Around 1.5 million Americans use supplemental oxygen every day to treat respiratory conditions such as chronic obstructive pulmonary disease (COPD), cystic fibrosis (CF), pneumonia, and more. Oxygen plays an important role in increasing oxygen saturation levels, maintaining pulmonary stability, and improving clinical outcomes for many patients.
If you’re one of many people who have been prescribed 24/7 oxygen use, you may be wondering how to go about using your oxygen therapy device at night. This is a valid concern as there are many different things you should take into consideration before you do so.
While there are many right ways to use supplemental oxygen at night, there are also some common mistakes that you’ll want to avoid. If you’re interested in learning more, read on. And if you have any questions, be sure to fill out the contact form at the side of the page so that one of our respiratory specialists can reach out to you.
Who Needs 24/7 Supplemental Oxygen?
“Supplemental oxygen” or “oxygen therapy” is a concept that’s been debated pretty heavily in the past. While it’s always been accepted that supplemental oxygen had some use in treating certain conditions, doctors were unsure about when to prescribe oxygen and how long to prescribe it for.
In the 1950s and 60s, it was more common to treat COPD with therapies like potassium iodide (used as a mucus thinner), antibiotics, and ephedrine. However, a number of studies including the Nocturnal Oxygen Therapy Trial Group 1980 and the Medical Research Council Working Party 1981 helped to establish the scientific basis of long-term oxygen therapy (LTOT).
Nowadays, it’s understood that long-term oxygen therapy is effective in treating COPD patients with chronic low blood oxygen levels (hypoxemia). However, patients should meet certain criteria before oxygen is prescribed. They include the following:
- A partial pressure of oxygen less than 55 mmHg (7.3kPa)
- An oxygen saturation of 88% or less
- Signs of tissue hypoxia (lack of oxygen in tissues)
- Pulmonary hypertension (high blood pressure in the lungs)
- Pulmonary edema (excess fluid in the lungs)
Most COPD patients will be prescribed long-term oxygen therapy at some point in their life and it’s usually advised that they stay connected to their oxygen machine for at least 15 hours a day to receive the full benefits. What this means is that COPD patients need to find a comfortable and effective way to receive oxygen while they sleep.
The Importance of Restful Sleep for COPD Patients
We all know the importance of getting an adequate amount of restful sleep each night: it makes us more alert during the day and makes us better suited to face the challenges that we might face. But when it comes to COPD patients, sleep plays an even more vital role in their short- and long-term well-being. The following are just a few of the reasons to get adequate sleep as a COPD patient:
Improved Immune System
Your immune system works 24/7 to protect your body from foreign invaders. Not surprisingly, the amount and quality of sleep that we get at night can have a major effect on how well our immune system operates. According to the Sleep Foundation, when you’re deprived of sleep, your body creates fewer cytokines, the protein that’s responsible for targeting inflammation and infections and creating an immune response.
While getting sick as a healthy person is not usually the end of the world, as a COPD patient, it could put you at a much higher risk of severe COPD complications. If you were to contract a common disease like influenza, pneumonia, or the more recent COVID-19 (coronavirus), your body may not be equipped to fight the virus.
Another danger of getting sick is as a COPD patient are the effects on your lungs. COVID-19 and Pneumonia, for example, are known to attack the lungs leading to symptoms like chest pain, shortness of breath, and a chronic cough. All of these symptoms will significantly increase your risk of experiencing a life-threatening COPD exacerbation.
What’s more, lack of sleep has shown to increase levels of inflammation in the body. This is the same problem that causes conditions like emphysema and chronic bronchitis and it can lead to elevated blood pressure as well as an increased risk for type 2 diabetes and heart disease. You might also notice a flare-up in your COPD symptoms after a poor night’s sleep.
One of the most notable symptoms of a poor night’s sleep is daytime sleepiness. If you feel chronic fatigue or drowsiness, you’re going to feel less prepared to follow through with your daily routine like making it to work on time, spending time with friends and family, or practicing self-care. Studies also show that disrupted sleep patterns can interfere with your physical, mental, and emotional functions.
One problem many COPD patients suffer from is a high rate of depression and anxiety disorders. According to the International Journal of Chronic Obstructive Pulmonary Disease, 40 percent of COPD patients exhibit symptoms of depression or are clinically depressed. This is very high in comparison to the 7 percent of the general population that is estimated to suffer from depression.
While there are many things that contribute to this issue such as a lack of depression diagnosis in older adults, many experts believe it has to do with an inability to cope with the symptoms of COPD. In this case, getting restful sleep each night will help these patients cope with their condition more effectively and experience some peace of mind.
From scheduling and attending doctor’s visits to following a strict diet and pulmonary rehabilitation routine, being a COPD patient requires a lot of fortitude and willpower. You’re likely well aware that COPD is a progressive disease meaning that symptoms tend to get worse unless you take action and change your state of mind and lifestyle. Undoubtedly, one of the most important ways to improve your willpower and give you the ability to work through this is to be well-rested.
