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Managing Breathing Problems at Night

breathing problems at nightMany people with COPD experience breathing problems at night, especially during sleep. In fact, up to 50% of all COPD patients report having significant sleep disturbances1 that are often related to breathing problems.

Symptoms associated with sleep disturbance in COPD include loud snoring, morning headaches, high blood pressure, excessive daytime sleepiness and periods of apnea (absence of breath) during sleep. The following highlights some of the most common conditions that contribute to breathing problems at night and how to manage them:


Orthopnea is defined as the sensation of breathlessness while in the recumbent, or lying down, position. Caused by congestion in the lungs that worsens when a person lies down, orthopnea is often a symptom of heart failure, pulmonary edema or lung disease. Once a more erect posture is assumed, congestion in the lungs decreases, making it easier to breathe.2

Because orthopnea is a symptom of a more serious, underlying condition, anyone experiencing it should be evaluated by their primary care provider. In the meantime, if orthopnea is interrupting your sleep, try sleeping on several pillows or elevating the head of your bed on blocks to reduce the congestion in your lungs so you can sleep more soundly.

Paroxysmal Nocturnal Dyspnea (PND)

PND is the sensation of shortness of breath during sleep that is significant enough to awaken the person experiencing it. Factors contributing to PND include pulmonary congestion and decreased responsiveness of the respiratory center in the brain during sleep.1 PND, like orthopnea, is often a symptom of a serious, underlying condition and is usually relieved by assuming a more upright position.

Transient Nocturnal Desaturation

Transient nocturnal desaturation occurs when there is a temporary drop in night-time oxygen saturation levels. Studies suggest that as many as 38% of patients with moderate to severe COPD, who do not qualify for home oxygen based on their daytime oxygen saturation levels, have transient nocturnal desaturation without evidence of sleep apnea.3

The primary cause of transient nocturnal desaturation is hypoventilation (a decreased rate of breathing). Patients identified as having transient nocturnal desaturation would benefit from long-term oxygen therapy (LTOT), especially if they have evidence of low blood oxygen levels during the day. Additionally, because many COPD patients who are currently undergoing LTOT desaturate at night, they should speak to their health care providers about increasing their oxygen flow rate during sleep.4

Sleep Apnea

Sleep apnea is a common sleep disorder that is characterized by one or more pauses in breathing (apnea), or shallow breaths, during sleep.1 Because it occurs during sleep, it often goes unrecognized unless it is witnessed by a partner. There are several types of sleep apnea, the most common of which is obstructive sleep apnea. Although COPD is not a risk factor for sleep apnea, it is not uncommon for people to have both conditions together.

Non-surgical treatment for sleep apnea includes weight loss, continuous positive airway pressure (CPAP) and the use of tongue retaining devices or bite guards during sleep. Surgery is also an option when sleep apnea is extremely severe.

Sleep Disturbance in COPD: No Laughing Matter

The National Institute of Health reports that as many as 70 million Americans suffer from chronic sleep problems.5 If you have trouble falling or staying asleep, talk to your primary care provider about what steps you can take to get a better night’s sleep. If an underlying condition is the root of your sleep disturbance, optimally treating the underlying condition may be all it takes to resolve your problem.


Author: Deborah Leader RN, BSN, PHN


1 The National Heart Lung and Blood Institute. What is sleep apnea? July 10, 2012.
2 Mukerji V. Dyspnea, Orthopnea, and Paroxysmal Nocturnal Dyspnea. In: Walker HK, Hall WD, Hurst JW, editors. Clinical Methods: The History, Physical, and Laboratory Examinations. 3rd edition. Boston: Butterworths; 1990. Chapter 11. Available from: http://www.ncbi.nlm.nih.gov/books/NBK213/.
3 Lacasse Y., et. al. Evaluating nocturnal oxygen desaturation in COPD – revised. Respir Med. 2011 Sep;105(9):1331-7. doi: 10.1016/j.rmed.2011.04.003. Epub 2011 May 10.
4 Robert Plywaczewski, MD, et. al. Incidence of Nocturnal Desaturation While Breathing Oxygen and COPD Patients Undergoing Long-Term Oxygen Therapy. CHEST / 117 / 3 / MARCH, 2000.
5 The National Institute of Health. The Benefits of Slumber: Why You Need Good Night’s Sleep. April, 2013.

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