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Why Do COPD Symptoms Worsen at Night and What Can You Do About it?

Jul 8, 2021 4:43:52 PM / by Daniel Seter

Why Do COPD Symptoms Worsen at Night and What Can You Do About it

Chronic obstructive pulmonary disease (COPD) is a condition that has a substantial detrimental impact on patients’ quality of life. Especially during the later stages of the disease, many people find themselves unable to complete daily tasks that they were once able to do without giving a second thought. For example, activities that were once fun and relaxing like going to the grocery store or cooking may feel more like a chore than anything else. This is often due to recurring symptoms like breathlessness, chest pain, and fatigue.

Believe it or not, even something as simple as getting to sleep is more difficult when you have COPD. According to Dispatch Health, fatigue and daytime sleepiness are some of the most commonly reported symptoms of COPD. This is likely due to the fact that respiratory symptoms usually get worse at night. There are several significant changes that our bodies undergo throughout the day and as we lay down to go to bed that can change the way we are able to cope with our respiratory condition.


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In this post, we are going to help you identify the root cause of the heightened respiratory symptoms you’re experiencing at night and give you some tips for dealing with them. There are many potential causes of nighttime chest pain, breathlessness, or restlessness, so be sure to consult your doctor if you aren’t able to find a solution that works for you. Additionally, if you’re looking for a quiet oxygen device to use at night while you sleep, reach out to our respiratory specialists and ask about our portable oxygen concentrators.


Sleeping Positions

Chronic obstructive pulmonary disease is a condition that causes damage to the airways and the lungs. It’s called an “obstructive” lung disease because it makes it difficult for the patient to fully expel air from the lungs. As a result, many COPD patients suffer from carbon dioxide (CO2) retention (hypercapnia) and an inability to clear mucus and phlegm from the airways. Both of which lead to breathlessness, chest pain, and fatigue.


One thing that many people discredit when it comes to managing their respiratory symptoms is the role that their anatomy plays. During the day, you probably spend most of your time upright, either walking or sitting in a chair. When you’re in this position, it’s much easier to keep your airways clear of mucus and breathe easily. However, when you go to bed at night your position changes which can lead to several problems.




When you lay down at night, you may notice that it becomes more difficult to breathe or clear congestion and this is largely due to the position that you’re sleeping in. For many people, laying on their back or stomach feels natural and comfortable, but for someone with a lung disease like COPD, these sleeping positions can put unnecessary pressure on the lungs and chest. As a result, you may experience frequent interruptions in your sleep and daytime sleepiness.




Adjusting your posture to accommodate your respiratory symptoms is known as positional therapy and it can be an incredibly effective way to get more sleep at night and prevent COPD flare-ups. 


Many medical specialists will advise sleeping in an upright position or in a slightly reclined position. And while this can prevent a lot of congestion and nearly eliminates the pressure on the chest, most people will have trouble falling asleep or staying asleep in this position. Instead, try sleeping on your side with your head slightly elevated. This will prevent your airways from closing up while you sleep which can hinder breathing.



Another piece of advice you should consider when it comes to how you sleep is to ensure that you aren’t encumbered by your bedding or your clothing. Things like weighted blankets or heavy comforters might feel nice at first, but you have a chronic respiratory problem like COPD, they can disrupt your sleep and make it more difficult to breathe. Additionally, tight-fitting sleepwear can be equally restrictive so it’s important to take this into consideration before you go to bed at night.


Gastroesophageal Reflux Disease (GERD)

Gastroesophageal Reflux Disease is a very common digestive condition that’s caused by stomach acid irritating the lining of the food pipe. GERD is more commonly known as acid reflux, and while it can be relatively harmless at first, long-term untreated GERD can begin to damage the lining of the esophagus, causing inflammation and pain. For COPD patients, GERD can be even more problematic because it can exacerbate respiratory symptoms. In extreme cases, stomach acid can even reach the lungs which can cause a severe flare-up in respiratory symptoms.



Research has shown that COPD patients are at a greater risk of experiencing GERD. According to Everyday Health, over 50 percent of people with advanced COPD also have GERD. One of the reasons it’s so common among COPD patients is that they trap air in their lungs when they breathe which increases pressure on the abdomen. This can cause the valve between the stomach and esophagus to malfunction and release bile into the esophagus.


Another possible explanation for the high incidence of GERD among COPD patients is medication. Several medications used to treat COPD including theophylline, corticosteroids, and beta-agonist drugs are also known to cause or contribute to the onset of GERD. If you believe this may be the case, be sure to contact your doctor immediately who will be able to tell you whether you should continue using the medication or not.



There are several reasons why GERD is more likely to occur or get worse when you go to bed at night. Firstly, since you are laying down, gravity is no longer keeping stomach acid down but closer to your esophagus. Secondly, your body produces less saliva while you sleep and you swallow less. Saliva can help dilute the stomach bile and swallowing is an important force that keeps the bile in your stomach. Lastly, eating right before you go to bed can significantly increase your chance of experiencing GERD at night.


One of the best lifestyle changes you can make to treat GERD is by eating a healthier diet. Avoid alcohol, caffeine, citrus fruits, and carbonated beverages, all of which are highly acidic. You should also avoid eating or drinking (with the exception of water) three hours before going to bed. Other lifestyle changes include elevating your upper body when you sleep and losing weight which puts pressure on the abdomen when you sleep. Medications for GERD include esomeprazole (Nexium), lansoprazole (Prevacid), omeprazole (Prilosec, Zegerid), pantoprazole (Protonix), rabeprazole (Aciphex) and dexlansoprazole (Dexilant).



