Orthopnea is a shortness of breath some people experience when lying down, which goes away once they return to an upright position. The definition of orthopnea comes from the Greek words for upright (ortho) and breath (pnoea). It’s often a sign of heart failure, but can be caused by other conditions, such as lung diseases, other heart conditions, and obesity.
People who have orthopnea will begin having trouble breathing when they lie down. Once they stand or sit up, their breathing normalizes again. This makes it distinct from other breathing conditions such as:
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.
If you have orthopnea, you may feel short of breath upon lying down. The sensation may come on instantly or develop gradually. You may also feel tightness or pain in your chest or experience additional symptoms like wheezing, coughing, or 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. Some people with chronic heart failure may still exhibit symptoms of orthopnea even when sitting up, although they’ll feel better than they did when lying down.
Orthopnea itself is commonly a symptom of a heart or lung condition.
Orthopnea occurs when there is a buildup of excess fluid that creates pressure around the lungs. When a person lies down, blood from the lower extremities is redistributed to the lungs. If their 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. Fluid may leak out 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 distribute oxygen back 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:
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, such as heart failure, COPD, obesity, anxiety, or another heart or lung disease.
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 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 pressure on the lungs and heart. You can also use an adjustable mattress to raise the head of the bed, or foam wedges underneath the mattress.
Your doctor may prescribe supplemental oxygen, which can be provided through an at-home device or at a hospital. If you are overweight or obese, your doctor may work with you to help reduce your weight.
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.
If you regularly experience difficulty breathing, whether when lying down or doing something else, speak to your doctor. They can help determine what’s causing your breathing problems and recommend appropriate therapies, such as lifestyle changes, medication, and other treatments.