When sleep apnea and COPD meet: Overlap Syndrome

  • Posted by: sleepapnea.org
  • Category: News, Uncategorized

example of gas exchange in the lungs for copd overlap syndrome blog post

Chronic obstructive pulmonary disease (COPD) and obstructive sleep apnea (OSA) are two of the most common pulmonary diseases. Unfortunately, they can also occur simultaneously in a phenomenon commonly referred to as Overlap Syndrome, creating twicefold the unpleasant conditions of disordered breathing.

This leads to long-term chronic health problems beyond the lungs (such as diabetes and heart disease) and their associated myriad complications.

The association between COPD as an obstructive lung disorder and OSA as a sleep breathing disorder means a person suffering from both has a compromised respiratory system that cannot even rely on sleeping at night for recovery or relief.

Why is this?

The endless struggle of Overlap Syndrome

Those with COPD struggle to maintain a healthy balance of oxygen and carbon dioxide in their bloodstream during the day.

If they also have OSA, this sleep breathing disorder kicks in as soon as they fall asleep. This leads to further imbalances to their blood chemistry.

While the rest of us rely on that nighttime period of consolidated sleep to maintain health and well being, and to recover from the stresses placed on our systems by chronic illness, those with Overlap Syndrome never catch a break.

This explains the term “overlap syndrome.” It’s a way to reference the never-ending challenges of breathing for those suffering from both COPD and OSA.

(Those with asthma and OSA are also said to suffer from “alternative overlap syndrome” because, while asthma is no longer considered a part of the definition of COPD, its presence with sleep-disordered breathing at night leads to the same respiratory stresses and complications.)

Overlap Syndrome as a term was coined in the earlier part of this century when pulmonologists began to notice a couple of things:

  • Patients who have COPD or asthma are more likely to also suffer from OSA based on the very mechanisms of their daytime breathing problems, which become equally evident during the night as they sleep.
  • Patients who had either COPD or asthma, but not OSA, still had breathing problems, but they weren’t as acute as those with the overlap of both.

While a person could have COPD or asthma, and not have OSA as well, the odds figure prominently that they will develop a sleep breathing disorder eventually. This is due to basic upper airway mechanisms that both kinds of disorders share.

Breaking down the overlap

Overlap Syndrome describes comorbidity (or the simultaneous presence) of two health conditions, COPD and OSA.

What is COPD?

COPD is defined by the Global Initiative for Chronic Obstructive Lung disease (GOLD) as:

A preventable and treatable disease with some significant extrapulmonary effects that may contribute to the severity in individual patients. Its pulmonary component is characterized by air-flow limitation that is not fully reversible. The air-flow limitation is usually progressive and associated with an abnormal inflammatory response of the lungs to noxious particles or gases.

More simply put, people who suffer from chronic bronchitis or emphysema, or both, experience compromises to their breathing caused by damage from either (or both) illnesses. This makes it difficult for the body to exchange oxygen through inhalation and carbon dioxide through exhalation.

Without this “gas exchange,” the chemistry of the blood is out of balance, and this can lead to a wide range of problems that can impact the organs, the cells, and overall ability by the body to maintain health and well being.

What is OSA?

We define OSA as the measurable collapse of the upper airway during sleep by a variety of means. This results in dangerous dips in blood oxygen levels as well as increases in carbon dioxide in the blood. Carbon dioxide is a waste product of cellular activity that needs to be exhaled (in exchange for inhalation of oxygen, hence “gas exchange”) in order to restore chemical balance to the bloodstream.

A flooding of stress hormones signaled by the brain during apneas also creates arousals necessary to encourage breathing again.

However, numerous lengthy apneas can create a constant state of stress on the heart, the lungs, and other organs.

Severity of sleep apnea is based on the length and frequency of these collapses and their related arousals. Untreated OSA can contribute to the development of still other problems, like diabetes, kidney disease, and obesity, without active treatment to correct these obstructions.

Are COPD and OSA linked?

