How You Can Improve Sleep Quality When Sleeping With COPD

Expert Insights by Dr. Funke Afolabi-Brown, a triple board-certified sleep medicine physician and founder of RestfulSleepMD, where she helps busy professional women and their children prioritize sleep. 

Medically Reviewed by Dr. Brooke Dulka, a medical writer and neuroscientist who received her Ph.D. in biological psychology from the University of Tennessee, and she is currently a postdoctoral researcher at the University of Wisconsin-Milwaukee where she studies the neurobiology of memory.

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Over 75% of people diagnosed with COPD have trouble getting a good night’s sleep. There are many reasons, including co-occurring conditions. Here are some things to consider and tips for improving sleep quality when sleeping with COPD.

What is COPD?

Chronic Obstructive Pulmonary Disease, commonly called by its acronym COPD, is a life threatening condition that is the fourth leading cause of death in the United States. COPD is an umbrella term that covers persistent breathing disorders like chronic bronchitis, emphysema, and long-term asthma and can lead to heart disease.

It generally doesn’t occur until later in life, around the age of 40 with most COPD patients age 50 or older. It affects about 12 million people, and there are another estimated 12 million that suffer undiagnosed.

What Causes COPD?

COPD is a slowly developing disease that results from prolonged exposure to various contaminants. Smoking is the most common cause of COPD, but environmental pollutants, Radon, and second-hand smoke can also be culprits.

Symptoms of COPD

“Common symptoms of COPD include shortness of breath, coughing, and wheezing,” says Dr. Dulka. 

Dr. Funke Afolabi-Brown adds, “When sleeping, patients with COPD may have worsening symptoms of snoring, coughing, and phlegm production.”

The symptoms associated with COPD include:

• Shortness of breath
• Low blood oxygen (hypoxemia)
• Fatigue
• Chest pain and tightness
• Wheezing
• Coughing
• Frequent urination
• Weight loss
• Erectile dysfunction

Many of these symptoms can interfere with sleep, and sleep issues like insomnia are often comorbid for COPD patients.

Symptoms can also vary depending on the time of day. Wheezing and chest tightness are more common in the evening and at night. Chest congestion and coughing are more common in the morning when phlegm has built-up overnight.

Sleeping with COPD

Sleep and COPD are intimately intertwined. Over three quarters of COPD patients have sleep disturbances like trouble falling asleep, trouble staying asleep, or trouble falling back asleep. The COPD Foundation states on their website that it is “highly important for individuals with COPD to get adequate sleep.”

Sleep is crucial to good health, and even more so when battling disease. Patients with COPD, however, are often involved in a vicious cycle with sleep: they need it, but they can’t get it. Their COPD symptoms disrupt their sleep, which compromises their health and worsens their COPD symptoms, which in turn worsens their sleep.

It is very important to address this cycle: improving sleep can improve COPD; improving COPD can improve sleep. You get the idea. Sleep deprivation is additionally associated with the development of cardiovascular disease, which is also linked with COPD.

Historically, the impact on sleep has not been a consideration in treating COPD. More recent research is demonstrating the impact of sleep’s importance on COPD’s prognosis. Meaning, more and better sleep definitely improves the long-term outcomes for patients. Most health issues are not isolated but are very much a part of a larger, more complex process that involves sleep, diet, exercise, and various lifestyle factors.

How Specifically Does COPD Interfere With Sleep?

There are various aspects to having COPD that directly relate to problems with sleep. You can wake from shortness of breath, coughing, and needing to use the bathroom. The way COPD creates changes in the body can disrupt sleep, lifestyle choices can disrupt sleep, and poor sleep hygiene can play a role. Comorbid conditions, as well as medications, can adversely affect the sleep of a COPD patient.

