Yawning

Hi again - I just finished my other post to you with the intention of getting on with the day, but now having seen this post I think I'll pop and make a coffee and give my thoughts on this too, as it is a problem we share! (back in a tick, just off to get coffee

This is another of those problems that many of us seem to share but little seems to be said or done about it. I know they usually give us the blurb about no caffeine in the evening, have a regular bed time etc. but none of that makes one iota of difference and anyhow most of us have tried all the usual stuff before we even raise the issue with others. Also this is a bit like the weight changes etc. in that it has happened over time and it takes us a few years to realize it is part of the disease. Worse still it adds to our weakness and exhaustion at a time when we need every bit of strength we can garner! I don't know about you, but on the odd night that I get 6 hours or more the rise in energy levels and mood the next day is amazing! If only every night could be like that.

Anyhow, this is one example I have got from the books ; It is taken from \"Courage and Information for Life with COPD\", (a lovely but slightly out of date ex library book).

\"Sleep disturbances are very common in people with COPD. These may be due to the lung disease itself. Sometimes just lying down can increase difficulty in breathing and interfere with the process of getting oxygen into the blood. This is why many people sleep sitting up in a recliner. They can't tolerate lying down.

With COPD, a significant cause of low oxygen levels is poor breathing while sleeping. In normal people, breathing is reduced in all stages of sleep compared to breathing while awake. A time during sleep when the eyes move rapidly under the eyelids - 'REM' stage, is the period of sleep when the most dramatic fall in oxygen occurs, even in normal people. Everyone needs a lot of REM sleep every night, but if lung disease is present, low oxygen levels during this time may waken you and cause sleep to be unrestful.\"

I don't know about you Jacee, but when I wake up it is usually roughly 2 hourly, which would coincide with REM sleep periods ie low 02 times. However, if you wake gasping / choking/ grunting for want of air it is likely to be sleep apnea, which may require using a C- PAP machine. If you look up sleep apnea you will see it is caused by things such as obesity and \"floppy pipes\". In my case I think it is a mix of the temporary drop in 02 at REM times, and a degree of sleep apnea if I turn on my back in sleep.

I don't want to use C-PAP , so I sleep on my side with pillows down behind my back to prevent me turning over, and hope that a combination of weight loss and (don't laugh) singing to myself around the house to exercise my 'floppy pipes' will gradually deal with any sleep apnea. Maybe weight loss and exercise will eventually improve my oxygenation in general too and I will then get more normal sleep. If it worsens however, I will see if I need to be on 02 at night, rather than just daytime.

Well, I don't know if that's of any help to you. It won't of course help you sleep, but it may give you some idea of whether you need to see anyone about it. In fact you might want to put it on your list of what to discuss with your consultant, seeing as you have an upcoming appointment - make the most of the opportunity!

Now I really, really must go, Issy will be home for lunch break from her holiday job at the paper shop in ten minutes .... and I'm STILL in my nightie! :oops:

Love and Peace :rainbow: Vanessa xxx :zzz:

WOW! Talk about Serendipity/ Kismet/ Karma /Chance call it what you will, I just quickly clicked on another place I check in with each day and came across the following that someone posted just hours ago ....

Woke up this morning feeling refreshed with my sats at 99 and HR in the 60's and this I owe to my sleep apnea bipap regimen started about 10 months ago...Plus the fact that I am now rested after a good nights sleep and allows more exercise makes it even better...If you suspect Apnea or do not sleep well then suggest a sleep test to confirm or deny apnea...My first test did not show apnea but the second one revealed severe apnea so glad I failed the second time around...gary

And .... COPD and Sleep Apnea Hypopnea are two common conditions that may coexist. When COPD and SAHS do coexist the individuals have more sleep desaturation and disruption than they would have with only one condition. Although awake oxygen saturation is the best predictor of sleep desaturation in COPD, the degree of airflow obstruction also independently predicts sleep desaturation. Overnight oximetry should be considered in most individuals with COPD, irrespective of whether they have symptoms of sleep disruption, to exclude significant overnight desaturation that may be associated with reduced survival. When individuals with COPD have sleep-related symptoms, other sleep disorders should be included in the differential diagnosis.....

AND.....