Sleep Disorders

It’s estimated that about 70 million people in the United States have a sleep disorder. There are many different types of sleep disorders like insomnia and restless leg syndrome, but the one that’s most likely to affect your COPD is obstructive sleep apnea (OSA). This is a condition where your airways close up intermittently as you sleep which can lead to sleep disruptions and snoring. For COPD patients, it can mean experiencing greater breathlessness, chest pain, and fatigue.


Sleep apnea


Obstructive sleep apnea is oftentimes a difficult disease to diagnose and treat. Many people live their whole lives without knowing that they have it and even if they are aware, they may not realize how big of an impact it’s having on their quality of life. Sleep studies are one of the best ways to diagnose OSA and they can help your doctor determine what the best treatment method will be.


OSA has a number of risks associated with it. You’ll be at a higher risk for high blood pressure (hypertension), stroke, abnormal heartbeats, and heart attack. Since OSA restricts your breathing, it can also put you at a higher risk of experiencing a COPD exacerbation.


CPAP device


Continuous Positive Airway Pressure (CPAP) is one of the most common treatments for OSA. It works by adjusting the pressure inside your airways in order to prevent them from closing when you sleep. CPAP is limited to some extent since it only delivers one pressure level. A BiPAP machine, however, delivers two pressure levels: one for inhalation and one for exhalation. For some patients, this makes it much easier to breathe because you don’t have to exhale against a high-pressure level.



If your doctor has you using medical oxygen while you sleep — which many patients do — you will need to use something called a continuous flow oxygen concentrator. These devices deliver a constant stream of oxygen and you’ll simply need to feed the oxygen into your CPAP or BiPAP tubing using a bleed-in adapter. Once you have everything set up, you’ll be receiving positive airway pressure therapy and oxygen therapy throughout the night. Just make sure both of your devices are plugged into the wall so that they don’t lose power.


Changes in Blood Flow

Have you ever noticed how when you get sick, your nasal congestion is much worse at night? This is partly due to the fact that mucus is not cleared out of the airways as easily, but it also has to do with changes to blood flow when you sleep. When you lie down, you tend to have more blood flow to your upper body which can contribute to inflammation and make congestion worse.


Blood flow


Circadian Rhythm

Circadian rhythm is your body’s way of telling time in order to optimize different functions based on the time of day. For example, when you’re exposed to daylight, this indicates to your brain that it’s time to wake up. However, when you’re not exposed to light, this indicates that it’s time for your body to “shut down” and get ready for sleep. COPD patients oftentimes have difficulty making it outside meaning they may be out of sync with their natural circadian rhythm. This can lead to poor sleep quality.


Circadian Rhythm


Recent studies have also found that the lungs have a circadian rhythm of their own. While studying mice, researchers found that lung immune function altered depending on the time of day. It found that the expression of genes that impact inflammation as well as the number and types of immune cells traveling through the lung varied over time. This can create an environment where the lungs are “jet-lagged” in a way and may result in more intense respiratory symptoms at night rather than during the day when they’re easier to cope with.


Poor Indoor Air Quality

While we love to think of our homes as the safest place to be, this is unfortunately not always the case if you’re a COPD patient. According to the Environmental Protection Agency (EPA), the problem with indoor air pollution is that it’s more concentrated than outdoor air pollution. If you spray a chemical or there’s a gas leak, there is nowhere for that air to escape so it’s more likely to be inhaled by anyone living or residing in the building.


cleaning products

Since you likely spend a lot of your time in your bedroom, it’s important to ensure that this room has high-quality air that won’t exacerbate your COPD symptoms. Firstly, you should take the time to dust and vacuum regularly. Dust particles can wreak havoc on your COPD symptoms leading to coughing or sneezing fits, congestion, chest pain, and breathlessness. You should also take the time to make cleaning products that are safe to use. Store-bought household cleaning products are oftentimes filled with chemicals that are unsafe for anyone, not just COPD patients.


The best way to prevent poor indoor air quality is to be more conscious about the types of products you are using in your home that could lead to pollution. If you do use some type of cleaning product, ensure that you open a window or door to let the air clear out and bring in fresh air. Humidity can also lead to mold which can destroy the air quality in your home, so be sure to vent your bathroom when you’re running water and use the fan. 




If you’ve done all of these things but still believe your home may have poor indoor air quality, be sure to get in touch with a home inspector who can run some tests to determine if your home is safe to live in. You can also consult with your doctor to learn more about the potential effects of poor indoor air quality on your symptoms and how they could be affecting your sleep.  



One of the most commonly reported symptoms of COPD is fatigue and daytime sleepiness. This is most often due to the poor sleep that COPD patients experience resulting from a flare-up in their symptoms when they go to bed. One of the best things you can do for yourself if you have COPD is to take steps to improve the amount and quality of sleep that you get each night. Lifestyle changes can make a world of difference, but you may need to work with your doctor to learn about more advanced treatment procedures.



Most COPD patients have to use supplemental oxygen in order to maintain their blood oxygen levels while they sleep. And in order to do that, you need a reliable oxygen device. Here at LPT Medical, we sell portable oxygen concentrators and feature some of the most trusted brands including Caire Inc., Inogen, and Respironics. Some of our most popular units include the Inogen One G5 and the Caire FreeStyle Comfort, both of which are great for nighttime use. However, if you want to use your CPAP machine alongside your oxygen, be sure to check out our selection of continuous flow oxygen concentrators.

Topics: COPD, Medication and Treatment, Respiratory Resource Center, Tips and Hacks, diet, portable oxygen concentrator, oxygen therapy, wellness goals, COPD education, COPD management, wellness for seniors, Continuous flow oxygen concentrator

Daniel Seter

Written by Daniel Seter