What Is Orthopnea? and How is Orthopnea Treated? Update 05/2024

Orthopnea is a form of sleep apnea in which a person experiences difficulty breathing while lying down but recovers when they rise or sit up. Although orthopnea can be caused by other illnesses, heart failure and lung disease are common causes.

When persons with orthopnea get up from a horizontal posture, their breathing problems usually go away almost immediately. Paroxysmal nocturnal dyspnea is a similar ailment in which the sufferer is roused from sleep by episodes of shortness of breath.
Do You Experience Breathing Issues When Lying Down? It Could Be Orthopnea - Do You Experience Breathing Issues When Lying Down? It Could Be Orthopnea

Orthopnea’s root causes, medical analysis, and therapeutic options are discussed here.

What is orthopnea?

Medical professionals use the word “orthopnea” to describe episodes of difficulty breathing experienced while lying flat and alleviated by sitting or standing. Depending on what’s triggering your orthopnea, it could develop gradually over time or appear out of the blue. Some people report that their chronic shortness of breath makes it necessary to utilize multiple pillows when sleeping. The need for more pillows when sleeping may be indicative of orthopnea’s severity. For instance, the severity of orthopnea can be measured by the number of pillows required to support the patient’s head and neck while sleeping.

Orthopnea develops when pulmonary congestion makes the lungs rigid and non-compliant, rendering them incapable of expanding and stretching to take in sufficient air. Recumbent (laying flat) posture reduces pulmonary compliance because the lungs move to a more backward position. Changes in compliance increase the work of breathing, necessitating a higher respiratory rate to adequately evacuate the lungs. While doing so, blood is also redirected from the lower extremities and splanchnic blood arteries (those supplying the digestive organs in the abdomen) to the lungs. Pulmonary arterial pressure rises when more blood is pumped to the heart. Pulmonary edema and orthopnea occur when an underlying condition makes it impossible for the body to adapt to the increased blood volume, increased pressure, and decreased compliance that occur when lying down.

What is the difference between orthopnea and dyspnea?

While both orthopnea and dyspnea refer to the experience of shortness of breath, the former is limited to the supine or recumbent position. However, shortness of breath is simply referred to as dyspnea.

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What causes orthopnea?

Several medical problems can contribute to orthopnea. Heart conditions such congestive heart failure, coronary artery disease, and valve malfunction are the leading causes of orthopnea. The left ventricle may not be able to efficiently pump blood into the systemic circulation in patients with heart failure or coronary artery disease. When this occurs, blood flows backwards into the left atrium and the pulmonary circulation, raising the pulmonary arterial pressure and leading to pulmonary edema (i.e., fluid in the lungs). Also, mitral stenosis and other forms of valve disease can lead to fluid accumulation in the left atrium and lungs. People with a myocardial infarction history are also at a higher risk of developing orthopnea.

The chronic obstructive pulmonary diseases (COPD) emphysema and chronic bronchitis are common causes of orthopnea. Orthopnea may also be caused by other limiting lung disorders such interstitial fibrosis or pneumoconiosis.

In addition to ARDS, abdominal obesity, ascites, pneumonia, and nervous system trauma can all lead to orthopnea.

How is orthopnea diagnosed?

Orthopnea can be diagnosed after a thorough medical history and physical examination. The answer may lie in the answers to questions on the number of pillows used to sleep on, the presence of chest pain or coughing, and the ability to exercise. Wheezing, rales, or dullness to percussion on a pulmonary physical exam can also indicate lung involvement, whereas the presence of murmurs, an atypical location of maximal impulse, or extra heart sounds can be seen on a cardiovascular physical exam.

Further medical investigation may be needed to determine the root cause of orthopnea, as it is merely a sign of a more serious condition. To diagnose anemia, hypoxia (low blood oxygen levels), or ventricular hypertrophy, a doctor may order a complete blood count (CBC), arterial blood gas (ABG), or B-type natriuretic peptide (BNP) blood test. Fluid accumulation in the lungs can be seen on an X-ray, and abnormalities in the heart’s structure can be seen on an echocardiography. If a pulmonary disorder is suspected, spirometry might be a helpful diagnostic technique. It’s possible that more investigation is required to rule out alternative explanations.

How is orthopnea treated?

In order to effectively treat orthopnea, the underlying cause must be addressed. The etiology can be treated in a variety of ways, depending on the underlying disease. Acutely, diuretics (such as furosemide) may be used to treat pulmonary congestion by reducing the volume in the pulmonary venous circulation. In addition to beta-blockers, ACE inhibitors, and diuretics, heart failure can also be treated with these medications. Bronchodilators, oxygen therapy, and glucocorticoids are all possible treatments for lung diseases.

What are the most important facts to know about orthopnea?

If you have trouble breathing when lying down, you may be experiencing orthopnea, pronounced “or-thaap-nee-uh,” which is a symptom of a more serious condition. It’s caused by the lungs not doing their job properly and by blood pooling in the pulmonary system. Orthopnea is more likely to occur in people who already have heart failure or lung illness. Orthopnea is typically diagnosed after a thorough examination of the patient’s medical history. However, additional testing may be required to pinpoint the precise cause. Treatment options for orthopnea include supplemental oxygen, repositioning, and diuretics. It may be more difficult, depending on the condition, to treat the root cause.


Some common questions about orthopnea are addressed here.

What is the difference between dyspnea and orthopnea?

A person with dyspnea has difficulty breathing in any position. When a person has orthopnea, they have difficulty breathing while lying down.

Feeling out of breath is a common side effect of exercise, but dyspnea occurs when a person experiences this sensation at rest or during mild activities.

Is orthopnea a symptom of heart failure?

Yes, orthopnea can be a symptom of heart failure. Yet there are numerous other circumstances that can bring about this effect.

Among these are chronic obstructive pulmonary disease, paralysis of the diaphragm, severe obesity, pleural effusion, and pneumonia.

Can GERD cause orthopnea?

Acid from the stomach flows back up into the esophagus, causing a condition known as gastroesophageal reflux disease (GERD). When lying down, the acid is more likely to enter the lungs.
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A person may feel difficulty breathing as a result of this.

Why do people with orthopnea prop up their pillows?

When a person has orthopnea, they have trouble breathing while lying flat, so sleeping with their head elevated is recommended. It may be necessary to use many pillows before you can sit up straight.

Is bendopnea dangerous?

Bendopnea, also known as shortness of breath when bending at the waist, is a symptom of increasing heart failure and may necessitate emergency medical intervention. Feelings of pressure or tightness in the chest are another symptom.


When lying down, people with orthopnea have shortness of breath that usually goes away when they sit or get up. Although orthopnea is frequently associated with heart failure, it can also arise from other lung disorders such chronic obstructive pulmonary disease.

It is recommended that anyone experiencing orthopnea see a doctor. Depending on the etiology of orthopnea, treatment options will vary. If you’re experiencing discomfort when lying in bed, propping yourself up with pillows may help.

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