Chronic obstructive pulmonary disease (COPD) is a term used to describe chronic lung diseases including emphysema and chronic bronchitis.
Millions of Americans are affected by COPD, a condition which affects the ability to breathe. Airflow is obstructed in and out of the lungs which can result in reduced oxygen levels in the blood.
The prime contributing factor for COPD is smoking. This includes breathing secondhand smoke. Indeed, inhaling any type of air pollutant can be a contributing factor to a condition which cannot be cured.
Diagnosing COPD earlier can help slow progression of the disease and improve quality of life.
While the wheezing and coughing associated with COPD can occur at any time of the day, many people can find it is worse at night. They struggle with their breathing even more when lying down, resulting in poor quality of sleep.
Having a sleep disorder like obstructive sleep apnea will make matters worse, causing further disruption to sleep.
When someone is affected by both COPD and sleep apnea, it is referred to as overlap syndrome. While there are several similarities between the two conditions, there does not appear to be a direct causal link.
If you have COPD, it does not mean you will automatically develop sleep apnea. It is estimated that between 10% and 15% of those with COPD also experience obstructive sleep apnea (OSA).
What is OSA?
OSA is the most common form of sleep apnea. Breathing is interrupted, as you sleep your upper airways collapse and become blocked. This causes a drop in blood oxygen levels which prompts the brain to awaken the body, and you wake gasping for air.
These interruptions to sleep can happen frequently through the night. Therefore, like COPD, OSA can severely affect sleeping patterns and lead to sleep deprivation.
The primary links between the two conditions are obesity, inflammation and smoking. Someone with overlap syndrome can be at increased risk from:
- heart problems
- chronic inflammation
- excess carbon dioxide in the blood
- high blood pressure in the blood vessels supplying the lungs
- excessive daytime fatigue and daytime sleepiness
The difficulties in sleeping caused by COPD and OSA make it harder for the body to receive the oxygen it requires. Having both conditions can worsen the issue, prompting an inflammatory reaction within the body.
Diagnosing Sleep Apnea
For someone with COPD, getting a diagnosis for sleep apnea is important so you can take steps to manage your condition at night.
Left undiagnosed, sleep apnea will continue to impede sleep, leading to sleep deprivation and increasing the risk of further serious health complications such as heart disease, high blood pressure, stroke and diabetes – the result of oxygen deprivation night after night.
The main symptoms of obstructive sleep apnea include:
- frequent awakenings at night, sometimes gasping for air
- loud snoring
- daytime fatigue
- morning headaches
- dry mouth in the morning
- poor concentration
- increased irritability
While there are some crossover symptoms with COPD, it is important to consult with your doctor if you suspect you have sleep apnea. They can arrange a test for the sleep disorder.
Testing for sleep apnea typically involves an overnight test which can be done from the comfort of your own home.
A home sleep test measures several parameters including snoring, breathing patterns, body position, oximetry and either respiratory effort or peripheral arterial tone. This type of testing is suitable for patients who suffer from obstructive sleep apnea and will also indicate the severity of the disorder.
The AHI (apneas and hypopneas index) as well as the RDI (respiratory disturbance index) will be the number of events per hour recorded. If your doctor believes you may also suffer from a neurological disorder such as parasomnias, then an overnight stay at a clinic where your sleep is monitored may be recommended. In this case EEG (Electroencephalogram) will measure your brain activity throughout the study.
Treatment for Overlap Syndrome
Sleeping with COPD can be difficult anyway. A disorder such as sleep apnea makes sleeping even tougher. Both conditions need to be treated separately and is why recognizing the presence of sleep apnea is so important. By treating the sleep disorder -- as well as COPD -- you can look to achieve better quality of sleep while also preventing low blood oxygen levels.
CPAP – Gold Standard OSA Treatment
Continuous positive airway pressure therapy (CPAP) remains the gold standard treatment for moderate to severe obstructive sleep apnea.
CPAP is a machine that supplies pressurized air through a mask worn while you sleep. The pressurized air prevents the collapse of the upper airways, keeping them open to allow the flow of oxygen into the lungs.
Mask types vary, including full face masks as well as nasal masks, depending on what is best suited for you. The key is tolerance to the air pressure and continued compliance to the treatment.
A BiPAP machine may be recommended if you struggle to adjust to CPAP as it uses two different pressure levels for inhalation and exhalation to help support your breathing.
Lifestyle Changes to Improve Sleep Apnea Naturally
Obesity and smoking are two contributing factors linked to both COPD and obstructive sleep apnea. Therefore, your doctor or sleep specialist will likely advise you to make lifestyle changes to help treat sleep apnea if you have COPD. This may include:
- maintain a balanced, nutritious diet, without saturated fat and excess sugar
- exercise regularly, like walking
- quit smoking, very critical
- reduce alcohol consumption and no alcohol before bedtime
- do not eat large meals prior to bed
If you sleep on your back, you may be advised to sleep on your side instead. When you sleep on your back gravity can pull the tissues in the throat down to obstruct the airways.
You will also want to maximize your chance of sleep by ensuring your bedroom is dark and quiet and that you avoid blue light emitting screens prior to bed.
Oxygen therapy may be prescribed for those with COPD to counter low blood oxygen levels. It can improve someone’s quality of life. However, supplemental oxygen does not prevent the collapse of the airways and is therefore not an effective treatment for obstructive sleep apnea.
If you have overlap syndrome, you will likely be recommended CPAP to address your sleep apnea, before assessing whether supplemental oxygen is still required to help with your COPD.
While separate conditions, COPD and sleep apnea both affect your breathing and blood oxygen levels. Together they form overlap syndrome, but by treating both conditions you can improve your breathing and blood oxygen levels, helping reduce the risk of serious health complications like heart disease.