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Orthopnea
- Definition: Orthopnea is shortness of breath while lying down that goes away when you stand or sit up.
- Symptoms: Orthopnea can cause symptoms like wheezing, coughing, heart palpitations, and chest tightness or pain.
- Causes: The cause of orthopnea is a buildup of excess fluid that increases pressure on the lungs. Orthopnea is commonly a symptom of a heart or lung condition.
- Diagnosis: Orthopnea is typically diagnosed alongside an underlying condition, through a physical assessment, imaging, and heart, lung, and blood tests.
- Treatment: Treatment for orthopnea can include sleeping with the head and chest elevated, medication, and supplemental oxygen.
If you’ve ever found it harder to breathe when lying down, you may have experienced orthopnea, a symptom that can signal an underlying health condition. Unlike general shortness of breath, orthopnea specifically occurs when you are flat on your back and often improves when you sit up or elevate your head.
Recognizing orthopnea is important because it may be an early warning sign of a more serious problem that requires medical evaluation.
Orthopnea Definition
Orthopnea (or-thaap-nee-uh) is shortness of breath when lying down that’s relieved by sitting or standing. This type of breathing trouble often signals heart failure, but can also be caused by other conditions, such as lung diseases, obesity, and other heart conditions.
People who have orthopnea have trouble breathing when they lie down in any position — back, stomach, or side — which makes it distinct from other breathing conditions such as:
- Dyspnea: difficulty breathing, regardless of position
- Platypnea: difficulty breathing when standing
- Trepopnea: difficulty breathing when lying down on the side
Orthopnea is also distinct from paroxysmal nocturnal dyspnea (PND), a condition where the person experiences sudden difficulty breathing during sleep. Symptoms occur a few hours after the person has fallen asleep, and the sudden shortness of breath wakes them up. Like orthopnea, changing to an upright position improves their breathing. Since relaxing into sleep is challenging when you feel like you can’t breathe, both conditions can disrupt sleep.
Orthopnea Symptoms
If you have orthopnea, you may feel short of breath upon lying flat. The sensation may come on instantly or develop gradually. You may also experience:
- Tightness or pain in your chest
- Wheezing
- Coughing
- Heart palpitations
Once you stand or prop yourself up, your breathing improves, as do any other symptoms.
The severity of orthopnea varies. Some people need just one pillow to prop themselves up and feel better, while others may need to sit fully upright or stand in order to feel relief.
Orthopnea Causes
Orthopnea is often a symptom of another underlying condition. It occurs when there’s a buildup of excess fluid that creates pressure around the lungs.
When a person lies down, gravity redistributes blood from the lower extremities, which creates pressure in the blood vessels surrounding the heart and lungs. If the heart is healthy, it can handle this additional volume around the lungs and pump it out adequately. When the heart is weakened by heart failure or another condition, it’s not strong enough to perform this process effectively. The extra blood takes longer to get out of the heart, increasing pressure on the lungs.
This pressure can cause fluid to leak from blood vessels into small air sacs in the lungs, causing what’s known as pulmonary edema . These sacs assist with the exchange of oxygen and carbon dioxide in the body. When fluid builds up, it disrupts the exchange, making it harder for the lungs to absorb oxygen into the bloodstream.
It’s easier for the lungs to clear out excess fluid when they’re in an upright position, which is why orthopnea symptoms are relieved once the person stops lying down. Orthopnea can be associated with health conditions such as:
- Heart failure
- Emphysema
- Chronic obstructive pulmonary disease (COPD)
- Fluid buildup between the lungs and chest wall (pleural effusion)
- Anxiety or panic disorder
- Abdominal swelling from liver failure (ascites)
- Diaphragm paralysis
- Pulmonary edema
- Pneumonia
- Sleep apnea
- Snoring
- Obesity
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Diagnosing Orthopnea
A doctor suspects orthopnea when a person experiences shortness of breath when lying down and they exhibit other symptoms of one of the conditions commonly associated with orthopnea.
During your appointment, your doctor will ask you about the onset and timing of your symptoms, in order to distinguish orthopnea from another type of breathing difficulty. They will also ask you to describe the severity of your orthopnea. For example, they may ask how many pillows you need to use to feel relief.
If you haven’t yet been diagnosed with a related underlying condition, your doctor may order additional tests, such as a chest X-ray, electrocardiogram, echocardiogram, pulmonary function test, or blood test, to evaluate for potential causes.
Treatments for Orthopnea
Treatments for orthopnea are focused on minimizing symptoms and treating the underlying cause. Specific treatments for orthopnea include pillow positioning, supplemental oxygen, and medication. Depending on the severity of the underlying condition, doctors may prescribe lifestyle changes, medications, medical devices, or surgery.
Propping yourself up with a pillow can help you breathe better by reducing fluid migration to the upper body. You can also use a wedge pillow or an adjustable mattress to raise the head of the bed.
A number of medications may be prescribed to improve orthopnea symptoms, including drugs that strengthen the heart, improve blood flow, or prevent fluid buildup or inflammation in the lungs.
For example, if you have orthopnea due to heart failure, your doctor may prescribe diuretics, angiotensin-converting enzyme inhibitors, or beta blockers. If your orthopnea is a symptom of COPD, your doctor may prescribe bronchodilators or inhaled steroids.
Your doctor may also prescribe supplemental oxygen, which can be provided through an at-home device or in a hospital. If you have obesity, your doctor may work with you to help reduce your weight.
When to See Your Doctor
Contact your healthcare provider if you experience any new difficulty with breathing in any position, including lying down. Orthopnea causes can be serious, and a doctor can help you determine what’s triggering your breathing problems and recommend appropriate therapies, such as lifestyle changes, medication, and other treatments. If you have severe shortness of breath with or without chest pain, go to the emergency room or call 911.
Frequently Asked Questions
What is the difference between sleep apnea and orthopnea?
When you have sleep apnea, your breathing pauses throughout the night because of airway obstruction or faulty brain signals, but orthopnea feels like you can’t draw a full breath while lying down.
Is orthopnea a symptom of heart failure?
Yes, orthopnea can be a symptom of heart failure, which can cause fluid buildup in the lungs.
How do people with orthopnea sleep?
People with orthopnea often sleep better when propped up on pillows. Depending on the cause of your orthopnea, oxygen and medications may also improve your sleep.
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Eric Suni has over a decade of experience as a science writer and was previously an information specialist for the National Cancer Institute.
Audrey Wells, MD attended University of Michigan Medical School and went on to train at Washington University School of Medicine in pediatrics and pediatric pulmonary medicine. It was during this time that she developed a specific interest in adult and pediatric sleep medicine. She returned to her home state of New Mexico to complete a sleep medicine fellowship.
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