Shortness of breath, or breathlessness, describes difficulty or discomfort when breathing. A person may feel tightness in the chest or feel as though they cannot get enough air. The medical term for shortness of breath is dyspnea. Potential causes include congestive heart failure, obesity, and respiratory issues.

Sometimes, people find it hard to breathe when they are lying down flat. The medical term for this is orthopnea. People who experience this will often need to prop themselves up on pillows so that they can sleep.

There are several possible causes of orthopnea, such as carrying excess weight or having an underlying health condition such as heart failure.

In some cases, the feeling of breathlessness can wake the person up suddenly. The medical term for this is paroxysmal nocturnal dyspnea. A few things, including snoring and certain sleep disorders such as obstructive sleep apnea (OSA), can cause paroxysmal nocturnal dyspnea.

This article will look at some of the more common causes of and treatments for shortness of breath when lying down.

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Possible causes of orthopnea are heart failure, emphysema, and obesity.

One of the most common causes of orthopnea is heart failure.

In heart failure, the heart can no longer pump blood to the rest of the body as well as it should. Or, it has trouble relaxing after squeezing. So, the pressures in the heart increase, which can cause the fluid to back up into the lungs, abdomen, or legs.

Heart failure can result in fatigue, shortness of breath, leg swelling, and, in some cases, coughing. Everyday activities such as walking and climbing stairs can become more difficult.

Some signs and symptoms of heart failure include:

  • shortness of breath
  • persistent coughing or wheezing
  • a buildup of excess fluid in the feet, ankles, legs, or abdomen
  • weight gain
  • lack of appetite
  • nausea
  • confusion or impaired thinking
  • increased heart rate or heart palpitations

There is no cure for heart failure, but people can usually manage the condition by using medications and making healthful lifestyle choices.

Typical medications for heart failure include:

  • angiotensin-converting enzyme inhibitors, such as lisinopril or enalapril
  • angiotensin II receptor blockers, such as candesartan or losartan
  • angiotensin-receptor neprilysin inhibitors, such as sacubitril/valsartan
  • beta-blockers, such as metoprolol or carvedilol
  • aldosterone antagonists, such as spironolactone or eplerenone
  • diuretics or water pills, such as furosemide and bumetanide

To treat orthopnea, a doctor may need to adjust a person's diuretic medication to remove the fluid buildup from the lungs and reduce intracardiac pressures.

Emphysema is a type of lung condition comprising chronic obstructive pulmonary disease (COPD).

This condition damages the air sacs in the lungs and makes the breathing tubes narrower, making it more difficult to breathe.

Smoking causes most cases of emphysema. Passive smoking and poor air quality can also play a role.

People with this condition will usually find it difficult to breathe when carrying out physical activities. In advanced emphysema, people may also experience shortness of breath when sitting or lying down.

The main symptoms of COPD include:

  • chronic cough
  • shortness of breath while doing everyday activities
  • frequent respiratory infections
  • blueness of the lips or fingernail beds
  • fatigue
  • producing a lot of mucus
  • wheezing

It is not possible to reverse the lung damage that emphysema causes. However, quitting smoking can stop the damage from getting any worse.

Treatments for COPD tend to focus on preventing further damage and improving the symptoms. They include:

  • inhalers that can relax the airways, such as bronchodilators
  • inhalers that can reduce airway inflammation and mucus production, such as steroid inhalers
  • pulmonary rehabilitation programs, which tend to combine education, exercise training, nutrition advice, and counseling
  • supplemental oxygen or oxygen therapy
  • lung surgery, which can help improve breathing for some people
  • complementary therapies such as yoga, massage, and acupuncture, which may help improve quality of life

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Regular exercise and a healthful diet can help ease orthopnea.

People who carry excess weight or have obesity may have difficulty breathing when lying down due to the compressive effects of the weight on their abdomen. Called "pannus," this phenomenon prevents the lungs from inflating fully.

Around 93.3 million adults in the United States had obesity in 2015–2016.

Obesity has links to health conditions including:

Losing weight can help ease orthopnea. The best way to lose weight is to get plenty of exercise and follow a healthful, balanced diet.

To adopt a healthful diet, try eating:

  • several servings of fruits and vegetables per day
  • whole-grain bread and cereals
  • healthful fats from nuts, seeds, and olive oil
  • lean protein from poultry, fish, and beans
  • limited amounts of red meat

People who follow a healthful diet often have lower rates of heart disease, diabetes, and some other chronic health conditions.

OSA is a sleep disorder that can cause breathing difficulties while sleeping.

A common sign of OSA is snoring that is interspersed with gasping and choking sounds. People with OSA may also pause their breathing.

Other symptoms of OSA may include nocturia (or getting up to urinate during the night), depression, irritability, nocturnal palpitations, and sexual dysfunction.

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Anxiety or panic attacks can cause shortness of breath.

Panic attacks and anxiety attacks can come on at any time and be very frightening. Although these episodes do not fit within the typical orthopnea bracket, they can cause shortness of breath when lying down.

People tend to describe these attacks as the abrupt onset of intense fear or discomfort that reaches a peak within minutes.

Symptoms of a panic or anxiety attack might include:

  • shortness of breath
  • heart palpitations
  • sweating
  • trembling or shaking
  • feelings of choking
  • pain or discomfort in the chest
  • nausea
  • feeling dizzy or lightheaded
  • feeling very hot or very cold
  • a numbness or tingling sensation called paresthesia
  • feelings of unreality or of being detached
  • fear of loss of control
  • fear of death

There are treatments available for panic disorder and anxiety, including counseling, psychotherapy, and cognitive behavioral therapy.

Shortness of breath that is not related to strenuous exercise, exposure to extreme temperatures, poor air quality, obesity, or high altitude could be a cause for concern.

Sudden shortness of breath accompanied by chest pain or pressure, fainting, or nausea could be a sign of a more serious medical condition.

If a person suddenly begins experiencing shortness of breath, they should seek medical evaluation.

Orthopnea is the medical term for shortness of breath when lying down. People who experience this condition often have to sleep with their heads propped up on pillows.

Many conditions, including obesity and heart failure, can give rise to orthopnea. Treatments tend to depend on the underlying cause.

Anyone who finds it difficult to breathe because they have obesity may find that the problem eases when they lose weight.

Unexplained shortness of breath or breathing difficulties that are accompanied by chest pain or pressure, fainting, or nausea could be a sign of a more serious medical condition.

Anyone who experiences this should speak to a doctor.