Orthopnea is a shortness of breath that affects a person when they are lying down but subsides in other positions, such as standing or sitting up. Orthopnea is often a symptom of heart failure or lung disease, but it can also result from other conditions.

For people with orthopnea, the breathing difficulty typically disappears quickly after they get up from a horizontal position. In a related condition known as paroxysmal nocturnal dyspnea, the shortness of breath wakes the person up a couple of hours after they fall asleep.

In this article, we look at the symptoms, causes, diagnosis, and treatment of orthopnea.

Man lying down holding chest in pain because of shortness of breath or orthopneaShare on Pinterest
Orthopnea is shortness of breath that occurs while lying down.

Orthopnea is a symptom rather than a condition in itself. The medical term for shortness of breath is dyspnea. Orthopnea is a type of dyspnea that only occurs when a person is lying down.

People often describe orthopnea as a sensation of tightness in the chest that makes breathing difficult or uncomfortable. Some individuals may also experience chest pain.

Orthopnea can be mild or severe. Some people may barely notice this symptom when they use one or two pillows to prop up their upper body. For others, it can cause significant breathing difficulties that they can only relieve by sitting upright or standing.

Other symptoms can also occur, which will depend on the underlying cause. For example, a common cause of orthopnea is heart failure, which can also cause the following symptoms:

  • fatigue
  • changes in appetite
  • nausea
  • confusion
  • increased heart rate
  • persistent coughing or wheezing

Orthopnea is often a symptom of conditions that affect the normal functioning of the lungs. These can include heart conditions.

Heart disease may result in the heart being unable to redistribute blood and other bodily fluids effectively while a person is lying down. The increased pressure in the blood vessels in the lungs can push fluid into the alveoli, causing a condition known as pulmonary edema.

The alveoli are small air sacs in the lungs. Here, oxygen passes from the lungs into the bloodstream, while carbon dioxide moves from the blood into the lungs. Fluid in the alveoli can interfere with this gaseous exchange, preventing a person from getting enough oxygen around their body.

Several other conditions can also cause orthopnea, including:

  • chronic obstructive pulmonary disease (COPD)
  • obesity
  • anxiety and stress-related disorders
  • sleep apnea
  • snoring

As orthopnea is usually a symptom of another condition, such as heart failure, a doctor will focus on trying to identify the underlying cause.

The doctor may begin with a physical examination to check the severity and timing of the breathing difficulties. They will also ask about other symptoms and review the person’s medical history.

Depending on the suspected cause, the doctor may recommend one or more of the following tests:

  • X-ray or CT scan of the chest. These tests create an image of the inside of the chest, which allows the doctor to see if there are any problems with the lungs or heart.
  • Electrocardiogram (ECG). This test involves placing sensors on a person’s skin to measure electrical signals from the heart. Doctors use an ECG to check the functioning of the heart.
  • Echocardiogram. Also known as an “echo,” this is a type of ultrasound scan that uses sound waves to create an image of the heart. Doctors use this test to check for any problems with this organ.
  • Pulmonary function tests. These tests include spirometry, which involves breathing into a machine. A doctor can use the results to determine how well the lungs are functioning.
  • Arterial blood gas. This is a type of blood test that checks whether a person is getting enough oxygen.
  • Blood tests. These involve taking a small sample of a person’s blood, and doctors use them to check for signs of a wide range of conditions.

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Propping up the upper body with pillows during sleep can help relieve orthopnea.

The purpose of orthopnea treatment is to lessen the symptoms and address the underlying cause.

Some people may be able to relieve symptoms temporarily by sleeping in a more elevated position. A simple way to do this is to prop up the upper body using pillows. Alternatively, a person could try placing foam wedges underneath the mattress or raising the head of the bed using wooden blocks.

If the individual is overweight or obese, losing weight may also help reduce orthopnea. A doctor or dietician can advise on an exercise or diet plan for losing weight.

Depending on the underlying cause of a person’s orthopnea, a doctor may prescribe medications, such as:

  • anti-inflammatory medications
  • drugs to improve the clearance of mucus from the lungs
  • steroids
  • diuretics
  • vasodilators
  • inotropic drugs, which alter the force of the heart’s contractions

Orthopnea is often a symptom of an underlying heart condition. The treatment of this condition may involve ongoing care and lifestyle changes. Depending on the severity of the heart condition, a person may sometimes require surgery.

Orthopnea is a shortness of breath that occurs when lying down but usually resolves on sitting or standing up. Orthopnea is often a symptom of heart failure, but it can develop due to other conditions that affect the normal functioning of the lungs, such as COPD.

Anyone who experiences orthopnea should see a doctor for an evaluation. The treatment of orthopnea will depend on its underlying cause. However, a person may find temporary relief by raising their head and chest with some pillows when lying in bed.