Dyspnea is the medical term for shortness of breath, a common symptom of heart and lung problems. Orthopnea is when shortness of breath occurs when lying down. The even can be severe or mild and can include chest pain or slight discomfort. It is most commonly a sign of a serious underlying heart problem. People experiencing orthopnea should see their doctor to determine the underlying cause and begin the appropriate treatment.

What Exactly is Orthopnea?

Orthopnea is shortness of breath that occurs only when lying flat. It is a specific form of dyspnea. When a person experiencing orthopnea sits or stands, the shortness of breath resolves. It is not a primary diagnosis, meaning there is always a larger reason for orthopnea. In some cases, orthopnea is symptomatic of serious health issues.

Laying Down Breathe Marccophoto / Getty Images


What Causes Orthopnea?

Fluid building up in the lungs is the most common cause of orthopnea. When standing, this excess fluid distributes throughout the body and presents as swelling of the legs and feet. When the person lays flat, though, gravity is no longer helping the fluid move throughout the body, which causes it to build up in the lungs.

Swollen Ankles Edema Toa55 / Getty Images


What Orthopnea Feels Like

Sometimes, people with orthopnea do not recognize the problem. They may find that they aren't sleeping as well at night and need a few extra pillows to get comfortable or realize that they can only take deep breaths when sitting or standing. Orthopnea can be mild or severe and many describe it as feeling like tightness in the chest.

Sleeping Multiple Pillows simarik / Getty Images


Left-Sided Heart Failure

Orthopnea indicates a problem with the lungs and is a common indicator of left-sided heart failure. The left side of the heart is responsible for receiving freshly oxygenated blood from the lungs and pumping it out into the body. When the left side of the heart is not working properly, blood cannot follow its normal path and backs up into the lungs. Lying down exacerbates this condition because gravity is no longer helping the blood move down into the legs and feet.

Left Sided Heart Failure Juanmonino / Getty Images


Other Causes of Orthopnea

Orthopnea is most commonly associated with left-sided heart failure, but other medical conditions can also cause it, including asthma, chronic bronchitis, sleep apnea, anxiety, or panic disorders. These conditions do not directly result from fluid in the lungs and may present a little differently.

Panic Attack Anxiety Juanmonino / Getty Images


Diagnosis of Orthopnea

When someone goes to a doctor with a complaint of orthopnea, the goal is to find the underlying issue. This might involve a chest x-ray or CT scan to visualize the heart, an electrocardiogram to check heart function, pulmonary function tests to evaluate the lungs, and various lab work to check oxygen and other levels in the blood.

Chest X-Ray Tests LajosRepasi / Getty Images


Treating Orthopnea Symptoms

There are two approaches to dealing with orthopnea -- treating symptoms and treating the cause. The first is to alleviate the symptoms so that the person can sleep without distress. This can be accomplished by using multiple pillows to elevate the head and shoulders or using a bed that the user can adjust to a more comfortable angle.

Adjustable Bed Upright Halfpoint / Getty Images


Treating Orthopnea Causes

The underlying cause will determine the treatment. Interventions include medications such as anti-inflammatories, steroids, diuretics, or vasodilators to treat underlying heart conditions. The orthopnea should improve slightly once the underlying condition is managed. This, combined with the right sleeping position, can lead to a dramatic improvement in the quality of life for people with orthopnea.

Heart Medication Treatment light_fire / Getty Images


Lifestyle Changes

Doctors often recommend lifestyle changes to help combat orthopnea and other symptoms of heart failure. People with these conditions are encouraged to lose weight and stick to a low-sodium diet. Too much sodium can cause fluid retention, which makes it harder for the body to cope when there are existing problems in the heart and lungs.

Low Sodium Diet designer491 / Getty Images


Paroxysmal Nocturnal Dyspnea

Paroxysmal nocturnal dyspnea is related to orthopnea and people with heart failure may experience this condition. These frightening episodes occur when the person is in a deep sleep and result in sudden, often panicked awakening. Whereas orthopnea occurs shortly after lying down, shortness of breath from paroxysmal nocturnal dyspnea begins a few hours into sleeping and, like orthopnea, only resolves with sitting or standing.

Sitting Nocturnal Dyspnea Mladen Zivkovic / Getty Images


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