Shortness of Breath When Lying Down? Orthopnea Causes and Treatment

Medically Reviewed By Luke Davis, MD
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Difficulty breathing is concerning, particularly while lying down. That is orthopnea, and it can occur due to various conditions. Sitting or standing up relieves orthopnea. Depending on the cause, orthopnea can appear gradually or suddenly.

Contact a medical professional immediately if you experience difficulty breathing, especially if it develops suddenly or worsens when lying down. Some causes are serious medical conditions, including heart failure. Contacting a clinician early on may help identify the underlying cause before it leads to additional problems.

This article will outline the causes of orthopnea and related symptoms. It will also look into possible treatments for the underlying conditions and how to manage them long term.

Orthopnea explained

woman lying flat in bed with look of concern
Demetr White/Stocksy United

Orthopnea is shortness of breath while lying down. You may feel like you cannot catch your breath.

Orthopnea is distinct from dyspnea, the general term for shortness of breath.

Tightness or pain in the chest may accompany difficulty breathing.

Possible causes of orthopnea

A range of conditions can cause orthopnea, including:

Diaphragmatic paralysis

The diaphragm is your breathing muscle. As the diaphragm contracts, your lungs fill up with air. The phrenic nerve is necessary for contraction. If there is a problem with the phrenic nerve, the diaphragm may not contract as usual.

Diaphragmatic paralysis is a serious but rare cause of orthopnea. Conditions that may affect the phrenic nerve include:

Sometimes, doctors cannot identify a cause of diaphragmatic paralysis. The diaphragm may also resume functioning after a period.

People with reduced diaphragm function may be candidates for diaphragmatic pacing. This process involves a device that stimulates the phrenic nerve so that the diaphragm contracts.

Obesity

Obesity is associated with reduced lung function. The effects of obesity on lung function are related to the distribution of fat within the body.

Severe obesity in the abdominal region restricts the expansion of the lungs. This restriction reduces the volume of air the lungs can inhale, leading to shortness of breath. With obesity, you may feel out of breath while sitting up, lying down, or both.

Heart failure

Orthopnea is frequently a symptom of heart failure. This is when the heart cannot pump blood effectively enough. Ultimately, this causes pressure in the heart to increase, which forces fluid back into the lung.

Fluid may leak into lung connective tissues and alveoli, restricting air from getting in and out of the lungs. This fluid impairs oxygen and carbon dioxide exchange at the alveoli.

Shortness of breath occurs as oxygen levels fall, carbon dioxide levels rise, and the nerve fibers in the lung and chest wall stretch.

Heart failure can occur due to:

Additional symptoms of heart failure may include:

COPD

COPD, such as emphysema and chronic bronchitis, can also cause orthopnea. The direct cause of this is unclear. However, one small study suggests that COPD coincides with a decrease in the ability to inhale enough air while lying down.

Additional symptoms of COPD may include:

Diagnosing the underlying cause of orthopnea

Orthopnea is due to an underlying medical condition, whether obesity, heart failure, or a rare disorder. Your clinician will evaluate your symptoms, listen to your lungs, and order tests. These may include:

Treatment options for orthopnea

Orthopnea is a symptom of an underlying problem. As such, a clinician will try to identify the underlying cause and treat that. Below is a summary of treatments for common causes of orthopnea.

Heart failure

There are many possible causes of heart failure. The first step to treating it is determining the cause, if possible. Depending on test results and other factors, recommendations for heart failure may include:

  • lifestyle changes, including a balanced diet and exercise plan
  • medications, including drugs to reduce lung congestion and make it easier for the heart to pump
  • surgery, which could include:
    • repair or replacement of the damaged valve
    • angioplasty and stenting of blocked blood vessels
    • pacemaker placement

COPD

Treatments for COPD that improve breathing may include:

  • lifestyle changes, such as stopping smoking and increasing exercise
  • medication, such as inhalers and tablets, to help relax airways and reduce inflammation
  • supplemental oxygen

Obesity

Medical and surgical management of obesity may include:

Self-care

If you have orthopnea, you may already know that sitting up helps relieve your symptoms. However, it is more difficult to sleep and rest comfortably when you have orthopnea.

Alongside medical care to address the cause of orthopnea, consider using pillows or bed risers beneath one side of your bed. These can help raise your upper body when sleeping or resting in bed.

Anxiety

Difficulty breathing can cause anxiety, which can make breathing problems worse. Inform your doctor if you feel anxious or are experiencing such symptoms as:

Talking with someone about your breathing and other symptoms may help relieve some anxiety about it. Additionally, some medications can reduce anxiety. Practicing stress reduction techniques, such as yoga, may also help.

Outlook

Your outlook will vary depending on the reason for orthopnea and its treatment.

Heart failure is usually a chronic, lifelong condition that worsens with time. However, there are treatments for some of its causes. Moreover, heart medications and lifestyle changes can help you maintain regular activities.

The outlook for people with COPD varies. The condition has no cure, but treatment can help many people manage it. However, despite treatment, COPD can worsen and reduce the quality of life. 

Your doctor can discuss your outlook based on your specific circumstances.

FAQ

Luke Davis, M.D., reviewed the following frequently asked questions.

Is orthopnea specific to heart failure?

Heart failure is the most common cause of orthopnea. However, other conditions, such as COPD, obesity, and diaphragmatic paralysis, can make breathing difficult when lying down.

Can you cure orthopnea?

You may cure orthopnea by curing or managing the underlying condition. Sometimes, lifelong medication is necessary to manage symptoms like orthopnea.

Summary

Orthopnea is the medical term for shortness of breath when lying down. It is commonly a sign of reduced heart function, which causes pulmonary congestion. This makes the lungs stiff and unable to expand fully with each breath. COPD can also cause it, making it difficult to draw air in and out of the lungs.

In addition to the physical causes of orthopnea, talk with your doctor if the symptom itself causes mental health problems, such as stress or anxiety.

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Medical Reviewer: Luke Davis, MD
Last Review Date: 2022 Aug 26
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THIS TOOL DOES NOT PROVIDE MEDICAL ADVICE. It is intended for informational purposes only. It is not a substitute for professional medical advice, diagnosis or treatment. Never ignore professional medical advice in seeking treatment because of something you have read on the site. If you think you may have a medical emergency, immediately call your doctor or dial 911.
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