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Sleep disturbance

Medication, sleep position and sleep-related breathing changes can cause COPD patients to have disturbed sleep.

Identifying sleep disturbance may result in medication changes (including prescribing oxygen or changing the dosage of bronchodilator therapy).

Consider hospital outpatient referral if:

• Frequent exacerbations to exclude bronchiectasis.

• If considering nebulised treatments or oxygen.

• Unintentional weight loss – for chest X-ray (lung cancer?). Consider investigation to exclude other causes.

• Severe symptoms or signs of cor pulmonale (e.g.: ankle swelling; MRC grade 4 / 5; FEV1 <30%; Sa0<92%).

• Diagnostic uncertainty e.g. symptoms disproportionate to lung function at initial assessment or follow up.

• Never smoked / occasional smoker.

• Age < 40 years.