Orthopnea

Medically reviewed by Suzanne Falck, MD on December 12, 2017Written by Stephanie Watson

Overview

Orthopnea is shortness of breath or difficulty breathing when you’re lying down. It comes from the Greek words “ortho,” which means straight or vertical, and “pnea,” which means “to breathe.”

If you have this symptom, your breathing will be labored when you lie down. It should improve once you sit up or stand.

In most cases, orthopnea is a sign of heart failure.

Orthopnea is different from dyspnea, which is difficulty breathing during non-strenuous activities. If you have dyspnea, you feel like you’re short of breath or you have trouble catching your breath, no matter what activity you’re doing or what position you’re in.

Other variations on this symptom include:

  • Platypnea. This disorder causes shortness of breath when you stand.
  • Trepopnea. This disorder causes shortness of breath when you lie on your side.

Symptoms

Orthopnea is a symptom. You’ll feel short of breath when you lie down. Sitting propped up on one or more pillows can improve your breathing.

How many pillows you need to use can tell your doctor about the severity of your orthopnea. For example, “three pillow orthopnea” means your orthopnea is very severe.

Causes

Orthopnea is caused by increased pressure in the blood vessels of your lungs. When you lie down, blood flows from your legs back to the heart and then to your lungs. In healthy people, this redistribution of blood doesn’t cause any problems.

But if you have heart disease or heart failure, your heart may not be strong enough to pump the extra blood back out of the heart. This can increase the pressure in the veins and capillaries inside your lungs, causing fluid to leak out into the lungs. The extra fluid is what makes it hard to breathe.

Sometimes people with pulmonary disease get orthopnea — especially when their lungs produce excess mucus. It’s harder for your lungs to clear mucus when you’re lying down.

Other possible causes of orthopnea include:

  • excess fluid in the lungs (pulmonary edema)
  • severe pneumonia
  • obesity
  • fluid buildup around the lung (pleural effusion)
  • fluid buildup in the abdomen (ascites)
  • diaphragm paralysis

Treatment options

To relieve shortness of breath, prop yourself up against one or more pillows. This should help you breathe more easily. You may also need supplemental oxygen, either at home or in a hospital.

Once your doctor diagnoses the cause of your orthopnea, you’ll get treated. Doctors treat heart failure with medication, surgery, and devices.

Medications that relieve orthopnea in people with heart failure include:

  • Diuretics. These medications prevent fluid from building up in your body. Drugs like furosemide (Lasix) stop fluid from building up in your lungs.
  • Angiotensin-converting enzyme (ACE) inhibitors. These drugs are recommended for people with left-sided heart failure. They improve blood flow and prevent the heart from having to work as hard. ACE inhibitors include captopril (Capoten), enalapril (Vasotec), and lisinopril (Zestril).
  • Beta-blockers are also recommended for people with heart failure. Depending upon how severe your heart failure is, there are other medications that your doctor may prescribe as well.

If you have Chronic Obstructive Pulmonary Disease (COPD), your doctor will prescribe medications that relax the airways and reduce inflammation in the lungs. These include:

  • bronchodilators like albuterol (ProAir HFA, Ventolin HFA), ipratropium (Atrovent), salmeterol (Serevent), and tiotropium (Spiriva)
  • inhaled steroids such as budesonide (Pulmicort Flexhaler, Uceris), fluticasone (Flovent HFA, Flonase)
  • combinations of bronchodilators and inhaled steroids, such as formoterol and budesonide (Symbicort) and salmeterol and fluticasone (Advair)

You might also need supplemental oxygen to help you breathe while you sleep.

Associated conditions

Orthopnea can be a sign of several different medical conditions, including:

Heart failure

This condition occurs when your heart can’t effectively pump blood throughout your body. It’s also called congestive heart failure. Whenever you lie down, more blood flows into your lungs. If your weakened heart can’t push that blood out to the rest of the body, the pressure builds up inside your lungs and causes shortness of breath.

Often this symptom doesn’t start until several hours after you lie down.

Chronic obstructive pulmonary disease (COPD)

COPD is a combination of lung diseases that includes emphysema and chronic bronchitis. It causes shortness of breath, coughing, wheezing, and chest tightness. Unlike in heart failure, orthopnea from COPD starts almost immediately after you lie down.

Pulmonary edema

This condition is caused by too much fluid in the lungs, which makes it difficult to breathe. The shortness of breath gets worse when you lie down. Often this is from heart failure.

Outlook

Your outlook depends on which condition is causing your orthopnea, how severe that condition is, and how it’s treated. Medications and other treatments can be effective at relieving orthopnea and the conditions that cause it, like heart failure and COPD.

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