Individuals with COPD may demonstrate gas exchange abnormalities when asleep. The mechanism, extent, and significance of these abnormalities have been the subject of much investigation. Sleep desaturation occurs in all sleep stages, but maximum desaturation usually occurs during rapid eye movement sleep. Alveolar hypoventilation, which occurs in normal sleeping individuals, is thought to be the major mechanism causing arterial oxygen desaturation . Oxygen saturation while awake is the best predictor of sleep desaturation in individuals with COPD. Many individuals with COPD are hypoxemic and have waking arterial oxygen tensions at or near the steep portion of the oxyhemoglobin dissociation curve. Accordingly, a decrease of alveolar ventilation will cause greater oxygen desaturation in these individuals than in normal individuals.

Hypoventilation is not the only cause of hypoxemia. Oxygen desaturation during sleep in COPD is also partly due to alterations in the distribution of ventilation–perfusion relationships (9). That oxygen desaturation is usually greatest during rapid eye movement sleep also provides insight into its etiology. Oxygen uptake is increased during rapid eye movement sleep, and this may contribute to the desaturation. The dissociation between diaphragmatic and intercostal activity during rapid eye movement sleep can also result in both hypoventilation and worsening of ventilation–perfusion disturbances. The Sleep Heart Health Study investigators found that participants with an FEV1/FVC ratio of less than 65% had an increased risk of sleep desaturation independent of awake oxygen saturation and the presence of SAHS (7). Sleep desaturation is associated with reduced survival (10) and cannot be accurately predicted by symptoms or awake measurements. Accordingly, the investigators proposed that overnight oximetry be routinely considered in patients with an FEV1/FVC of less than 65%.

Individuals with severe COPD sleep badly. They have decreased sleep time, less rapid eye movement sleep, and more changes in sleep stage. Poor sleep quality is probably a major factor in the chronic fatigue and impaired quality of life reported by patients with severe COPD (11). Nevertheless, sleep duration and quality are frequently overlooked in studies that evaluate the effectiveness of therapy on quality of life in individuals with COPD. The mechanism of the sleep disturbance is not clear. It may be related to gas exchange abnormalities, medications (e.g., theophylline) (12), or general debility associated with COPD. Hypoxia stimulates the reticular activating system, and there is a strong association between hypoxemia and the incidence of arousals in COPD. The frequency of arousals, however, does not decrease after nocturnal oxygen therapy (2), suggesting it is not the hypoxemia but some related phenomenon, possibly hypercapnia, that is the principal arousing stimulus. The Sleep Heart Health Study investigators found that sleep quality was minimally impaired in their participants with predominantly mild COPD without SAHS (7). Based on this finding, they recommended that when individuals with COPD have sleep-related symptoms, other sleep disorders, such as periodic limb movement disorder or SAHS, should be considered. They were unable to record limb movements, and thus it is not known whether the prevalence of periodic limb movements is increased in individuals with COPD. Although the prevalence of SAHS was not higher in the participants with COPD, sleep quality and sleep desaturation was worse when participants had both COPD and SAHS.

-----Sorry there's so much, but it may be worth printing out and studying when you have the time, got to dash STILL in nightie .. Vanx

A quickie

Vanessa you are wonderful. So much info but I will have to look up a lot of the technical terms. Thanks a million. I hope you managed to dress before Issy got home!

Jacee

xx

Hi Van & Jacee,

:D

I have sent you both PM!!

I too have sleep problems from time to time so it could be part of the condition!

Do you nap during the day?

Knitty xx

Hi Jacee and Vanessa,

I wake in the morning and feel I've had no sleep and been run over at the same time. I sleep for a good three hours in the afternoon now and I start continual yawning after I've been awake for just an hour or so. My doctor has requested blood tests to see if she can find the cause but she also thinks that the yawning could be a side-effect of medication.

Best wishes,

Stitch

Hi Everybody, I have great difficulty with sleeping either lying down or propped up in bed and now am starting to dislike the very thought of going to bed because of the discomfort I feel there. I bought an oximeter and have found that when my sleep is disturbed and I am feeling bad my oxygen level is in the 80s. Can anybody tell me what my oxygen level should be when I am sleeping? I have even noticed when I try to relax and my breathing slows down while awake oxygen level goes down to 80s and I feel really uncomfortable. Even when my oxygen level is at 98 each breath seems to take effort to get air in to my lungs. I have received a great deal of help reading all the different posts and would be grateful for any advise given. thanks.