According to a variety of studies, the way we process and utilize glucose in the body is affected by our sleep, and in turn, influences our level of self-control during the day. Our circadian rhythm, the process that influences body temperature, sleep cycles, and hormone secretion also influences the way our body processes glucose. Sleep disruptions and sleep deprivation may alter blood glucose and glucose utilization, which in turn impairs the nervous system and your level of self-control.
Improved Long-Term Prognosis
One of the biggest concerns people have about COPD is its long-term prognosis. They hear from their doctor that COPD is a progressive disease and symptoms tend to get worse rather than better. While this is true, COPD can be remedied and managed with a precise diet, pulmonary rehabilitation, and an improved sleep routine.
Sleep doesn’t just improve short-term symptoms, however. In fact, many studies have shown that long-term prognosis of COPD can be improved if sleep issues are managed appropriately. This study examined 98 adults with spirometrically-confirmed COPD to determine the cross-sectional association between COPD and disrupted sleep patterns. It determined that poor sleep was associated with higher instances of dyspnea, cough, and a higher COPD severity score. What’s more, it was predictive of frequency of COPD exacerbations, emergency room visits, and even mortality.
How COPD Prevents Restful Sleep
COPD is characterized by symptoms such as a persistent cough, breathlessness, and chest pain. Poor sleep can actually exacerbate these issues or create new symptoms that patients will need to account for in their treatment plan. Whether you have COPD yourself or you are a caretaker for someone with COPD, it’s important to understand specifically how COPD can affect sleep patterns, even if you don’t experience identifiable symptoms.
Transient Nocturnal Desaturation
A well-known side-effect of COPD is something called transient nocturnal desaturation (nocturnal hypoxemia). Studies have shown that around 27 to 70 percent of COPD patients with waking oxygen saturation levels of 90 to 95 percent may experience desaturation at night, specifically during rapid eye movement (REM) sleep. These symptoms are also more common in people with comorbidities like obstructive sleep apnea (OSA). There are two known causes of transient nocturnal desaturation:
Hypoventilation - You’ve likely heard the term “hyperventilation” before which means breathing at a faster rate than what is considered normal. For an average adult at rest, a normal breathing rate is around 12 to 20 breaths per minute. Hypoventilation, on the other hand, refers to a reduced breathing rate and it’s very common in COPD patients at night. Hypoventilation is known to lead to hypercapnia (high blood carbon dioxide levels) and hypoxemia (low blood oxygen levels).
Ventilation/perfusion (VQ) mismatch - VQ mismatch is when the process of ventilation (the exchange of air between the environment and lungs) and perfusion (the movement of blood in the lungs) are not equal. This is important because, in healthy lungs, there is a smooth transition between the inspiration of air and oxygenated blood flowing out of the lungs to the rest of the body. Unfortunately, many COPD patients suffer from a disruption in the process which can also lead to hypoxemia and hypercapnia.
Obstructive Sleep Apnea (OSA)
It’s estimated that about 22 million Americans have obstructive sleep apnea (OSA). It’s a condition that not only leads to lost sleep and daytime drowsiness, but it’s also known to increase a person’s risk for high blood pressure, stroke, and heart problems such as an irregular heartbeat, heart attack, and heart failure. Obstructive sleep apnea causes breathing to repeatedly stop and start again due to throat muscles relaxing and obstructing the airways. Like with many sleeping disorders, someone may not know that they even have OSA unless their doctor identifies it through a sleep test.
COPD patients are at risk for a condition called COPD-OSA overlap syndrome. This is a condition where COPD and OSA both contribute to nighttime sleep problems. While little evidence has shown that COPD can cause OSA or vise versa, it’s likely that many COPD patients have been living with OSA and don’t even know it. According to some sources, undiagnosed OSA could account for about 80 percent of cases throughout the country. This poses serious economic and health concerns for the country.
Respiratory Symptoms Worsen at Night
Chances are, you’ve experienced an acute respiratory infection at some point in your life. Both upper and lower respiratory infections can lead to coughing fits, increased mucus production, and a lot of congestion. During the day, symptoms tend to get better, because you’ll be sitting or standing upright. This allows a lot of the mucus to drain from your nasal passage and airways. However, when you sleep, you’re laying horizontally which can lead to a lot of the mucus getting stuck and making it difficult to breathe.
Another reason respiratory symptoms worsen at night is because there are lower levels of cortisol in the body. This is a steroid hormone that’s responsible for regulating a number of functions in the body including immunity. When cortisol is low, your body will more readily release white blood cells to fight infections and wounds. When COPD is combined with acute respiratory illnesses it can make nighttime symptoms even worse and even increase your risk of exacerbation or hospitalization.
