Bedtime Breathing & Daytime Health: Sleep Apnoea and COPD

This article is general information and not a substitute for professional medical advice. If you have severe difficulty breathing – you are gasping, choking or cannot get words out – or your lips or skin are turning very pale, blue or grey, call 999 or go to A&E immediately.

Quick answer: how you breathe while you sleep can affect how you feel the next day. Sleep apnoea – where breathing repeatedly stops and starts during sleep – can leave you very tired, foggy and headachy in the morning, and when it occurs alongside a long-term lung condition such as COPD it deserves particular attention. The good news is that it can be tested for and treated. If you snore loudly, gasp or choke in your sleep, or wake unrefreshed despite a full night in bed, talk to your GP.

What happens to your breathing at night?

Breathing naturally changes during sleep, and most people never notice. Problems arise when the airways become too narrow while you sleep. The NHS explains that sleep apnoea happens when your airways narrow during sleep, which stops you breathing properly. Symptoms mainly happen while you are asleep and include your breathing stopping and starting, gasping, snorting or choking noises, waking up a lot and loud snoring (NHS: sleep apnoea).

Because these episodes happen while you are asleep, many people only find out when a partner or relative notices them.

How night-time breathing shows up during the day

The effects of disturbed night-time breathing often appear the next day. According to the NHS, people with sleep apnoea may feel very tired during the day, find it hard to concentrate, have mood swings or wake with a headache. Sleep apnoea needs to be treated because it can lead to more serious problems.

For people who already live with a lung condition, these daytime effects can be easy to put down to the condition itself – which is one reason it is worth mentioning poor sleep to your GP or respiratory team rather than assuming it is “just your COPD” or “just your asthma”.

COPD and sleep apnoea together: the overlap syndrome

Some people have both chronic obstructive pulmonary disease (COPD) and obstructive sleep apnoea. This combination is recognised clinically as the COPD–OSAHS overlap syndrome, and it is specifically covered in the NICE guideline on obstructive sleep apnoea/hypopnoea syndrome, obesity hypoventilation syndrome and COPD–OSAHS overlap syndrome in people over 16 (NICE guideline NG202).

It matters because the two conditions together may carry more risk than either alone. A large observational study published in the American Journal of Respiratory and Critical Care Medicine found that the overlap syndrome was associated with an increased risk of death and of hospital admission for COPD flare-ups, and that CPAP treatment was associated with improved survival and fewer hospital admissions in people with the overlap syndrome (Marin et al., 2010). Because this was an observational study, it shows an association rather than proving cause and effect – but it is a strong reason to take symptoms of sleep apnoea seriously if you have been diagnosed with COPD.

If you live with COPD and are struggling with sleep for other reasons, such as night-time breathlessness or coughing, our guide to sleep problems with COPD covers practical steps.

Asthma at night

Night-time breathing problems are not limited to COPD. The NHS notes that asthma symptoms may be worse at night and early in the morning, and that symptoms waking you up at night are a reason to seek advice (NHS: asthma). Our article on why asthma gets worse at night explains the common reasons and what to do during a night-time asthma attack.

Signs worth mentioning to your GP

Someone has noticed your breathing stopping and starting while you sleep.
Loud snoring, or gasping, snorting or choking noises in your sleep.
Waking up a lot during the night.
Feeling very tired during the day, or finding it hard to concentrate.
Waking with a headache.
Night-time breathlessness, coughing or wheezing that is new or getting worse.

None of these signs proves you have sleep apnoea, but together they are worth a conversation with your GP or respiratory nurse.

How sleep apnoea is tested for

If a GP thinks you might have sleep apnoea, the NHS says they may refer you to a specialist sleep clinic for tests. You may be given devices to wear overnight that check things like your breathing and heartbeat while you sleep. You can usually do this at home, although sometimes you may need to stay in the clinic overnight (NHS: sleep apnoea).

Treatment and things that can help

CPAP

Many people with sleep apnoea need a CPAP machine, which gently pumps air into a mask worn over the nose, or nose and mouth, during sleep. The NHS explains that it helps by stopping your airways getting too narrow, which can improve your breathing and the quality of your sleep, and that you will be given it free on the NHS if you need it.

Everyday changes

The NHS lists several things that can help, and that may be all you need if your sleep apnoea is mild:

try to lose weight if you are overweight;
exercise regularly;
keep good sleep habits, such as a dark, quiet bedroom and regular bed and wake times;
sleep on your side – for example with a special pillow or bed wedge;
do not smoke;
do not drink too much alcohol, especially shortly before going to sleep;
do not take sleeping pills unless recommended by a doctor, because they can make sleep apnoea worse.

If you have been diagnosed with COPD

The NHS describes stopping smoking as the most effective way to prevent COPD getting worse, and pulmonary rehabilitation – a specialised programme of exercise and education – as one of the main treatments (NHS: COPD treatment). If COPD causes a low level of oxygen in your blood, you may be advised to have oxygen at home; the NHS notes this can help stop oxygen levels becoming dangerously low, although it is not a treatment for the main symptoms of COPD such as breathlessness (NHS: home oxygen treatment).

Keep to your prescribed treatment

Do not stop or change inhalers, oxygen or CPAP without speaking to your healthcare team. If you think a treatment is not working for you, raise it at your next review – there is often an adjustment that helps.

Sleep apnoea and driving

Excessive daytime sleepiness affects safety on the road. The NHS advises that if sleep apnoea with excessive sleepiness has been confirmed, you must not drive until symptoms like feeling very tired are under control, and you should check the rules on GOV.UK (GOV.UK: sleep apnoea and driving).

Frequently asked questions

Can sleep apnoea make my breathing worse during the day?

Sleep apnoea mainly causes problems at night, but its effects – feeling very tired, poor concentration and morning headaches – show up during the day. In people with COPD, having sleep apnoea as well is associated with a higher risk of flare-ups needing hospital care, so it is worth getting checked if you have symptoms.

Should I take a sleeping aid if I sleep badly with a lung condition?

Speak to your GP first. The NHS warns that sleeping pills can make sleep apnoea worse and should only be taken if recommended by a doctor.

Is CPAP free in the UK?

Yes. The NHS says you will be given a CPAP machine for free if you need one.

Who can I talk to about lung conditions and sleep?

Your GP or respiratory nurse is the first port of call. Asthma + Lung UK also provides information on obstructive sleep apnoea and a helpline for people living with lung conditions (Asthma + Lung UK: obstructive sleep apnoea).

The bottom line

Night-time breathing and daytime wellbeing are closely linked. Sleep apnoea is common, can be tested for, and is treatable – and for people with COPD, recognising it may matter even more. If your sleep is disturbed, you snore heavily or wake exhausted, tell your GP or respiratory team.

Sources

This article is general information and not a substitute for professional medical advice. Always speak to your GP, pharmacist or respiratory team about your own situation.

Bedtime Breathing and Daytime Health: Sleep Apnoea, COPD and the Overlap Syndrome