At a Glance
Orthopnea is shortness of breath that occurs when lying flat and improves when sitting or standing upright. It's often a symptom of an underlying medical condition, such as heart failure, obesity, or certain lung disorders. People with orthopnea may need multiple pillows to sleep comfortably or may wake up feeling breathless during the night.
Being able to lie down in a comfortable position is an important part of getting a good night’s sleep. But for some people, lying down can trigger shortness of breath, making it necessary to prop themselves up with pillows or move into a sitting position in order to breathe fully. This kind of breathing problem is called orthopnea and may be caused by a number of conditions.
Below, we explore what orthopnea is, why it happens, and the treatments that may help reduce symptoms and improve sleep.
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Orthopnea Definition
Orthopnea (or-THAAP-nee-uh) is a type of dyspnea, which is the medical term for feeling a shortness of breath. Depending on the body position that triggers symptoms, healthcare providers may use different terms to describe the condition:
- Dyspnea: Difficulty breathing, regardless of position
- Platypnea: Difficulty breathing when standing
- Trepopnea: Difficulty breathing when lying down on the side
Other types of dyspnea include paroxysmal nocturnal dyspnea, which occurs when shortness of breath wakes a person up during the night. Although paroxysmal nocturnal dyspnea may also be relieved by sitting up, it only occurs during sleep.
Sleep Apnea vs. Orthopnea
Sleep apnea is a disorder that involves multiple short periods of reduced breaths or lapses in breathing while a person is asleep. Signs of sleep apnea can be more subtle than orthopnea, and people with sleep apnea may not be aware that breathing problems are disrupting their sleep during the night. Rather, common symptoms of sleep apnea occur during the day, such as excessive sleepiness, headaches, and mood changes.
Although sleep apnea and orthopnea are different conditions, they share a number of risk factors. For example, up to half of people who have heart failure may also have sleep apnea, particularly central sleep apnea (CSA). And research suggests the risk of obstructive sleep apnea (OSA) increases significantly for people who have obesity. Extra weight can lead to more tissue in the upper airway, causing increased upper airway resistance during sleep.
Symptoms of Orthopnea
A person experiencing orthopnea feels breathless or short of breath while lying flat on their back. This feeling is a subjective sensation that may feel different from person-to-person. For example, one person may say they feel short of breath, while another may say they feel like they can’t get enough air as they attempt to breathe. People with orthopnea may also experience:
- Chest tightness or pain
- Wheezing or coughing
- Heart palpitations
Moving to a seated position or propping oneself up to be closer to upright should reduce or eliminate this feeling of breathlessness. Unlike paroxysmal nocturnal dyspnea, the breathlessness of orthopnea occurs even when a person is awake.
Causes of Orthopnea
Orthopnea is generally caused by internal pressure put on the lungs or diaphragm while lying down. This pressure is usually the result of a medical condition.
- Heart failure: Heart failure can cause fluid to accumulate in the lungs, which can lead to breathing problems. Sometimes, orthopnea is the only symptom present in people experiencing heart failure. Other symptoms of heart failure include leg swelling and fatigue.
- Obesity: In people with obesity, a large abdomen may create pressure that causes orthopnea. This pressure could block the diaphragm from moving fully during breathing, or narrow the airways at the bottom of the lungs.
- Pulmonary hypertension: Pulmonary hypertension is a type of high blood pressure that affects arteries in the lungs and is often associated with heart disease. Some people with pulmonary hypertension also experience orthopnea.
- Diaphragm paralysis: The diaphragm is a large muscle below the lungs that enables the lungs to breathe in and out. People with diaphragm paralysis have extreme weakness in their diaphragm and may experience severe orthopnea shortly after lying down.
Diagnosing Orthopnea
Orthopnea is a symptom rather than a medical condition itself, so diagnosis focuses on identifying the underlying cause of the breathing difficulty. A healthcare provider will typically begin by asking about your symptoms, including when shortness of breath occurs, whether it improves when you sit up, and how many pillows you use to sleep comfortably. They may also ask about your medical history, medications, and any existing heart or lung conditions.