Studies have shown a prevalence of both OSA in those with COPD measuring between 11 and 19 percent of those who participated in research. Almost half of all people who have COPD experience some challenges with breathing while asleep, even if they don’t have full-fledged OSA.

People with COPD tend to have reduced levels of blood oxygen all day long, even while they are alert and breathing. When they fall asleep, obstructions to their airways caused by OSA can radically reduce these already reduced levels. This could be life threatening, depending upon severity.

Also, both disorders originate through the same mechanisms, namely the dysfunction of the muscles and tissues of the upper and lower airways. This includes the connective organs and structures between the oral cavity (the mouth) and the respiratory system (the lungs).

But it’s important to note that, while both conditions are difficult to live with and to treat, those people with COPD and OSA have a much higher risk for worsening morbidity and early mortality, compared to those who only have one or the other, but not both disorders.

How is Overlap Syndrome identified and treated?


When COPD (or asthmatic) patients complain of sleep problems, the best way to address these is through an overnight sleep study. During this assessment, accurate measures of blood oxygen and breathing patterns can identify an underlying sleep breathing problem which could qualify as Overlap Syndrome. Once identified, new efforts to manage breathing during sleep can be prescribed.

Guidelines established in 2010 by the American Thoracic Society also suggest that patients with less severe COPD who also suffer from pulmonary hypertension undergo overnight polysomnography to pinpoint hidden problems or customize treatment.


The main effort to treat Overlap Syndrome focuses on two things:

  • the maintenance of adequate blood oxygen at all times of the day
  • the prevention of sleep-disordered breathing (OSA)

The use of continuous positive airway pressure (CPAP), often in combination with supplemental oxygen, is a common approach. Weight loss for those who are obese, and proactive use of short- and long-term steroids to treat COPD symptoms, may also be part of the equation.

Researchers are still refining their clinical definition of these combined conditions and seeking new and better ways to manage them. Still, the challenges of patient quality of life and morbidity still linger.

This reality spotlights the need for patients with breathing disorders of all kinds to receive complete and accurate diagnoses so they can receive the best possible therapy.

COPD FoundationThe American Sleep Apnea Association is proud to partner with the COPD Foundation to help empower and education patients seeking the diagnoses, treatments and support they need.

Further reading
Author: sleepapnea.org

Leave a Reply


  • […] network (PPRN) demo project titled “O2verlap,” based on newly emerging research into Overlap Syndrome, a condition in which two breathing disorders—chronic obstructive pulmonary disease (COPD) and […]

  • […] concerns: tumors, emphysema, chronic obstructive pulmonary disease (COPD), pulmonary fibrosis, or other lung […]

  • Susan

    Four years ago I experienced a severe breathing and wheezing problem that my doctor diagnosed as chronic bronchitis with dust allergy. A year later, it worsened and I was diagnosed of COPD. I came across Herbal HealthPoint (ww w. herbalhealthpoint. c om) December, 2018 and learnt about their successful herbal therapy for COPD. I immediately started on the COPD treatment; few weeks into the treatment, i began to notice a reduction in symptoms till it all vanished. I feel better and breath better. I Just wanted to share for people suffering from this horrible lungs disease.

    • Cathy Browning

      What kind of tea do we need to drink?

      • Darren Chester UK

        I am awaiting assessment for overlap. I have severe COPD and Obstructive Sleep Apnea, 3 years of suffering with this awful disease. CPap did not work for me I’m awaiting BiPap treatment similar machine but allows easier breathing out

        To relieve mucus symptoms and tightness of chest as well as prescribed medication try

        Ginger, and honey and lemon in hot water
        Peppermint also and garlic can ease your chest

  • Triptimoy Gupta

    Please suggest current medicine for copd with sleep apnea using cpap. And inhaler

  • Asley Simon

    Last year I started on COPD formula treatment from Akanni  herbs foundation, the treatment worked incredibly for my lungs condition. I used the herbal treatment for almost 5 months, it reversed my chronic obstructive pulmonary disease. My severe shortness of breath, dry cough, low energy, fatigue, chest tightness and others gradually disappeared. Visit Akanni herbs foundation official web page www. akanniherbalcentre .com. This COPD treatment has improved the quality of my life greatly, i breath much better and feel comfortable doing so!

