Better Sleep, Better Breathing: How Sleep Disorders Impact COPD

Dr. Christopher Kosky is a general respiratory physician with particular expertise in severe emphysema / bronchitis and in patients needing oxygen or other support for their breathing. Dr. Kosky is also a Consultant in the Pulmonary Physiology and Sleep Medicine Department – with expertise in measuring lung function and sleep disorders.

For World Sleep Day (14 March) Respiratory Care WA spoke with Dr. Chris Kosky, Clinical Associate Professor at the Institute for Respiratory Health UWA, Sleep and Respiratory Physician at Sir Charles Gairdner Hospital, and Clinical Advisor for Respiratory Care WA, to better understand the connection between sleep and Chronic Obstructive Pulmonary Disease (COPD). We share some of his insights below.

A major global study (1) found that nearly 40% of COPD patients experience sleep disturbances. More recent studies suggest this number may be as high as 75%, including insomnia, obstructive sleep apnoea (OSA), and frequent nighttime awakenings due to coughing and breathlessness.

Since sleep is as vital as exercise and nutrition for overall health, disrupted sleep worsens COPD symptoms, increases hospital admissions, and affects mental well-being. The good news? Effective treatments are available, with new advancements offering even more hope.

For many COPD patients, sleep doesn’t come easily with many experiencing difficulty getting to sleep or staying asleep (insomnia). Breathlessness, inactivity, and social isolation contribute to restlessness, while anxiety about hospitalisations can create a cycle of poor sleep and worsening symptoms.

Once the COPD is under control with the right medication, the gold standard treatment for insomnia is Cognitive Behavioural Therapy (CBTi) which is recommended over sleeping tablets.

According to research, up to 70% of patients with insomnia see improvements with CBTi. This sleep “retraining” is done with the help of a sleep psychologist such as Sleep Matters Perth.

However, insomnia is only part of the problem—another major concern is Obstructive Sleep Apnoea (OSA), which can further complicate COPD.

Obstructive Sleep Apnoea (OSA) affects 30% of adult men and 20% of women, while COPD impacts 10% of the global population. Many people suffer from both conditions, creating a cycle where each worsens the other.

OSA is marked by snoring and repeated breathing interruptions due to airway collapse, leading to oxygen deprivation and increased strain on the heart. This can further exacerbate COPD symptoms and increase long-term health risks.

For COPD patients who snore or experience excessive daytime fatigue, a sleep study is recommended. These are available through pharmacies, healthcare providers, or hospitals for more severe cases.

Other effective treatments include continuous positive airway pressure (CPAP) therapy, which maintains open airways during sleep, along with lifestyle changes such as weight control, reduced alcohol intake, and side-sleeping to improve breathing and overall health.

While CBTi and CPAP therapy help many patients, some do not respond to standard treatments. For these individuals, new medications and therapies are showing promise.

At the Institute for Respiratory Health, Dr. Kosky and a team of specialists are exploring biologic treatments and new medications to improve sleep and breathing in COPD.

One major advancement is Dupilumab, recently approved for COPD treatment, though it is still awaiting inclusion on the Pharmaceutical Benefits Scheme (PBS) in Australia. Clinical trials are also underway for biologic drugs targeting inflammation, aiming to reduce flare-ups and improve quality of life.

As research continues to uncover the connection between COPD and sleep disorders, one thing is clear: better sleep leads to better breathing and a better life.

With promising advancements in both pharmacological treatments and emerging biologic therapies, new possibilities are opening for those struggling with COPD-related sleep disturbances.

For World Sleep Day, Dr. Chris Kosky emphasises the importance of early diagnosis and intervention. By raising awareness and improving access to effective treatments, healthcare providers can make a meaningful difference in patients’ lives.

1. S Rennard M Decramer PMA Calverley . Impact of COPD in North America and Europe in 2000: subjects’ perspective of Confronting COPD International Survey. Eur Respir J 2002; 20: 799–805 

2. Agusti A, Hedner J, Marin JM, Barbé F, Cazzola M, Rennard S. Night-time symptoms: a forgotten dimension of COPD. Eur Respir Rev. 2011 Sep 1;20(121):183-94. doi: 10.1183/09059180.00004311. PMID: 21881146; PMCID: PMC9584119