What Is Orthopnea?

Key Takeaways

• Definition: Orthopnea is shortness of breath that arises or gets worse when lying flat on your back.
• Symptoms: The main symptom of orthopnea is difficulty breathing, which may involve shallow breaths or a sensation of not getting enough air.
• Causes: Many health issues can cause orthopnea. The most common causes are heart failure, lung problems, and obesity.
• Diagnosis: Doctors diagnose the underlying cause of orthopnea by asking questions about your symptoms and health history and conducting a physical exam. They may also order tests to find out why you feel short of breath.
• Treatment: Treatment for orthopnea focuses on addressing the underlying cause of your difficulty breathing.

Orthopnea Definition

Orthopnea is the feeling of shortness of breath when lying on your back. The medical term for shortness of breath is dyspnea. For some people, dyspnea only occurs in certain situations, and there are different terms for these issues.

• Orthopnea: Orthopnea is difficulty breathing when lying down flat on your back.
• Platypnea: The opposite of orthopnea, platypnea is shortness of breath that occurs when a person is upright and gets better when they lie down.
• Trepopnea: Trepopnea is shortness of breath that only happens when lying on one side of the body. 
• Bendopnea: This is a type of dyspnea that occurs when leaning or bending over.

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Orthopnea Symptoms

Orthopnea and other forms of dyspnea involve difficulty breathing and can include different sensations, such as: 

• Heavy breathing
• Unsatisfying breaths
• Breathing that takes more effort than normal
• Breathing that is shallow and rapid
• Feeling suffocated

Dyspnea can occur in any body position and in diverse situations. Orthopnea specifically refers to dyspnea that either starts or worsens when lying down, and it usually disappears or improves when sitting or standing up.

A type of dyspnea called paroxysmal nocturnal dyspnea (PND) shares similarities with orthopnea. PND causes people to wake with severe shortness of breath an hour or more after falling asleep. As with orthopnea, PND usually subsides when a person sits or stands up, but unlike orthopnea, PND only occurs after a person has fallen asleep.

PND can be a symptom of a serious heart condition, so it’s important to talk to your doctor if you wake up gasping for breath or feeling like you can’t get enough air.

Orthopnea Causes

Orthopnea isn’t a medical condition itself but a symptom that points to one or more underlying medical conditions. Several common health conditions have been associated with orthopnea.

• Heart failure: Heart failure is when a person’s heart struggles to pump enough blood to supply the body with enough oxygen. Lying down causes increased blood flow to the heart, and that may be more than the heart can pump for some people with heart failure. This may cause fluid to accumulate in the lungs, and this pulmonary edema can cause shortness of breath.
• Chronic Obstructive Pulmonary Disease(COPD): COPD is a lung disease characterized by difficulty breathing, coughing, and limited air intake. People with COPD may feel like they aren’t able to get enough air, and this feeling may intensify when they’re lying down.
• Obesity: Some people with obesity may experience shortness of breath when lying flat. This is because of increased pressure on the lungs and because the diaphragm — a muscle involved in breathing — has trouble fully contracting.
• Sleep Apnea:Sleep apnea is a disorder that causes breathing to temporarily slow or stop during sleep. People with sleep apnea sometimes awaken with breathing discomfort, which may be related to orthopnea or PND.

Orthopnea has also been reported in individuals who snore or who have other heart conditions, panic disorder, or the neuromuscular disease amyotrophic lateral sclerosis (ALS).

The particular sensations that a person with orthopnea feels may point to a specific underlying medical condition. A detailed description of the breathing sensations and any accompanying symptoms, such as cough, nasal congestion, swelling, chest pain, or muscle weakness, can help a doctor determine the cause of orthopnea and how to best treat it.

How Orthopnea Is Diagnosed

Because orthopnea can be related to different underlying health issues, the focus of orthopnea diagnosis is identifying the cause of your breathing difficulties.