  • Anastasia Royal

    Hello Everyone, my name is Anastasia from Russian, I was suffering of COPD since 2016 and I was taking my medications, I wasn’t satisfied all i needed is to be permanently free from this disease, I searched about some possible cure for COPD i saw a comment about  Herbal Health remedies Foundation how they cured COPD with herbal medicine. I asked for solutions, all they said to me was that i should not worry that they will send me the remedy cure that i will use to get rid of it. they sent me the medicine. I took the medicine as prescribed by the Herbal remedies Foundation a week and 6 days later i was cured from COPD After doing a test and was confirmed Negative, thank you Herbal Health remedies Foundation.

  • Lucia

    hi, i quickly want to tell you all here what Dr peter did for my family , my husband was diagnosed with Chronic Obstructive Pulmonary Disease (COPD) 8 months ago and i was so scared because i was told there was no cure to it . the thought of loosing my husband was eating me deep and i hardly go to work because i have to look after my husband to ensure he is always with his inhaler , 3 months ago i contacted Dr peter about my husband COPD and he told me not to worry that he will help me and truly Dr peter helped my husband get rid of the Chronic Obstructive Pulmonary Disease with his power healing spell and now my husband can breathe well and his lungs are now in good condition , my husband health is now in good condition and he was recently confirmed COPD FREE . thanks Dr peter for saving my husband from COPD . if you have anyone who is strongly with COPD , ALS, PARKINSON contact Dr peter via peterwiseherbalcenter@ gmail. com

    • Wendy

      That was very interesting. I sleep with bipap as I have a sleep and have COPD. And having trouble sleeping with my bipap should I sleep with just oxygen.or what. Can’t stay up all night. Help plz

  • Steve Vanetta

    I’ve just learned within 4 months of each other that I have stage 2 COPD and sleep apnea. I’m lost

  • Daniel

    I have sleep apnea and use a cpap machine at night. Am I at an increased risk from Coronavirus?

  • Tom Hoel

    I am a disabled vet with 60% COPD / Asthma. I was just diagnosed with Sleep apnea and I am on a cpap machine every night. I would like to link them together for another claim at the VA. Can you help

  • RK Dutta

    I am suffering from OSA since 2010 and use an Auto CPAP machine. Since July 2019 I am diagnosed with COPD also. I am being treated for COPD but off late my situation is worsening. Now a days I am unable sleep continuously for more then few minutes. Please suggest what what should I do. I am 76 years old, living in Delhi, India

  • Wyatt Hunter

    I was diagnosed with severe COPD and emphysema at 48. I had LVRS (lung volume reduction surgery) a year later, which I am forever grateful for it actually led me to multivitamincare .org . I have read some of their stories online before using their natural herbal formula , I had very hard time breathing then, and even more so at night, it was so bad I can’t sleep. I get up with a tight chest that feels blocked and can’t breathe well at all,I was excused from normal life responsibilities but natural herbs from multivitamincare org really helped a but sometimes I think is God prodigy that I was able to treat my Chronic obstructive pulmonary disease but multivitamin care herbal formula has a big impact on my recovery because my heart condition has been fully reversed . They do things for me, and was too happy to comply with their service. This is a equitable of a way to get of your COPD emphysema .

  • Pete Sexton

    I have Agrona. Should I see a pulmonary Dr,?

  • Asley Simon

    . My severe shortness of breath, dry cough, low energy, fatigue, chest tightness and others gradually disappeared. Visit Akanni herbs foundation official web page www. akanniherbalcentre .com. This COPD treatment has improved the quality of my life greatly, i breath much better and feel comfortable doing so!