Sleep and Chronic Obstructive Pulmonary Disease (COPD) · rather than sleeping. If you follow this retraining programme you will start to think of your bedroom as a place to sleep

Information for patients

For more information about our Trust and the services we provide please visit our website: www.nlg.nhs.uk

Sleep and Chronic Obstructive Pulmonary Disease (COPD) Name: _______________________________ Who to contact and how: _______________________________ Notes: _______________________________ _______________________________ _______________________________ _______________________________ Diana, Princess of Wales Hospital Scartho Road Grimsby DN33 2BA

03033 306999 www.nlg.nhs.uk

Scunthorpe General Hospital Cliff Gardens Scunthorpe DN15 7BH


Goole & District Hospital Woodland Avenue Goole DN14 6RX




Sleep and COPD We all want a good night’s sleep, but what is a ‘good night’s sleep’ and does having Chronic Obstructive Pulmonary Disease (COPD) affect your chances of having one?

What is a good night’s sleep? A good night’s sleep is when you wake up in the morning feeling rested and refreshed.

An adult requires 7 – 8 hours of sleep per night. The quality of sleep is usually measured by the amount of uninterrupted sleep that we have. It is often thought that as we get older, we need less sleep, but what really happens is that we do not sleep as deeply and are more likely to have disturbed sleep.

The Sleep Cycle

Normal sleep follows a clear pattern. There are four stages of sleep, the first two being lighter and the last two being deeper. Stage four is known as the rapid eye movement stage (REM).

A complete cycle of sleep takes about 90-110 minutes. In order to feel refreshed we need to complete all four stages. A good night’s sleep will consist of five or six complete cycles, which means between 7½ to 11 hours sleep. A disturbed night’s sleep will consist of fewer complete cycles.



Sleep Disturbance The occasional night when you don’t sleep well will not affect your health, but if you have several nights of poor sleep you will feel tired all the time, may drop off to sleep during the day and find it difficult to concentrate and make decisions.

Sleep disturbance or ‘sleep fragmentation’ can happen for a variety of reasons, including things like your sleeping environment, emotional problems, shift work, sleep disorders, medication and physical problems such as COPD.

Evidence has shown that people with COPD can experience many changes in their sleep patterns. These may include increased time taken to get to sleep, decreased sleep time and increased waking after falling asleep. The time spent in the Rapid Eye Movement (REM) stage and stage three of the sleep cycle is also decreased. The reasons for this are varied, but can be due to the following factors:

• Age (many people who have COPD are over the age of 50)

• Drugs used in the management of COPD symptoms

• Wheezing or coughing

• Other sleep disorders such as obstructive sleep apnoea

• Psychological problems such as anxiety as a result of having COPD

• Altered lung function, for example oxygen saturation can decrease more at night time especially during the REM phase of sleep

What can you do to improve your sleep? In the first instance you should think about your sleep and whether you have always had difficulty with getting a good night’s sleep or whether your poor sleep has only developed since you were diagnosed with COPD.

Sleeping Difficulties due to COPD

Inhaled Therapies If your sleeping difficulties are due to the effects of having COPD then ensure that you have taken your inhalers correctly before going to bed. Check with the nurse or GP that you are taking the right inhaler to maximise your ability to breathe during the night as some inhalers can cause disturbed sleep.



Sleeping Position People with COPD often find that lying down flat in bed makes them short of breath. It may be easier to sleep in a more upright position. Make sure that you are supported by your pillows. If you are too upright then you will slip down the bed during the night. A pillow supporting your knees may help to stop this. Be aware that it is more difficult to get to sleep sitting up than lying down. Try different numbers and firmness of pillows so that you have the minimum to help with breathing, but can be as near to lying down as possible.

Cognitive Behavioural Therapy This has been shown to have a positive effect on people with COPD. It is a combination of techniques but can include relaxation and stimulus control techniques. Stimulus control will be discussed later. Sleep Hygiene – see below.

Long Term Sleeping Difficulties

Sleep Hygiene If you’ve always had difficulties with sleeping, look at your current sleeping habits and see if these can be improved. Sleep hygiene is a way of looking at both your behaviour and environment and changing them, if necessary, in order to improve your chances of getting a good night’s sleep.

It may be easier to change your environment than your behaviour at first. Look at your bedroom and consider the following:

Environment Generally is your bedroom a comfortable and inviting place to be? If not, can you make simple changes to achieve this? It may be something as simple as tidying it and putting things away. Regular damp dusting and vacuuming can be beneficial, especially if you have asthma or allergies.

Lighting The sleep-inducing hormone melatonin is easily affected by light. If you can identify objects in your room when you have turned out the lights there may be too much light in your room.

Black out blinds can help if the light is coming from outside. The blue light from digital clocks, TV’s, ipads etc, can stimulate you into wakefulness. If you can’t remove the items from your bedroom, see if it is possible to cover the source of the light with insulation tape. A sleep mask can be helpful; although it needs to be well fitting or it will slip off when you move around as you sleep.



Gadgets This applies to anything that may stimulate your brain rather than relax it. The blue light from computer screens, tablets, mobile phones and TVs suppresses the production of melatonin, which will reduce your chances of getting a good night’s sleep. Try not to use these for two hours before you go to bed or use a night screen to minimise the impact of the light. Although a radio may help you get to sleep, the noise from it may wake you up during your lighter stages of sleep.

