Dear Dr. Mahler:
The respiratory therapist who checks on my oxygen system told me about use of a breathing machine when I sleep. She said that it may help my COPD, and suggested that I talk to my doctor about it. It sounds a bit scary, but I want to feel more energetic and be able to do more. My lung doctor said that I have severe COPD, and I use oxygen when I do things and at night when I sleep. What do you think?
Kim from Syracuse, NY
I believe that you are referring to a system called non-invasive ventilation. It is abbreviated NIV. It consists of a small machine that pushes air thru plastic tubing into your lungs. The air is delivered either by a mask that covers your nose and mouth (photo on left below) or by plastic tubes in your nose (photo on right below).
It is unclear whether home use of NIV during sleep works for those with stable but severe COPD. In theory, use of NIV when you sleep may help to rest breathing muscles and reduce drops in oxygen level. Many pulmonary doctors start home NIV in those who have severe symptoms and elevated levels of carbon dioxide (CO2). Carbon dioxide is a waste product of our body, and we exhale CO2 every time that we breathe out. Higher than normals levels of CO2 can cause sleepiness, fatigue, and morning headaches.
Another reason for NIV is if you have obstructive sleep apnea along with your COPD. Obstructive sleep apnea is a condition when the tongue relaxes and fall backward obstructing (or blocking) the passage of air in the throat when we breathe. Many people with this problem snore loudly, stop breathing many times during the night, and then wake up before they reach deep sleep. As a result, those with sleep apnea are tired and may fall asleep easily during the daytime.
In my practice I prescribe NIV for those with COPD who have high levels of CO2. This is called hypoventilation, or not getting enough air into the air sacs. NIV can allow more air to reach the air sacs and allow someone to exhale excess CO2. This should help improve fatigue, sleepiness, and morning headaches due to the build up of CO2. You will be able to continue using oxygen during sleep along with NIV.
One cautionary note – it may take some time to get used to the system with mask or nasal pillows on the face and the pressure of air being pushed into the lungs.
Please share this response with your pulmonary doctor. He/she may wish to order a blood gas test to measure the CO2 level in your body.
Donald A. Mahler, M.D.