Anxiety and Depression
As aforementioned, anxiety and depression rates among COPD patients are high. Mental illness is common among people with chronic illnesses because they feel like they’re trapped inside a box that they can’t get out of. What’s more, COPD patients may feel anxiety about their reliance on loved ones or their lack of mobility. A lot of the time, they simply have trouble managing their thoughts when going to bed and this can all lead to a loss of sleep.
How to Use Oxygen Effectively While Sleeping
For the most part, the benefits of sleeping with oxygen are similar or the same as the benefits of using oxygen during the day. The main difference is that — because sleep is so vital to our health — using oxygen at night might be even more important than using oxygen during the day. Unfortunately, many people aren’t aware of how to use oxygen at night or they have concerns about using it safely while at night. Read the following to get you started:
Speak With Your Pulmonologist
Your pulmonologist should always be your first line of contact when it comes to using oxygen while sleeping. He/she will first and foremost determine whether nighttime oxygen use will be a necessity and present you with any concerns or risks based on your medical history as well as the severity of COPD that you currently face.
Using an Oxygen Concentrator at Night
In the past, COPD patients didn’t have many options when it came to oxygen therapy. For the most part, they were limited to the small amount of options that were available to them including heavy and bulky oxygen tanks and home oxygen concentrators. Fortunately, in 2020, there are far more options for oxygen patients to choose from.
If you just need oxygen and you don’t need to be connected to a CPAP or BiPAP machine while you’re sleeping, pulse flow portable oxygen concentrators are usually the way to go. The Inogen One G5, for example, has a built-in mechanism called Intelligent Sleep Mode Technology. Simply put, this will monitor your breathing while you sleep, and as your breathing becomes more shallow, the oxygen concentrator will put out larger oxygen boluses in order to compensate.
On the other hand, if you suffer from a sleeping disorder such as obstructive sleep apnea along with COPD, you will need to use a continuous flow oxygen concentrator. Pulse flow oxygen concentrators are not CPAP compatible because they need to be able to detect your breathing and slight changes of pressure in the nasal cannula. Continuous flow concentrators will instead put out a constant stream of oxygen irrespective of your breathing rate.
Connecting Oxygen to Your CPAP or BiPAP Machine
Once you’ve determined if your CPAP/BiPAP machine and oxygen concentrator are compatible with each other, it’s time to connect them. Start by inspecting your CPAP mask for an oxygen port. Unfortunately, most CPAP masks don’t have these, so you’ll need to purchase an inexpensive component called an oxygen bleed-in adapter.
Now that you’ve located the oxygen port and you’ve purchased the bleed-in adapter if it was needed, it’s time to connect the two. When you push the tubes together, wiggle them around ensuring that it’s secure and there are no spaces where oxygen could leak out of it.
If you’re using a bleed-in adapter, you’re going to need to connect your oxygen tubing to the small port on the side of the adapter also ensuring that it’s securely in place. You can then push the other side of the adapter into the CPAP or BiPAP machine.
Making Supplemental Oxygen More Comfortable
Dry Nasal Passage
It’s not uncommon to experience nasal irritation at night while using oxygen, but luckily, there are some simple fixes to this issue. If you’re using the oxygen concentrator by itself, you may want to invest in an oxygen concentrator humidifier. Many CPAP and BiPAP machines already come with humidifiers if you are using oxygen therapy and positive airway pressure simultaneously. You should also check to ensure there are no leaks in your oxygen tubing. This can lead to dry nasal passages as well.
Too Much Condensation
While some people experience too much dryness while using their oxygen, others have too much condensation in their oxygen tubing or CPAP mask. While this may seem harmless at first, it can actually make it very difficult to breathe and make your oxygen equipment more prone to bacteria which could make you sick. If this happens, be sure to remove the mask, clean it, and let it dry fully. Discontinue the use of humidifiers on both the oxygen concentrator and the CPAP machine.
Nasal Cannula Irritation
It’s not uncommon for oxygen patients to experience irritation in their nose due to the nasal cannula. This is the part of the oxygen tubing that goes inside the nose. In order to avoid this, purchase an ultra soft nasal cannula which won’t rub away at your nose while you sleep.
If you have any other issues with making oxygen more comfortable at night, please read this blog post.
Nighttime medical oxygen is a necessity for many respiratory patients. Achieving an adequate amount of restful sleep each night will ensure that oxygen patients are able to limit their symptoms including chronic cough, chest pain, and exacerbations. However, you should first speak with your pulmonologist who will tell you how long you need oxygen and give you some helpful tips to get started.
If you’re using supplemental oxygen with your CPAP or BiPAP machine, it’s imperative that you read the instruction manual first. This will teach you the proper way to connect the two devices as well as notify you of any considerations you should know before getting started. If you have any further questions, please feel free to fill out the contact form at the side of the page and one of our respiratory specialists will reach out to you.