COPD
CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD) is any respiratory disease (e.g., emphysema, chronic bronchitis, asthma) in which the exchange of gases (e.g., oxygen, carbon dioxide) within the lungs is impeded because of airway tissue inflammation, excessive mucus production, and/or the destruction of lung tissues.
In early COPD, a person may have shortness of breath and an ongoing cough, but the symptoms may be so mild that the person is unaware that something is wrong. As COPD progresses, the person has increasing difficulty in breathing after physical exertion, sleep problems, frequent respiratory infections, increased coughing, lower limb swelling due to inefficient heart pumping, and ultimately frequent hospitalizations because of breathing complications, respiratory infections, and respiratory failure.
Insomnia, obstructive sleep apnea, and restless leg syndrome are common in people with COPD. If left untreated, these sleep problems may worsen problems that are already occurring with COPD.
Insomnia
Insomnia is difficulty in initiating or maintaining sleep. In people with COPD, breathing difficulties may delay going to sleep at a desired time. Insufficient sleep due to insomnia has been associated with an increased inflammatory response. Thus, untreated insomnia may increase the risk of flare-ups (i.e., a sudden worsening of symptoms) in people with COPD.
Obstructive sleep apnea
In obstructive sleep apnea (OSA), a person intermittently stops breathing (i.e., apnea) during sleep because tissues such as tonsils, adenoids, and fatty tissues block the airway. This blockage partially or fully impedes airflow. The blood oxygen level consequently falls until the person awakens briefly to take some quick, deep breaths that restore the oxygen level. Once the person resumes sleep, another episode of sleep apnea can occur. Untreated OSA in people with COPD may increase their risk of developing more serious problems such as pulmonary hypertension, heart failure, or severely low blood oxygen levels during sleep.
Restless leg syndrome
People with restless leg syndrome (RLS) begin to experience uncomfortable sensations in the legs soon before bedtime. These sensations are relieved, but only temporarily, by moving the legs (e.g., rubbing, walking). The urge to move the legs to relieve the sensations may be irresistible (hence, “restless legs”). The sensations disappear just before sleep onset. RLS has been associated with—but is not necessarily caused by—low brain levels of dopamine and low blood levels of iron. Why some people with COPD also have RLS is unclear. However, some research indicates that low brain dopamine levels and low blood iron levels may negatively impact respiratory muscle movement in COPD.
If you have COPD and note the following symptoms, you may want to consider undergoing a sleep study. Treating an underlying sleep disorder could be helpful in improving symptoms and your quality of life.
Insomnia: difficulty going to sleep, awakening during the night or awakening earlier than desired, daytime sleepiness, and feeling unrested after a night’s sleep.
OSA: people witness you not breathing during sleep, loud snoring or gasping, awakening with feelings of being choked, daytime sleepiness, and feeling unrested after a night’s sleep.
RLS: uncomfortable sensations in the legs that begin soon before bedtime that are relieved temporarily by moving the legs; the sensations disappear right before sleep onset.
Regina Patrick, RPSGT, RST, is a freelance writer/editor and a registered sleep technologist. She has been involved in the sleep field for more than 30 years.
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