Night time symptoms – a forgotten aspect of COPD

Chronic obstructive pulmonary disease (COPD) is a lung disease that damages the airways inside the lungs, causing chest tightness, shortness of breath and persistent cough. It greatly affects the sleep quality of a patient and causes sleep disturbances but most often a patient does not report night time symptoms until the condition exacerbates like in case of Vishnu who had an episode of COPD at night due to altered lung function (a long-term impact of COPD).

A pan European survey to explore the prevalence and impact of night-time symptoms in COPD patients revealed that 78% patients complained about bothersome night-time symptoms like chest tightness, wheezing etc, but only 67% clinicians reported that their patients came with night time lung problems due to COPD.  

The “troublesomeness” of the classic symptoms of COPD differ in the morning and at night; the most troublesome symptoms in the morning are phlegm and cough, while at night, signs span both respiratory and other symptoms of the disease itself which include wheezing, chest tightness, frequent nocturnal awakenings, difficulty falling back to sleep after an awakening and shortened sleep duration.

Patients who experience night time symptoms of COPD complaint more breathlessness during the day hours, and report more exacerbation. Experts contemplate that night time symptoms may be the marker for the emergence of severe condition with more risk for an exacerbation. 

Nocturnal symptoms and symptomatic sleep disturbance is prevalent in patients with COPD, unfortunately, it is not a focus of current clinical management guidelines of the disease. Not much heed is paid to its management even though there is substantial data that proves unmanaged night time symptoms of COPD can lead to worsen the long-term outcome of the disease including all-cause mortality, the frequency of adverse cardiovascular events, exacerbation frequency, cognitive effects, depression, quality of life, among others.

Experts believe that ensuring proper sleep by managing severity of night-time symptoms can ultimately help in improving health outcome of disease which can be considered as novel therapeutic goal for patients with COPD. Optimizing the underlying condition causing breathlessness during sleep can invariably benefit sleep disturbances in COPD and improve the quality of life. There are pharmacological therapies (drug that improve the passages of air into the lungs) that help improve the breathing and sleep quality. 

In cases where patients do not respond effectively to pharmacological therapies, some form of assisted ventilation is recommended such as noninvasive ventilation (NIV) therapy to provide relief . There has been growing attention towards noninvasive methods of ventilatory support, particularly during sleep, considering its effective clinical outcome. NIV device provides predetermined pressure support through mask attached to an air tube, improving breathing through reversing nocturnal respiratory insufficiency. 

NIV is a  method that helps patients to breathe in a better way without the need for surgical airway by delivering breaths assisted mechanically. NIV also furthers patient comfort. It decreases respiratory rate and acute problem of breathlessness including issues like pneumonia associated with ventilator. Moreover, it also reduces the length of patient’s stay in the hospital, mortality and intubation rate.