Sleep Apnea and COPD: What You Should Know

Posted on July 15, 2015   |   

This blog post was written by Xavier Soler, MD, PhD

Chronic obstructive pulmonary disease (COPD) is very common leading to frequent physician visits and hospitalizations and become the 3rd leading cause of death in the U.S. COPD is the only major disease among the top 10 that continues to increase. Because of the long pre-clinical period, signs and symptoms of COPD develop predominantly in older adults.

Sleep-related disorders are most prevalent in adults and are associated with increased mortality and morbidity from obesity, cardiovascular diseases, diabetes, and depression, resulting in reduced quality of life (QOL) and increased health care costs. Patients with severe COPD commonly exhibit abnormal sleep like insomnia contributing to chronic fatigue, daytime sleepiness. Additionally, medications used to treat COPD, such albuterol or prednisone may affect sleep quality. A nocturnal reduction of nocturnal oxygen levels commonly seen in patients with COPD can have profound effects and contribute to long-term sequelae, producing arrhythmias, myocardial stress, and, possibly, lower survival.

Sleep apnea (OSA) is a chronic medical condition where the affected person repeatedly stops or nearly stops breathing during sleep. These episodes last 10 seconds or more and cause oxygen levels in the blood to drop leading to important health consequences. Usually it is caused by obstruction of the upper airway, resulting in obstructive sleep apnea. However, it may be caused also by a failure of the brain to initiate a breath, called central sleep apnea. OSA is very common, especially in older adults, occurring in up to 70% of men and 56% of women. Patients with untreated OSA have more automobile accidents and suffer from more family and social discord. Other important risk factors associated with OSA include smoking and alcohol. The symptoms of obstructive sleep apnea include loud snoring and/or abnormal pattern of snoring with pauses and gasps. Other symptoms include excessive daytime sleepiness, memory changes, depression, erectile dysfunction and irritability. OSA occurs in about 10 to 15% of patients with COPD, a condition referred to as the “overlap syndrome”. Although the prevalence of OSA is similar in patients with COPD as in the general population, individuals with both conditions without CPAP treatment have an increased risk of death and more hospitalizations from acute exacerbations.

Summer Heat Effective available treatments for OSA include continuous nasal airway pressure devices (e.g., CPAP); a mask is worn over the nose during sleep while compressed air is gently forced through the nose to keep the airway open. Different patients need different mask sizes and different pressure levels for optimal treatment results.

Oxygen therapy is used for low nocturnal oxygen levels and, medications such as non-benzodiazepines and behavioral therapy are current treatments for insomnia. Another type of treatment for obstructive sleep apnea is surgery to correct obstructions in the airways. The most common surgery is called UPPP, for uvulopalatopharngyoplasty. This surgery removes tissue from the rear of the mouth and top of the throat. The tissues removed include parts of the uvula (the flap of tissue that hangs down at the back of the mouth), the soft palate, and the pharynx. Tonsils and adenoids are usually removed in this operation. Surgical interventions are sometimes considered but are rarely successful. Another approach to treating OSA involves the use of oral appliances intended to improve breathing either by holding the tongue in place or by pushing the lower jaw forward during sleep to increase the air volume in the upper airway. In treating insomnia in COPD, benzodiazepines such diazepam should be avoided. However, newer compounds, such as zolpidem, may be safer in less severe COPD. Melatonin agonists can also be used. Cognitive behavior therapy is still considered the primary first-line treatment for insomnia, but has not yet been studied in COPD.

Exercise has been demonstrated to improve sleep in epidemiological studies. In a prospective study of 86 patients with chronic lung diseases referred to the UCSD pulmonary rehabilitation program (PR), we demonstrated a significant improvement in sleep quality after pulmonary rehabilitation measured with the Pittsburgh Sleep Quality Index (PSQI), a well-validated measure of overall sleep quality. Further studies to better characterize sleep-related disorders among COPD are under way.

