Calling Dr. Bauer

image025-3Dear Dr. Bauer,

I have a lot of trouble sleeping at night – is this related to my COPD? Vicky M., Florida

Many of us have a love­hate relation with sleep. We love it when we get that great night of refreshing sleep but become frustrated on those many nights when sleep doesn’t go well. Our readers with lung disease may have special concerns and causes for having sleep difficulties.

There are four major causes for sleep­related breathing disorders in those with COPD. First is a low oxygen level while sleeping. It’s reported that up to 70 percent of people with COPD have oxygen reductions below 88 percent. Next would be a co­existing diagnosis of sleep apnea. This common condition occurs in those with or without lung disease. Next is a condition called hypoventilation during sleep. All of us breath shallower during sleep. Those with elevated carbon dioxide levels at baseline (seen commonly in people with bad lung disease) can have further elevations while they sleep. Finally, the wheezing and airflow obstruction seen in COPD frequently cause arousals throughout the night.

Coexisting conditions such as obesity, smoking, heart failure and opioid use can all increase the risk of sleep­related breathing problems.

Treatment depends in large part according to the type of problem as well as the severity. Night time oxygen can be very helpful in selected peo­ ple. CPAP or BiPAP may be indicated for sleep apnea. As much as sleeping pills of all sorts can be thought of … they usually depress respiratory effort and make oxygen levels dip even further during sleep.

My best wishes are that all you have better sleep and sweet dreams!

Good Luck to Dr. Bauer who is working on completing his over 2,100- mile Appalachian Trail adventure. He is in the third year of this endeavor. Look for him heading south, follow along at

Oral Appliances for Adult Sleep Apnea

Oral appliances are devices that can be used to treat some people who have mild or moderate Obstructive Sleep Apnea (OSA) and snoring.

They hold your tongue in place so that your air­ way stays open while you sleep. Oral appliances are placed into your mouth at night before you go to bed, and worn for the entire time you are sleeping, and taken out when you are awake.image042-2

How do oral appliances work?

Oral appliances work by pushing or pulling your lower jaw forward. By doing this, your tongue is kept in a position that does not block your airway. This reduces the risk of snoring or that your tongue may obstruct your airway during sleep. If this de­ vice is helping you, the sound of snoring should be gone entirely or lessened.

Approximately 70 million Americans suffer from one type of sleep disorder.image049-2

Approximately 4 percent of American men and 2 percent of women suffer from obstructive sleep apnea which temporarily blocks breathing in the upper airways, caus­ ing loud, labored snoring and stressful sleep interruptions frequently throughout the night. Sleep apnea afflicts more than 936 million people worldwide, almost 10 times as many people as previously estimated, according to a report presented by ResMed at a recent American Thoracic Society meeting.

Other forms of sleep disorders include advanced sleep phase disorder which occurs when your biological clock sets to rise earlier than it should. This commonly affects se­ niors and is often linked to changes in seasons. Narcolepsy is one of the most dangerous sleep disorders which affects approximately 100,000 Americans. A dysfunction in the brain causes a person to instantly fall asleep during normal daily activities

image051-4How do I know if my oral appliance is working? When an oral appliance is working well, there should be no snoring. If you are wearing the appliance because of sleep apnea, you may see improved sleepiness, fatigue and other symptoms of sleep apnea. A good way to find out if you are getting the help you need from your oral appliance is to have a repeat overnight sleep study with the oral appliance in place. If the study shows that wearing the oral appliance has helped your OSA, you should continue to use if every night. If it is not helping your sleep apnea, other treatments (such as CPAP) will be recommended.

This information is an except from a public service piece of the American Thoracic Society. For more information, visit

 .Restless Leg Syndrome, whose cause is unknown, causes the lower legs to burn, ache, itch, twitch, and tingle upon falling sleep. It has been suggested to cut caffeine intake and alco­ hol consumption to help with the symptoms.

You might visit the American Sleep Asso­ ciation website ( for support and information or http://sleep sponsored by the American Academy of Sleep Medicine.