Overview
Orthopnea is a type of breathing difficulty that occurs when a person lies down. Some people may need to sleep with extra pillows or in a more upright position to breathe comfortably. Orthopnea can occur when lying down changes the distribution of blood and fluid in the body, increasing pressure on the lungs in certain conditions. It is commonly associated with heart failure but can also occur with lung diseases, obesity, sleep-related breathing problems and other medical conditions. New or worsening orthopnea should be medically evaluated because it may indicate an underlying heart or lung problem.
Causes
Possible causes include: Heart failure Fluid buildup in the lungs COPD Severe asthma Pneumonia Pulmonary edema Certain heart valve conditions Obesity Sleep apnea and other sleep-related breathing problems Pleural effusion Other heart or lung conditions
Risk Factors
Risk may be higher in people with: Heart disease Previous heart failure High blood pressure Heart valve disease Coronary artery disease Chronic lung diseases such as COPD Asthma Obesity Sleep apnea Kidney conditions that contribute to fluid retention A history of fluid accumulation
Diagnosis
A doctor will ask when the breathing difficulty occurs, whether it improves when sitting or standing, how many pillows are needed for sleep and whether other symptoms are present. Evaluation may include: Physical examination Pulse oximetry Blood tests Chest X-ray ECG Echocardiogram Lung function tests Sleep testing when appropriate CT or other imaging when clinically indicated
Treatment
Treatment depends on the underlying cause. Possible treatments include: Treating heart failure or other heart conditions Managing fluid retention according to medical advice Inhaled medicines for asthma or COPD Treatment of pneumonia or other infections Management of sleep apnea Weight management when appropriate Supplemental oxygen when medically indicated Other treatments directed at the underlying heart or lung condition Do not start or change diuretic, oxygen or other prescription treatment without medical advice.
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Prevention
Some causes of orthopnea may be reduced by: Following prescribed treatment for heart and lung conditions Monitoring and managing blood pressure Avoiding smoking and secondhand smoke Maintaining a healthy weight Following medical advice regarding fluid and salt intake when relevant Managing sleep apnea Taking prescribed medications regularly Seeking medical attention when breathing symptoms become worse
Complications
Persistent orthopnea can interfere with sleep and daily activities. More importantly, it may be a sign of an underlying heart or lung condition. If the underlying condition is severe or untreated, complications may include worsening breathing difficulty, poor sleep, reduced exercise tolerance and, in serious cases, respiratory or cardiac complications.
When to See a Doctor
Consult a doctor if you: Develop new shortness of breath when lying down Need more pillows than usual to sleep comfortably Wake up at night struggling to breathe Have progressively worsening breathing difficulty Notice swelling of the legs or ankles Experience unexplained fatigue or reduced exercise tolerance Have a known heart or lung condition and your breathing symptoms are worsening Seek emergency medical attention for severe or sudden breathing difficulty, severe chest pain, blue or grey lips or skin, fainting, confusion or rapidly worsening symptoms.
Conditions Related to This Symptom
Learn more about medical conditions that may cause or be associated with this symptom.
Asthma
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Chronic Obstructive Pulmonary Disease (COPD)
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pneumonia
Pneumonia is an infection that causes inflammation of the air sacs (alveoli) in one or both lungs. The air sacs may fill…
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Pulmonary Embolism (PE)
Pulmonary embolism (PE) is a life-threatening condition caused by a blood clot that blocks an artery in the lungs. Learn…
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Sleep Apnea (Obstructive Sleep Apnea - OSA)
Sleep apnea is a common sleep disorder in which breathing repeatedly stops and starts during sleep, leading to poor sleep…
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