COPD and Changes in the Body

A diagnosis of COPD generally means you have pronounced breathing difficulties. People with COPD use ancillary muscles to help with their breathing during the day. At night, and particularly during deeper sleep stages like REM, these same ancillary muscles are naturally paralyzed. The body does this so we don’t physically act out our dreams (which mostly occur during REM sleep).

This natural paralysis leaves the COPD patient challenged to get enough oxygen during sleep. Lack of oxygen in the bloodstream is called hypoxemia and can cause a host of symptoms including abnormal heart rate, shortness of breath, confusion, sweating, inability to speak, or even unconsciousness or a coma. Many of these symptoms interfere with getting deep and consistent sleep and can wake up the COPD patient.

Lifestyle Choices that Affect Sleeping with COPD

Smoking

Many COPD patients are unable to quit smoking even after the severity of their diagnosis is understood. Smoking is considered problematic for healthy people in relation to sleep, and for those with COPD, even more so. The National Institutes of Health have examined the relationship between smoking and sleep and concluded, “Sleep disturbance may be more prevalent among smokers due to the stimulant effects of nicotine, nightly withdrawal, and an increased prevalence of sleep disordered breathing relative to nonsmokers.”

Alcohol

Alcohol has an interesting relationship with sleep. It can in fact help you fall asleep, but its effects wear off and can result in premature waking. It is generally not considered a good idea to consume alcohol in the 2 to 3 hours before going to sleep. Since alcohol also lowers immune function, it is not a good idea for anyone managing a chronic disease like COPD to drink.

Stimulants

Because people with COPD experience profound fatigue due to lack of oxygen, they may try to counteract their tiredness with caffeine or other stimulants. This might help during the day but can backfire at night as leftover stimulants in the system tend to disrupt sleep.

Diet

A healthy diet is integral to good health and good sleep. Proper nutrition supports production of sleep hormones like melatonin and helps regulate the body’s systems. There is some evidence that certain foods, like dairy (which can cause extra mucus and phlegm), should be avoided by COPD patients.

As well, there are diets that seem to support sleep like low sugar diets and whole foods diets. Diets that are higher in nutrients from foods like whole grains, leafy greens, fruits, and vegetables support better health. Sour cherry juice in particular is associated with good sleep.

“Regular exercise and a healthy, well-balanced diet full of whole grains and leafy greens can improve COPD conditions and as a result, help you sleep better at night,” says Dr. Dulka.

Exercise

Physical movement is good for the body and good for sleep. Although COPD as a condition is considered irreversible, some studies are finding notable improvement in patients that follow an exercise routine. This is generally mild exercise like walking and specific breathing exercises.

Poor Sleep Hygiene

Many people who are not suffering with COPD have trouble sleeping, and more poor sleep is linked to poor sleep hygiene. Sleep hygiene is all the lifestyle choices you make that affect your quality of sleep: eating late, drinking, caffeine, too much screen time, noisy city environments, and not enough daylight. COPD patients need to be extra vigilant about good sleep hygiene.

See the section on practicing good sleep hygiene under: Treating COPD for Better Sleep.

Comorbid Conditions that Affect Sleeping with COPD

Often patients have some other condition along with their COPD. Common pairings are COPD and sleep apnea, acid reflux, or anxiety and depression. A patient can have one or more comorbid conditions with their COPD, and these conditions can exacerbate sleep problems. Additionally, medications taken for the secondary conditions may be disruptive of sleep.

Overlap Syndrome and Sleep Apnea

COPD and Sleep Apnea are acquainted and can travel together. This combination is referred to as overlap syndrome and affects about 15% of COPD patients. Either one of these disorders can disrupt sleep, but the two together generally require medical intervention.

Acid Reflux and GERD

Another co-occurring disorder with COPD is acid reflux and it’s more advanced version, Gastroesophageal Reflux Disease (GERD). The symptoms of GERD can include an inflamed esophagus, heartburn, and coughing that can cause sleeplessness or add to difficulties with breathing for the COPD patient. More than 50% of those diagnosed with COPD also have GERD.

