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Tuesday, July 17, 2012
Dear Dr. Camardi:
I just wanted to drop you a note to tell you where I am with that advice you gave me about sleeping at night and my COPD.
The first thing is I got that allergy medicine you told me to get and it made the CPAP mask work better because my nose wasn’t so clogged anymore. And I know I gave you a hard time on this, but as much as I didn’t want to do it, the dog and the cat are both out of my bedroom and I can’t begin to tell you the difference it has made with my allergies. I don’t wake up feeling like I’m dying to breathe anymore and can pretty much sleep the whole night through.
And the big news is that I started the stop-smoking program you told me about and by September, I bet I’ll be off smoking altogether. Thanks for putting up with my stubborn self — I really appreciate ya!
For a patient with COPD (chronic obstructive pulmonary disease), which is the name for how smoking destroys your lungs’ ability to breath, sleeping can be a major challenge.
Readers of this space know that I consider restful sleep to be the foundation of good health and something that patients tend to take for granted — until they lose the ability to sleep soundly.
If you are a smoker, you can do your well-being a world of good if you stop smoking and begin an exercise program under the supervision of your physician. And it’s never too late, as it can take up to 20 years of exposure to develop COPD, so stop as soon as you can.
For the female smoker, this is really important as studies at the University of Kentucky recently demonstrated that smoking affects a woman’s lungs differently and more seriously than a male’s.
For the same smoking history as a male, the female smoker tends to have more shortness of breath, weakness from re current infections and fatigue than her male counterpart. The dire issue of lung cancer seems, at this stage of investigations, to be at the same unacceptably high risk. The reasons for this are not entirely clear, but it simply emphasizes the need to stop smoking and to protect yourself from infections by keeping up with your vaccinations.
Unlike the time of your life before COPD, now you have to prepare yourself to get a restful night’s sleep. The key here is to try and not do anything that would affect the way your body naturally wants to put you to sleep. This “sleep cycle” is affected by many things we do each day that we tend to take for granted.
Here are some approaches I have found useful in preventing oneself from tampering with the body’s natural way to get rest:
1. Do not drink anything with caffeine after lunch. The conventional wisdom used to be not to use these beverages after 4 p.m., but I feel for the amount we consume this is too late in the day.
2. Try not to nap during the day, but if you find yourself being excessively tired during the day, call your doctor.
Now this can be a little tricky as it’s expected that you would feel sleepy if you postpone a nap. The difference here is that the sleep you experience does not refresh you enough to feel rested and instead makes you feel exhausted.
This could be a sign that your CPAP (continuous positive airway pressure) machine setting may need adjustment. Either way, be sure to discuss this with your doctor.
3. Make sure you maintain your medication schedule so that you will go to sleep with enough medication in your bloodstream without the risk of taking them too close to your bedtime as some of these drugs can be stimulants.
4. Try to establish a cycle of going to sleep and waking up at the same time each day as this will help to re-establish your normal bio rhythms.
5. Getting the pets out of the bedroom will help the allergy issue along with cleaning the bedroom every other day . There should be no rugs or window drapes in your bedroom, as they retain a host of allergens .
6. Keep the temperature on the cool side to help reduce the work of breathing.
7. Keep the bedroom dark by putting up window shades or even wearing an eye mask as this will help settle you into a sleep cycle.
The key here is that I want you to take control of your COPD — not have it control you.
And by what you have written to me it seems as if you have. You should be proud of yourself because I certainly am!
Dr. Michael Camardi is a geriatrician at the Carilion Center for Healthy Aging and an assistant professor of medicine of the Virginia Tech Carilion School of Medicine. His column runs monthly in Extra.
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