Your doctor will ask questions about your symptoms and medical history. You may be asked to describe:

• The nature of the uncomfortable breathing sensations you’re experiencing
• If the orthopnea comes on quickly or gradually
• How many pillows you need to sleep comfortably
• If you have breathing discomfort in other positions
• If you have recently experienced changes in your weight
• If you have other symptoms in addition to orthopnea

During the physical exam, your provider will use a stethoscope to listen for any abnormal heart or breathing sounds. They’ll also check for other signs of heart or lung problems, like swelling in the legs or feet.

Your doctor may also order medical tests to uncover the causes of orthopnea, especially if they suspect a heart or lung condition.

• Blood tests: Analyzing different markers in the blood can help doctors identify or rule out some potential causes of dyspnea. One specific blood test that doctors may suggest is for the hormone BNP, which can help tell if there’s excess fluid in the lungs.
• Chest X-ray: X-rays provide images of organs, bones, muscles, and other structures inside the body. A chest x-ray can show signs of heart problems and certain lung diseases.
• Echocardiogram: This test uses ultrasound to create images of the heart. If a person has heart failure, it may detect problems in the structure of the heart or a decreased ability to pump blood to the body.
• Electrocardiogram: This test, also called an EKG or ECG, uses electrodes attached to the chest and limbs to record electrical signals produced by the heart. It can help diagnose different types of heart problems. 
• Pulmonary function tests: These medical tests provide information about how well your lungs are working. During the tests, you’ll be asked to breathe through a mouthpiece or tube, sometimes normally and sometimes rapidly. If the tests detect limited airflow, this may be evidence of COPD or another lung condition.

If you experience orthopnea, you should talk to your doctor about your breathing discomfort. They can determine the most appropriate tests based on your symptoms and health history.

Orthopnea Treatment

Orthopnea treatment is designed to address the underlying cause. As a result, treatment plans vary but may include:

• Medications that remove fluid from the lungs or improve the heart’s ability to pump blood
• Supplemental oxygen or positive airway pressure treatment (such as CPAP or BiPAP therapy) 
• Low-sodium diets 
• Weight loss 
• Lifestyle changes, such as exercising more, quitting smoking, or reducing stress

In the short term, propping up the upper body withpillows may help relieve symptoms of orthopnea. However, it’s important to talk to a doctor when orthopnea appears in order to determine the underlying cause and most appropriate treatment. 

When to See a Doctor

You should see a doctor if you have difficulty breathing or shortness of breath, including when you lie down. If you’ve talked with your doctor about orthopnea before, contact your doctor if it persists or gets worse.

Go to the emergency room for immediate medical attention if you have shortness of breath and nausea or chest pain.

Frequently Asked Questions

How is orthopnea different than dyspnea?

Dyspnea is the medical term for shortness of breath, and orthopnea is dyspnea that occurs or gets worse when lying on your back. 

In effect, orthopnea is a specific type of shortness of breath. All orthopnea is dyspnea, but not all dyspnea is orthopnea.

What is the difference between sleep apnea and orthopnea?

Sleep apnea is a disorder involving repeated breathing disruptions (called apneas and hypopneas) during sleep. Orthopnea is a sensation of shortness of breath when lying down on your back.

Orthopnea affects people while they’re awake, while sleep apnea occurs during sleep. However, sleep apnea provokes brief awakenings during the night, and those awakenings may involve gasping for air and the sensation of shortness of breath.

Is orthopnea a symptom of heart failure?

Orthopnea can be a symptom of heart failure. When lying down, more blood moves toward the heart, and if the heart can’t pump blood properly, fluid may enter the lungs and cause difficulty breathing. 

However, not all orthopnea is caused by heart failure. Other health issues, including lung problems and obesity, can cause orthopnea.

How do people with orthopnea sleep?

For people with orthopnea, getting proper treatment is an important step that can enhance their sleep. Orthopnea is caused by another health issue, and addressing the underlying cause can help resolve shortness of breath when lying in bed.

In addition, some people with orthopnea elevate their upper body with pillows or an adjustable bed frame, which may provide some relief while lying down.