A physical exam can help identify signs of fluid retention, heart disease, or respiratory problems. Depending on the suspected cause, additional testing may be recommended. Common tests used to evaluate orthopnea include:
- Blood tests
- Chest X-ray
- Pulmonary function test
- Electrocardiogram (ECG or EKG)
- Echocardiogram
- Sleep study
Treatments for Orthopnea
The treatment for orthopnea depends on its underlying cause.
Heart Failure
Treatment of heart failure depends on the type of heart failure a person has and its severity. Doctors often recommend healthy lifestyle habits, such as exercising regularly, limiting alcohol consumption, managing stress, and sleeping well. Additionally, multiple types of medications are available.
Obesity
Lifestyle changes are also commonly recommended to help people manage obesity. For example, eating healthy foods and regularly engaging in physical activity may help with weight loss. When lifestyle changes are not enough, medications, devices, and surgeries are available.
Pulmonary Hypertension
Treatment for pulmonary hypertension depends on its cause. Reducing salt intake may help some people, as can following an exercise plan designed by a professional. Multiple medications are also used to treat pulmonary hypertension. In severe situations, doctors might recommend surgery or oxygen therapy, if oxygen levels have dropped.
Diaphragm Paralysis
Diaphragm paralysis occurs when the connected nerves stop working properly. It can be caused by a tumor, inflammation, an autoimmune condition, or a traumatic injury. Treatment for this disorder depends on the underlying cause and can range from medication to surgery. In many cases, diaphragm paralysis can be quite serious, requiring oxygen and the use of a ventilator.
When to Talk to Your Doctor
Occasional shortness of breath can occur for many reasons, but you should talk to your doctor if breathing difficulties consistently occur when you lie down or interfere with your sleep. Orthopnea is often a sign of an underlying medical condition that may require evaluation and treatment. Consider contacting a healthcare provider if you:
- Wake up feeling short of breath during the night
- Experience persistent shortness of breath when lying flat
- Notice swelling in your legs, ankles, or feet
- Have chest discomfort, fatigue, or reduced ability to exercise
- Snore loudly or experience other symptoms of sleep apnea
Seek immediate medical attention if shortness of breath develops suddenly, becomes severe, or is accompanied by symptoms such as chest pain, confusion, fainting, or bluish skin or lips.
Frequently Asked Questions
Orthopnea often improves when the underlying cause is treated. For example, managing heart failure, controlling asthma or COPD, treating sleep apnea, or losing weight may reduce or eliminate symptoms.
The duration of orthopnea varies depending on the cause. Some people experience short-term orthopnea related to a temporary illness or flare-up of a chronic condition, while others have persistent symptoms that continue until the underlying problem is treated.
Orthopnea itself is not usually dangerous, but it can be a sign of a serious underlying medical condition. Heart failure is one of the most common causes, though lung disease, obesity, and sleep-disordered breathing can also contribute.
Anxiety can cause shortness of breath and a sensation of not getting enough air, but it does not typically cause true orthopnea. Orthopnea specifically refers to breathing difficulty that occurs when lying flat and improves when sitting or standing.
In some cases, gastroesophageal reflux disease (GERD) may contribute to breathing difficulties when lying down. Acid reflux often worsens in a reclined position, which can irritate the airways and trigger coughing, wheezing, or a sensation of shortness of breath. However, GERD isn't one of the most common causes of orthopnea.
Medical Disclaimer: This content is for informational purposes and does not constitute medical advice. Please consult a health care provider prior to starting a new treatment or making changes to your treatment plan.
Written by
Audra Sarver, MHS, PA-C, Contributing WriterAudra is a licensed, certified physician assistant and freelance health writer. She has specialized in psychiatry since completing her clinical training in 2018. Her passion for writing was born from the desire to make complex medical information more accessible and understandable to patients and their loved ones. Audra likes to write about all things related to behavioral health and physical wellness.
Reviewed by
Gerard J. Meskill, MD, FAASM, Medical ReviewerDr. Gerard J. Meskill is a neurologist and sleep medicine physician specializing in the diagnosis and treatment of sleep disorders, including narcolepsy, obstructive sleep apnea, and insomnia. He is board-certified in both neurology and sleep medicine and has extensive experience helping patients manage complex sleep conditions and disorders of excessive daytime sleepiness.