In conclusion, sleep is poor in COPD patients and sleep disorders such OSA have profound effects on this population. Prediction of the patients diagnosed of COPD who are at risk for sleep difficult but crucial because their clinical implications. Therefore, increase public awareness about this serious condition is of paramount importance. Clinicians should include sleep evaluation in patients diagnosed of COPD asking about daytime sleepiness, snoring, pauses while sleeping and insomnia symptoms, referring to the specialist when necessary to address treatment options of comorbid sleep disturbances, which may provide significant long-term benefit for such patients.

For more information about Sleep Apnea and COPD please visit information about the O2verlap Research Study completed in 2020.


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  • I will be wearing a monitor to record oxygen levels during sleep.
    • Did you have to get the monitor from your doctor and can a patient directly buy? Thanks!
    • They do sell oximeter she that record oxygen saturation levels overnight but they are generally several hundred $$$$.

      You can have your MD order an overnight oxygen saturation study (which is covered by insurance and find in your home).

      The best way to find out if you have sleep apnea is getting a complete overnight sleep study done, which can be ordered by any of your providers (tho may require pre-authorization with some insurers). The overbite sleep study can reveal several different health conditions that can be treated.
  • I have COPD and Sleep Apnea I use a B-PAP machine because the C-PAP is a little too much pressure for me to expel air. The B-PAP solves this problem. I also have an oxygen tube from a large O2 concentrator that feeds O2 directly into the air tube from the B-PAP. I also have 3 Herniated discs in my lower back which forces me to sleep on my sides. I use a nose mask at night which works very well for me. The full face mask drove me nuts it would wake me up in the middle of the night with face mask blowing in my ear. Not a comfortable feeling. FYI they make 3 nose masks that I know of, one is made from anylon type material with the head harness, one that goes into the nostrils made of a very soft rubber ( I can't imagine wearing this it would feel trying to sleep with somebodys fingers in your noise) the one that I use and like very well is a full nose cover of a very soft ( I mean very soft) rubber with a head harness. It all takes a little time to get comfortable and once you get use to it you will find you can't sleep without it. There is a humidifier attached to my machine to keep from drying out my siniuses. I also keep that little devise the doctor puts on your finger to ck your O2 level and heartbeat. I use this several times a day and some times during the night. I am 74 years old I was a very heavy smoker ( I started when I was 12-13 years old) my doctor told me the damage was done with my first cigarette. I quit over 20 years ago. Had I known then what I know now I probabley would never have started. I don't beat myself up over it I deal with it knowing it is my fault and no one elses. I try to do what Doc tells me and take my meds when I'm supposed to.
    • Hi Jim,
      Hope this finds you well.
      Your write-up has been been very helpful for me.
      Many thanks,
    • I am surprised that you can wear a nose piece with a Bypap. I was told I HAD to use the face mask and have had trouble every night. I haven't had an uninterrupted sleep in the last year.
    • Hello JimC

      What mask are you using? It sounds like it might work for me.
  • I was wondering is there things we do during the day that can trigger our apneas? I'm watching the read out on my cpap machine and the graph on the apnea section is different each night.

  • TO Calico and Barbara Moore, first of all thank you Calico for the comment. To Barbara sleeping with a full face mask is difficult at best. Some people sleep without ever changing their position when sleeping, others like me change position all night because of my back. If you are truly having a problem with your mask you need to be very stern and positive with your doctor. If he/she makes you uncomfortable say so. I had that problem with my first pulmonologist. I wanted a nose mask and a full face mask that I was having problems sleeping with the mask. His comment as he stormed out of the room that I was not cooperating. Needless to say I changed doctors my new doctor was an absolute jewel until he moved with his doctor wife to another city 150 miles away. I have since moved to another state, have a new pulmonologist and who I think is great and LISTENS to my answers to the questions he ask me. My point is if you are not happy with your doctor, your not getting the answers or the help you need change your doctor. Before who ever in the COPD orginization reads this I have personally been thru this scenerio. I hope this helps both of you remember it's your life not the doctors. JimC