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

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

This article looks at the causes, diagnosis, and treatment of orthopnea.

A woman adjusts the pillows on her bed for orthopnea comfort. Share on Pinterest
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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 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 depending on the underlying cause. For example, a common cause of orthopnea is heart failure, which can also cause the following symptoms:

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

Several other conditions can also cause orthopnea, including:

Heart disease may make the heart 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.

Orthopnea is a respiratory symptom that happens when a person is lying down. People may experience other respiratory symptoms. These include:

  • Dyspnea: This is where a person has difficulty breathing during activities that are not strenuous.
  • Platypnea: This condition causes shortness of breath when people are standing up.
  • Trepopnea: This is where people experience shortness of breath when lying on their side.

As orthopnea is typically 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. This 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. Doctors use them to check for signs of a wide range of conditions.

The purpose of orthopnea treatment is to ease 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 with 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 has overweight or obesity, taking steps to reach a moderate weight may also help reduce orthopnea. A doctor or dietician can advise on exercise and diet plans 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.

Treating heart failure

Heart failure is not curable. It is treatable, and doctors will work with people to determine an appropriate treatment plan. Treatment for heart failure may include:

Treating COPD

There are many treatment options for COPD. These include:

  • medications
  • pulmonary rehabilitation
  • supplemental oxygen
  • surgery
  • clinical trials

This section answers some frequently asked questions about orthopnea.

What is the difference between dyspnea and orthopnea?

Dyspnea is when a person experiences shortness of breath regardless of what position they are in. Orthopnea is when a person experiences shortness of breath when lying down.

It is typical for people to feel as though they cannot catch their breath after doing strenuous exercise, but if a person feels this way no matter what activity they are doing, it is known as dyspnea.

Is orthopnea a symptom of heart failure?

Yes, orthopnea can be a symptom of heart failure. However, it can also be the result of many other conditions.

These include COPD, diaphragm paralysis, massive ascites, morbid obesity, pleural effusion, and pneumonia, among others.

Can GERD cause orthopnea?

Gastroesophageal reflux disease (GERD) is where stomach acid moves into the esophagus. The acid can enter the lungs, especially when a person is lying down.

This can cause a person to experience shortness of breath.

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

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