Noise Ear plugs are an easy solution, but you may find that you need double / triple or secondary glazing if you live in a particularly noisy area.

Bed and mattress The Sleep Council suggests that a mattress is replaced every 7–8 years. (If you are rolling into the centre of the bed and crashing into your partner you should consider changing your mattress even if it is only a few years old.)

Buy the best quality mattress you can afford and ensure that it provides both support and comfort. Use allergen proof barrier covers to reduce the effects of dust mites and protect your bed.

Temperature Ideally your bedroom should be 18-21°C. A room that is too hot will prevent your core body temperature from going down which can prevent your body from going into “sleep mode”. However, studies have shown that cold hands and feet can prevent you from sleeping. A hot water bottle is better at warming up cold feet than bed socks.

Behaviour Bed Time Routine - this is not just for children! The idea behind it is to get your mind and body used to the idea that it is time to slow down and get ready for sleeping.

Ideas include:

• Switching off any equipment or stopping any activity that stimulates the brain

• Taking a warm bath (a hot bath will stop your body cooling down which it needs to do in order go to sleep)

• Having a warm milky drink and a light snack

• Reading a book, but try something which isn’t too exciting

• Listening to relaxing music

• Do not go to bed until you feel tired



• Go to bed and get up at the same time each day - don’t be tempted to lie in if you haven’t slept very well

• Avoid alcohol, nicotine and caffeine. Alcohol may help you drop off to sleep, but as it works its way out of your system the withdrawal from it will wake you up. Nicotine and caffeine are stimulants and will keep you awake. Ecstasy, cocaine and amphetamines are also stimulants so don’t expect to sleep if you have used them

• Exercise is good, but do not do it too late at night. There is a theory that if you raise your body temperature then it does not have time to drop which will hinder your efforts to get to sleep. Research into this theory has yet to be proven, so it may be better to exercise in the evening than not at all!

• Do something relaxing before going to bed

What if I’ve tried all of the above and I still can ’t get to sleep?

Sleep retraining (Stimulus Control Therapy)

The idea behind this is that you have learned to associate your bedroom with staying awake rather than sleeping. If you follow this retraining programme you will start to think of your bedroom as a place to sleep rather than a place to toss and turn. You limit your time in bed awake and move to another environment.

There are 6 stages which you must follow. (Continue with the sleep hygiene tips previously described)

Stage 1:

Don’t go to bed until you feel sleepy.

Stage 2:

Remove anything that prevents you from sleeping. This includes books, TV, radio, mobile phones, and laptops. As soon as you get into bed, turn the light off and try to sleep.

Stage 3:

If you don’t fall asleep in 25 minutes, get up

Go back to the living room. Do not watch TV. Do not eat or drink. Do something such as reading a boring book or listening to relaxing music. Do not do anything that “rewards” you for staying awake. Keep the lights dim and do not use a computer, mobile phone or tablet due to the back light. You must stay in the living room until you feel tired again no matter how long this takes. When you feel sleepy, go back to bed.

Stage 4:

Repeat (and repeat and repeat). Repeat stage 3 until you go to sleep.



Stage 5:

Get up early each morning

It is important that you set the alarm for the same time the next day and do not have a lie in to compensate for the lack of sleep. Do not get up any later than 8.30am. As soon as the alarm goes off, get up and out of bed. Even if you do not feel that you have slept at all you must follow this to the letter. You should also try to follow this for 7 days a week, i.e. no lie-ins at the weekend until you change your sleep behaviour.

Stage 6:

Don’t try to catch up on sleep

Do not take a nap during the day catch up on lost sleep. Save the sleep for bedtime.

Work out when you are most likely to nap during the day, then work out a way of dealing with this – go out for a walk, phone a friend, do the ironing, have a shower, do the washing up.

Keep at it – this is a very good approach but it is also a hard one to follow. It will make great demands on you. It will be tempting to stay in bed if you are still awake after 25 minutes or to have an afternoon nap. Fight these urges.

Don’t expect rapid changes. Your poor sleep may have built up over a long time, so it will take time to improve.

What about sleeping pills? Sleeping pills are not generally considered good for long term use as they can be addictive; interfere with breathing and the effects of taking them decrease over time. A GP may prescribe sleeping pills for a short time if your sleeplessness is due to a sudden event like bereavement, but their use should be reviewed. If you have been taking sleeping pills for a long time, ask your GP to review them with the possibility of slowly reducing the dose. Do not just stop taking them.

If you have any concerns about your sleeping please talk to a member of the team who will try and help with further advice.

Contact Details for Further Information Therapy Reception, Scunthorpe General Hospital Tel: 03033 306999.

Any Comments, Compliments, Concerns or Complaints If you have any other concerns please talk to your nurse, therapist or doctor. Our Patient Advice and Liaison Service (PALS) are available on 03033 306518 (Grimsby, Scunthorpe and Goole). You can also contact [email protected]

As a Trust we value equality of access to our information and services, therefore alternative formats available on request at [email protected]



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Date of Issue: January, 2020

Review Period: January, 2023

Author: Senior Occupational Therapist, Hope Street Clinic

IFP-0915 v1.1

Documents

Sleep and Chronic Obstructive Pulmonary Disease (COPD) · rather than sleeping. If you follow this retraining programme you will start to think of your bedroom as a place to sleep