Breathing Exercises Can Help Elderly Patients with COPD Sleep Better

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Breathing exercises, such as diaphragmatic breathing (DB) and pursed-lip breathing (PLB), improved sleep quality in elderly patients with chronic obstructive pulmonary disease (COPD). However, a sequential approach — abdominal breathing followed by PLB — offered the greatest benefit. These exercises represent an effective, nonpharmacological technique to manage sleep-related issues in this population.

Sleep-related disorders are common among patients with COPD — with approximately half of patients reporting sleep issues. This is particularly prevalent among older individuals who are at an already elevated risk of complications and mortality.

“Breathing exercises, part of the lung rehabilitation program, offer benefits to patients with COPD, including improved breathing patterns, increased arterial oxygen saturation and enhanced lung volumes,” wrote a team of investigators from the Guilan University of Medical Sciences in Rasht, Iran. “These exercises also improve pulmonary function, respiratory muscle strength, exercise capacity, dyspnea and health-related quality of life in COPD patients. As a complementary and non-pharmacological therapy, breathing exercises can reduce sleep deprivation and stimulate body and brain function, sympathetic-parasympathetic systems function and relaxation.”

Although these techniques may improve sleep quality, the impact of these exercises in elderly patients has not been explored. To compare the effects of PLB and DB on sleep quality among this patient population, investigators conducted a crossover clinical trial between February and November 2022. Sixty patients with COPD who were treated at public hospitals in Iran were randomly assigned into two cohorts: DB followed by PLB (Group 1) and PLB followed by B (Group 2).

Each of these exercises was performed for four weeks each, and patients were required to complete the Pittsburgh Sleep Quality Index (PSQI), the COPD Assessment Test (CAT), the Abbreviated Mental Test (AMT) and a demographic information questionnaire prior to training.

Eligible patients were aged 60 years and older, had a clinical diagnosis of COPD, scored a 7 or higher on the AMT, had a CAT score of 20 or lower, had a STOP-BANG score (a two-part questionnaire used to determine the likelihood of obstructive sleep apnea) of 2 or lower, and were able to perform the required respiratory exercises.

DB works by increasing ribcage motion, which may represent the work of breathing, and PLB promotes maximum exhalation and improved patency.

To perform the PLB exercise, a patient is advised to breathe in through the nose for two seconds (“smell the flower”) and then breathe out slowly for four to six seconds while shaping their lips as if they are about to “blow out the candle” while engaging their abdominal muscles. This was limited to three to five breaths per day.

For the DB exercise, the subject placed one hand on their abdomen and the other on the middle of their chest to help understand the position of their diaphragm and its function during breathing. They then breathed slowly and deeply through their nose, pursed their lips, contracted their abdominal muscles and exhaled slowly through the mouth. This exercise was to be performed in increments of six breaths for six minutes (each breath in one minute), two times a day.

Results revealed both abdominal and tightly pursed-lips breathing exercises improved sleep quality of patients with COPD, and no significant differences were found between the two exercises. However, the sequence of exercises in Group 1 resulted in greater improvements in average sleep quality than those in Group 2.

“Based on these results, it is recommended to focus on educational initiatives for nursing staff and other healthcare providers (respiratory therapists, chest physiotherapists, physical therapists, pulmonologists, and hospitalists), especially those following the patients after discharge regarding the effects of respiratory exercises on sleep quality and how to perform them,” investigators concluded.