Anxiety and Depression

Anxiety and depression are often comorbid with COPD. Patients with both disorders can have difficulty turning off their minds and getting to sleep. Anxiety can act like a stimulant and depression is linked to insomnia.

Medications

Prescription medications used to help with COPD symptoms can cause insomnia and inhibit sleep. Benzodiazepines are a class of commonly prescribed medications that can help with anxiety, depression, and insomnia. They can also have respiratory side-effects and decreased alertness: two things that are already a challenge for COPD patients. And yet, these drugs are very commonly prescribed for people with COPD.

Coping with COPD for Better Sleep

Experts recommend looking at what is causing your sleep disruption and making changes where needed. Are you still smoking? Is your medication causing problems? There are two things you can do to get a better handle on the cause.

Keep a Sleep Diary

Record information about your challenges with sleep. When did you last eat? What time did you go to bed? Were you on any screens before bed? When did you wake in the night? What caused it? A detailed account of your sleep will give you, and if need be a professional, lots of information in order to make changes.

You may find that when you stream your favorite show before bed, you don’t sleep as well. You may find on the days you take a walk and practice your breathing exercises, you don’t wake up as easily. Information from your sleep journal can really help pinpoint things that affect sleep.

Consider a Different Sleeping Position

“Since they [patients with COPD] often feel short of breath, sleeping on their back can make [COPD] symptoms worse,” says Dr. Funke Afolabi-Brown.

If you’re a back sleeper, consider trying a new sleeping position that helps to alleviate pressure on your chest.

Related: What is The Best Sleeping Position?

Have a Sleep Study Done

This is an overnight study where you sleep in a mock bedroom in a clinic attached to monitors that record information about your vital functions: your breathing, heart rate, whether you have sleep apnea, and other concerns related to sleep. There are specific devices like a CPAP (a forced airway machine) that can be prescribed by your doctor after a sleep study is complete. Most sleep studies are covered by insurance.

Here is a list of things to try that can help improve sleep when coping with COPD.

• Inhalers: They can keep airways open and improve breathing while asleep. “Using an inhaler or changing your sleep position can help alleviate COPD and promote a healthy night of sleep,” says Dr. Dulka.
• Medications: Specific medication can help with sleep or other comorbid conditions that are affecting sleep. Check with your doctor.
• CPAP: Get a Continuous Positive Airway Pressure machine, a device that covers the mouth and nose and forces air into the lungs. It works to keep blood oxygen levels higher and counteract sleep apnea.
• BiPAP: A Bi-level Positive Airway Pressure machine acts similarly to a CPAP, by forcing air into the lungs and keeping the airways open. The BiPAP additionally draws carbon dioxide out of your system.
• Medication Check: Talk to your doctor about the medications you are on and how they might be affecting your sleep. Change prescriptions if necessary. Consider natural remedies like melatonin or tart cherry juice to support sleep.
• Sleep Hygiene: Increase your exercise, get exposure to daylight early in the day, don’t eat in the evening, skip caffeine later in the day, avoid alcohol, stop smoking, take melatonin, sleep in a dark cool room, and don’t be on a screen for at least two hours before bed. These are some of the basics of good sleep hygiene and if followed regularly, can dramatically improve sleep.
• Sleep Position: Lying on your back can encourage closure of airways. Get a good wedge pillow and sleep in an elevated position on your side.

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Summary

Chronic Obstructive Pulmonary Disease, COPD, is a term used to describe serious, long-term, and life-threatening lung diseases. The symptoms of COPD, namely trouble breathing, chest pain, coughing, and wheezing, can really interfere with sleep.

Diminished lung capacity causes fatigue, and sufferers may be inclined to use stimulants like caffeine to counteract it. COPD is also often associated with conditions like acid reflux and sleep apnea that can further disrupt sleep. Check with your doctor, have a sleep study done, or try some of our other suggestions to improve sleeping with COPD.