Kathie,

My mom had COPD before passing away, I have chronic asthma and my husband has been recently diagnosed with emphysema and has a history of bronchitis and pneumonia, so I have some knowledge of your conditions. 

It sounds like you may have lower oxygen levels while sleeping, so I'd recommend talking to your doctor about using oxygen especially at night.  Raising the head of your bed may help as well.  I'd also see about changing your meds from inhalers to a nebulizer if possible and would ask about "Spiriva" it is a medication developed especially for copd patients.  My mom was able to move more air with it, it is a special inhaler medication, also she was on prednisone daily for several years.  You are young to be starting steroids for life, so that may be why you aren't on them, but a round or two may help for awhile.  My husband has been put on Spriva and has noticed his breathing is getting better. 

With my chronic asthma I use a nebulizer instead of the inhaler as the albuterol gets into the lungs better.  My doctor who is an asthma specialist  is trying to avoid the steroids if possible due to the side effects they have, but I have been on them off and on for a couple years, sometimes it takes 3 rounds in a month to get my lung function up where it needs to be.    To help get your oxygen levels up some, try pursed breathing.  (breathe in through nose as long as you can, out through mouth as if you are trying to whistle for as long as you can...try about 5 or more in a row.)  I didn't see albuterol on your list, but it sounds like you may benefit from using it 4 times a day (with my attacks, I use it every 4 hours around the clock, and have used it more if really needed, again in the nebulizer as it works better) and I always have a rescue inhaler with me.   I try to stay active more so when the weather is nice, I take walks with my grandkids, golf, ride 4 wheelers,  just get outside and move.  In the winter I will go to the store and walk around some and just household chores helps me move more...I always wear a scarf around my face and breathe through it during the colder weather.   I have found that getting some exercise, even if it's walking slowly and short distances will help increase the lung function.  I was told that you need to move around to get the blood flowing which will help with the lungs as well.

I assume you have a peak flow meter so you can check your outflow due to the asthma.  Do you have something to measure the amount of air you take in?  My doctor had me get a "Coach 2" device to use and improve my intake.  I am to use it several times a day.  It cost about $35.  You suck in it to measure the amount of air you bring in (as opposed to the peak flow measuring output)  My husband also uses a device that you blow into and it vibrates and loosens up the mucus to help get it out.  They gave it to him in the hospital when he had pneumonia and my mom also had one.  I'm sorry, I don't remember the name of it. 

If you haven't seen a pulmonologist, I'd recommend it, they are more knowledgeable about medications to help you breathe better than a regular doctor.  Search the internet for information about your conditions and see what tips others have...I like the mayo clinic site for information, it's one I really trust.  Some communities have a support group for people with cronic conditions, so you can check that out (check your local health dept. or hospital for info) 

You may also benefit from having a diaretic added to your medications to help get rid of fluids (usually taken first thing in the morning and again in the afternoon, they work for about 6 hours)  also try and not drink too much for a couple hours before going to bed and urinate right before bed to avoid accidents.  Most people with COPD have fluid retention and getting rid of it will help take the stress off your lungs, heart, etc. 

One last thing, avoid smoking or being around anyone who smokes.  It really irritates the lungs.  My husband is smoking again, although trying to quit and he has to smoke outside and not in the van either as it irritates my lungs. I was told I can't be around smoke, although there are some places I can't avoid it, but do try to.  I love the smell of wood burning and bonfires in the summer, but they seem to be out now as well, although I'll play that by ear come summer.  It was just this fall I was told to avoid all those things.  I was started on new medication, so hopefully it will turn things around.  This last attack started the beginning of October and hasn't gone yet, but is getting better.  My lung function has improved from 41% in October to 72% a couple weeks ago, so we're headed in the right direction. 

Good luck and I hope some of my suggestions  will work for you and others who are having problems.

Sheri