Regards,

Robert

Hi Robert.

Your oxygen level should be 100%, a perfect score. Most smokers will be down to about 98% whilst anyone with COPD may drop lower. I would suggest you ask for a referral to your local respiratory clinic. When my oxygen dropped to about 88% I was put onto oxygen therapy.

Stitch, I have not heard of a side effect of COPD medication being yawning - and I read every leaflet and consider every side effect before taking any medication. Sounds to me as though you are tired through disturbed sleep or lack of oxygen when you sleep, which may need addressing so ask for a referral to your local respiratory clinic and get it checked out.

Jacee

[quote:c0bee92572=\"waterman\"]Hi Everybody, I have great difficulty with sleeping either lying down or propped up in bed and now am starting to dislike the very thought of going to bed because of the discomfort I feel there. I bought an oximeter and have found that when my sleep is disturbed and I am feeling bad my oxygen level is in the 80s. Can anybody tell me what my oxygen level should be when I am sleeping? I have even noticed when I try to relax and my breathing slows down while awake oxygen level goes down to 80s and I feel really uncomfortable. Even when my oxygen level is at 98 each breath seems to take effort to get air in to my lungs. I have received a great deal of help reading all the different posts and would be grateful for any advise given. thanks.

Regards,

Robert[/quote:c0bee92572]

Hi Robert

You should really mention your difficulties to the doc - or as Jacee recommends get referral to consultant. Your oxygen levels need checking and this drop to 80 you speak of can be dangerous to your health. The hospital respiratory specialists can get a more accurate reading about what is happening with your blood oxygen levels than any oximeter, they are not going to be satisfied with what you say your reading is, they will want to establish what is happening using standard medical procedures.

Not sure if you have already enquired about the pulmonary rehabilitation ? If you can get on one soon as, you may find your blood oxygen is tested even before your specialist appointment comes around.

Do mention about your sleep disturbance and oxy sats to your GP who really should refer you asap.

Take good care.

Hi Jacee,

my yawning is a side-effect of anti-depressents, according to doctor. She put me on them because she thought I was having difficulty coming to terms with this...

I think she knew she was going to be telling me that I probably wouldn't work again, because that's what she told me last week.

Best wishes,

Stitch

Stitch, please don't let others dictate what you can or cannot do. If you feel that your working life is at an end then fine. However, they do not know what you feel, how you manage or how determined you may be (counts for a lot). Please don't let them make such life-altering decisions for you. And don't rush it. I am evidence that what you feel now may not be what you feel in a few months. Also, remember the Disability Discrimination Act and the Equality Act. Look at what problems you have faced and whether or not there is something that could be put in place to help you continue, if that is what you want to do. For example, they have a duty in law to allow flexible hours, to purchase any special equipment or to delegate other members of staff to undertake duties that your disability prevents you from undertaking, or make any other \"reasonable adjustment\".

Have you considered part-time rather than giving up all together? Please consider all of your options before taking steps which cannot be un-taken.

Sorry if I am being bossy - choice it is something I feel very strongly about.

Jacee :wink:

xx

Hi Jacee,

I won't let them push me into that particular corner. If I'm too ill to work, that's one thing - but being banned from working because I'm ill is a whole different thing to me. I accept that I can't do it now but I don't accept that I won't be able to do it in the future. I'm slowly improving all the time, I think - expecially since I've tried to follow Vanessa's lead with exercise. To ban me is to say I've done something wrong...

I'm not having my choices taken away or reduced by rule-makers. But anyway, I guess it's best to hold-fire till I find out if it's actually true...

Stitch

Thanks Jacee and Visitor for advise given. At the minute I am not allowed to go to Pulmonary Rehab as I am waiting to see a Heart Consultant re an ECG that showed up an abnormality. I don't know much of the terminology re COPD eg, Sats and FEVs etc. At last clinic check, about three weeks ago, my spirometer reading was in the 50s% and oxygen was 89% while previous check two months earlier showed higher figures. Asked about oxygen and nebuliser and wasn't allowed either. I'm not complaining as I am so thankful that I am as well as I am in spite of all that is happening. Thank you all for the help and support.

Regards,

Robert.