc). This can contribute to poor lung function, according to the University of Maryland Medical Center.

Here are some common sleep-obstructions for those with COPD, with tips and techniques to help you get the rest you need.

Lung problems
COPD connection:
Whether your COPD is due to emphysema or chronic bronchitis, the symptoms are the same: chronic cough (with or without mucus), feeling short of breath and wheezing – all can keep you up at night or wake you.

How to get relief: Use inhaled anticholinergic medications, which inhibit nerve impulses and reduce nighttime coughing and wheezing, recommends David Edelson, M.D., founder and medical director of HealthBridge, a health care facility in Manhasset, N.Y.

For flare-ups or worsening symptoms, inhaled steroids can help reduce airway inflammation.

Other parts of your treatment program may include pulmonary rehabilitation, which focuses on exercise, nutrition and breath training. In serious cases, you may also be given extra oxygen.

Acid reflux
COPD connection:
Heartburn-promoting acid reflux (also known as gastroesophageal reflux disease, or GERD) can cause a chronic cough, thus worsening the bronchitis component of COPD.

How to get relief: Acid-reducing medications – either prescription or over-the-counter – will help control your symptoms.

Also, “avoid alcohol, caffeine, chocolate, tobacco, as well as peppermint or spearmint candies or gum” – all of which can trigger reflux, Edelson suggests.

“Don’t eat heavy meals late at night, and keep meals smaller and more frequent,” he adds.

Medication issues
COPD connection:
COPD medications such as anticholinergics and beta agonists (which work on receptors for adrenaline and other chemicals) are “bronchodilators,” meaning they relax muscles around the airways to make breathing easier.

Beta agonists in particular can also interfere with sleep, Edelson says. They stimulate the central nervous system, which may increase heart rate, raise blood pressure and trigger the “fight or flight” reaction, putting the brain in a state of high alert.

How to get relief: If you suspect your medications are the reason you toss and turn, talk to your doctor about changing them or adjusting the dosage.

Sleep position
COPD connection:
Lying down may make breathing more difficult, because your diaphragm has to work harder to inflate the damaged lung.

“Sleep position can certainly have an effect on breathing,” says Loutfi Aboussouan, M.D., a specialist in lung disease and sleep medicine at the Cleveland Clinic in Ohio.

“Lying on your back reduces your lung capacity compared to sitting or standing,” he says. “For patients with a compromised lung capacity or with sleep-related breathing disorders, this may cause a drop in blood oxygen level.”

How to get relief: Try elevating the head of the bed on six-inch blocks, using a foam pillow wedge, or even sleeping in a reclining chair, Edelson suggests.

Sleep apnea
COPD connection:
Apnea is characterized by stopped breathing, occasional or frequent, as you sleep. If you have it in addition to COPD (a combination known as “overlap syndrome”), you’re at greater risk of hospitalization and even death than people who have just one condition, according to a 2010 study published in the American Journal of Respiratory and Critical Care Medicine.

“Combined with already low blood oxygen levels seen in advanced COPD patients, apnea [stopped breathing] or hypopnea [diminished breathing] can starve the heart muscle of oxygen,” Edelson says. “This can result in serious heart arrhythmia, congestive heart failure or a myocardial infarction [heart attack].”

How to get relief: Diagnosing overlap syndrome is the first step, Aboussouan says. He recommends that patients undergo a sleep evaluation – including nocturnal oximetry (which measures oxygen levels in your blood) and, if sleep apnea is suspected, a polysomnogram, which records brain activity, eye movements, heart rate and blood pressure.

Once overlap syndrome is diagnosed, your treatment would include CPAP (continuous positive airway pressure) – a means of delivering oxygen through a face mask.

COPD connection:
Pregnant women with COPD can experience worsening symptoms, Aboussouan says.

The increase in estrogen can have inflammatory effects, such as swelling of the mucous membranes, making breathing more difficult. Also, pregnant women are likely to have narrowed upper airways, contributing to a greater risk of snoring and sleep apnea.

The hormone progesterone can also be a culprit, according to Aboussouan. While in some conditions it can actually improve sleep apnea, it may also trigger “central apneas” (a temporary interruption of the drive to breathe when carbon dioxide is too low).

Add to this a growing fetus and expanding uterus, which put even more pressure on the chest cavity, and it’s not surprising that pregnant women with COPD have a hard time sleeping.

How to get relief: Pregnancy is no time to skip your medications.

“It’s more dangerous for the fetus if the mother doesn’t use the inhalers, because the lack of oxygen and difficulty breathing puts the fetus at risk,” says Georgianna Donadio, Ph.D., an integrative health expert in Wellesley, Mass.

She suggests finding “elongated” positions (such as sitting up straight, without slouching) so the baby doesn’t press up against the ribs as it grows, which makes breathing more difficult.

It may also help if you control how much weight you gain. In fact, try to stabilize your body weight before you become pregnant, Donadio advises.

“Women with extra weight generally have a harder time with COPD because of the increased demand of body mass on the lungs and heart,” she says.

Depression and anxiety
COPD connection:
About 40%of patients with COPD experience depression or anxious feelings, according to a 2008 article in the journal Chest. And that can cause sleep problems.

How to get relief: Your doctor may suggest medication. Common antidepressants such as SSRIs [selective serotonin reuptake inhibitors] and SNRIs [serotonin–norepinephrine reuptake inhibitors] are good choices, Edelson says.

Unfortunately, many antidepressants promote weight gain, which can worsen COPD, notes psychiatrist Matthew Edlund, M.D., author of The Power Of Rest: Why Sleep Alone Is Not Enough (HarperOne). Work with your doctor to find a medication and dosage to avoid or control this side effect.Edlund recommends cognitive behavior therapy (CBT) or psychotherapy, as well as joining a COPD support group.

“They can prove very valuable in making your overall life better, through social support and learning from others,” he says.

He also suggests regular exercise – even in short bouts – because it has the dual effect of boosting your mood and improving your ability to use oxygen.

Are You Smart About Sleep?
Getting a good night’s sleep affects every aspect of your day, including your mood and your ability to be productive. And if that doesn’t get your attention, listen up: Your sleep habits can even affect the number on the scale. Find out if you’re smart about sleep, or if you need to be schooled by the Sandman.

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