Orthopnea

What is orthopnea?

Orthopnea (or-thaap-nee-uh) is shortness of breath (dyspnea) that happens when you’re lying on your back (in a supine position). Sitting or standing up relieves this symptom. Orthopnea can occur randomly or worsen over time. It’s almost always a sign of an underlying medication condition.

Orthopnea is different from paroxysmal nocturnal dyspnea (PND). PND occurs when shortness of breath wakes you up at night. It only occurs during sleep, whereas orthopnea can occur when you’re not sleeping. For example, it can happen when you’re lying down to watch TV or lying down for an exam at your healthcare provider’s office.

Since orthopnea is usually a sign of a more serious condition, it’s important to talk to a healthcare provider if you experience breathing difficulties.

How do people with orthopnea sleep?

People with orthopnea may need several pillows to prop themselves up so they aren’t lying flat. Some may sleep sitting up on a couch or chair because they find it helps them breathe better.

What are the symptoms of orthopnea?

People experiencing orthopnea become short of breath or feel like they can’t get enough air when they lie on their backs. The exact feeling varies from person to person, but people describe it as having difficulty breathing or feeling like they can’t catch their breath. It improves when you sit or stand up.

You may also experience symptoms like:

• Tightness or pain in your chest.
• Wheezing or coughing.
• Heart palpitations.

What causes orthopnea?

An underlying medical condition is usually the cause of orthopnea. These conditions tend to cause fluid to build up around your lungs or make it hard for your lungs to expand and take in air. When you lie flat, your blood redistributes from your legs to your lungs. This puts extra pressure on your lungs, making breathing difficult. If your heart is healthy, it pumps this extra blood out. But, if your heart is weak, it isn’t strong enough to do this. That’s why when you sit up and redistribute the blood again, you find breathing is easier.

Some of the medical conditions that may cause orthopnea or put you at risk for it are:

• Congestive heart failure: People with heart failure often have excess fluid around their lungs, which makes it difficult to breathe. Heart failure makes your heart weak, which doesn’t allow it to pump blood out of your heart when you lie down.
• Pulmonary hypertension (PH): PH is high blood pressure that affects the arteries in your lungs.
• Chronic obstructive pulmonary disease (COPD): COPD is a group of diseases that causes chronic inflammation in your lungs and breathing problems.
• Obesity: People with obesity may not be able to fully expand their diaphragm when they breathe, which leads to feeling short of breath.
• Pulmonary edema: This is a condition that causes fluid to build up in your lungs. Other conditions like pleural effusion can also cause fluid to build up around your lungs.
• Severe pneumonia: Pneumonia is an infection in your lungs that can make it difficult to breathe.
• Diaphragm paralysis: If you have diaphragm paralysis, your diaphragm is too weak to let you fully inhale and exhale when you breathe. This can happen due to a tumor, injury, autoimmune disease or another condition.

What are the complications of orthopnea?

Since orthopnea is typically a sign of another condition, it’s important to see a healthcare provider if you have shortness of breath while lying down.

How is orthopnea diagnosed?

If your healthcare provides suspects orthopnea, they’ll review your symptoms and health history to see if you have a condition that’s associated with orthopnea. They may ask you to describe how breathing feels and how many pillows you need to prop yourself up. Your provider may also order tests to look at your heart and lungs. This could include:

• Chest X-ray.
• Echocardiogram.
• Electrocardiogram (EKG).
• Pulmonary function test.

How is orthopnea treated?

Your healthcare provider will treat the underlying condition while also helping you to take steps to minimize your symptoms. This could involve help with learning how to reposition yourself, giving you supplemental oxygen or taking medication. Some underlying conditions have treatment with surgery or a medical device like a pacemaker.

Lifestyle changes like managing your weight or using an adjustable mattress or foam wedge to prop yourself up may be beneficial.

Some of the common conditions and their treatments include:

• Congestive heart failure: Treatment for heart failure depends on how severe it is. Lifestyle modifications, medication, surgery to open blocked arteries or wearing a device to help your heart work better are all possible treatment options. Common medications include diuretics, angiotensin-converting enzyme (ACE) inhibitors and beta-blockers.
• Pulmonary hypertension: Reducing the amount of salt in your diet and exercising can help with pulmonary hypertension. Surgery or treatment options like oxygen therapy may also help.
• COPD: Treatment for COPD involves medication that relaxes your airways (bronchodilators) and reduces inflammation in your lungs (corticosteroids).
• Obesity: Lifestyle changes, like eating a nutritious diet or exercising, are often the first line of treatment for people with obesity. Sometimes medication or surgery is necessary.
• Pulmonary edema: Treatment usually involves getting extra oxygen and medications to help your heart.
• Pneumonia: Antibiotics are the most common treatment for pneumonia. Getting extra oxygen through a tube in your nose or a mask on your face is also common for severe pneumonia.
• Diaphragm paralysis: This condition can become quite serious and require supplemental oxygen or using a ventilator if you can’t breathe on your own.

Can I prevent orthopnea?

The only way to prevent orthopnea is to reduce your risk of the conditions that commonly cause it. Living a healthy lifestyle is the best way to do this. Some examples of how you can try to avoid conditions that may cause orthopnea are:

• Managing health conditions that can contribute to heart failure like diabetes, high cholesterol, high blood pressure or coronary artery disease (CAD).
• Getting exercise and physical activity regularly. Aim for about 30 minutes of exercise most days of the week.
• Not smoking cigarettes or misusing drugs. If you smoke, ask your provider for help to quit.
• Drinking alcoholic beverages in moderation or not at all.
• Eating a wide range of fruits, vegetables and whole grains each day.
• Visit a healthcare provider yearly for a physical exam and health screenings.

Does orthopnea go away?

It depends on what’s causing orthopnea, the severity and the treatment. With the right treatment, many people see improvement in their breathing when lying down.

Does orthopnea mean you have heart failure?

No, having difficulty breathing while lying down doesn’t mean you have heart failure. Heart failure is one of the main causes of orthopnea, but only your healthcare provider can diagnose you with heart failure.

When should I see my healthcare provider?

Contact your healthcare provider if you have difficulty breathing when you lie down. It may be a sign of a more serious medical condition like heart failure or pulmonary hypertension, which requires immediate attention.

How is orthopnea different than dyspnea?

Dyspnea is the medical term for shortness of breath or difficulty breathing. If you have dyspnea, you’re short of breath no matter what you’re doing or what position you’re in. Orthopnea is shortness of breath when you’re lying down. So, orthopnea can be thought of as dyspnea when you’re lying down.

A note from Cleveland Clinic

Not only can orthopnea make it hard to sleep; it can also be a sign of an underlying health condition. If you feel short of breath when you’re lying down, contact a healthcare provider. Finding and treating the condition causing orthopnea can help make it easier for you to breathe when lying down.