Orthopnea: Types, Causes, Symptoms, and Treatment

Disclaimer: Results are not guaranteed*** and may vary from person to person***.


What Is Orthopnea?

What is orthopnea? The medically accepted orthopnea definition is difficulty breathing or shortness of breath when lying down. In Greek, the word comes from ortho, which means “vertical,” and pnea, which means “to breathe.”

Breathing is labored when lying down; however, it improves once you stand or sit up. Often, orthopnea is a symptom of heart failure.

Orthopnea differs from dyspnea, which is shortness of breath during non-strenuous activities. Basically, you would have difficulty breathing no matter your position or level of activity.

In this article, you will learn about the types of orthopnea as well as the causes, symptoms, and treatment associated with this condition. Why should you diagnose orthopnea? Read on to find out.

Types of Orthopnea

Besides orthopnea, there are other variations of shortness of breath or breathlessness. For instance, platypnea leads to shortness of breath when standing. Trepopnea is a type of shortness of breath experienced when lying on your side.

Moreover, paroxysmal nocturnal dyspnea is shortness of breath that will wake you up, often after an hour or two of sleep. It is also often relieved by assuming an upright position.

Other than these variations, orthopnea types will include:

  • Pediatric orthopnea: This type occurs in infants and children below age 12. Children may have difficulty breathing due to an improper lying down position.
  • Orthopnea during pregnancy: In pregnant women, conditions that lead to orthopnea include severe anemia, fluid overload, heart failure, and peripartum cardiomyopathy.
  • Cardiac orthopnea: This is where left-sided congestive heart failure is the cause of orthopnea. People with left-sided congestive heart failure may experience relief when right-sided congestive heart failure instead becomes an issue.

What Causes Orthopnea?

The shortness of breath associated with orthopnea is due to increased pressure in the veins that carry oxygen from the lungs to the heart. When lying down, blood flows from the legs to the heart and lungs. In healthy people, this does not cause a problem.

However, when you have heart failure or heart disease, the heart may not be strong enough to pump extra blood from the heart. This can increase pressure in the capillaries and veins in your lungs, causing fluid to leak into the lungs.

This extra fluid can make it difficult to breathe.

Orthopnea causes include:

Heart Disease

Heart conditions like congestive heart failure or high blood pressure (hypertension) can lead to orthopnea. Congestive heart failure can lead to extra fluid in your body, and the heart cannot perform the additional work needed to keep this extra fluid from accumulating in the lungs. As a result, shortness of breath will occur.

People with high blood pressure often have a weak heart that is unable to pump a lot of blood throughout the body. As blood gets redistributed while lying down, this can lead to shortness of breath as well.

Pulmonary Heart Disease

Pulmonary heart disease is where the right ventricle of the heart fails due to high blood pressure in the arteries. This can lead to shortness of breath, coughing, and wheezing.

Other Orthopnea Causes

Orthopnea can also be caused by upper respiratory tract infections, such as inflamed tonsils, congested nose, chronic bronchitis, and asthma. Orthopnea due to anxiety and intense fear can also lead to difficulty sleeping at night and chest pain.

Other possible causes of orthopnea include diaphragm paralysis; obesity; angina; emphysema; severe pneumonia; chronic obstructive pulmonary disease (COPD); and excess fluid buildup in the lungs (pulmonary edema), around the lungs (pleural effusion), and in the abdomen (ascites).

Symptoms of Orthopnea

Orthopnea is a symptom on its own, characterized by shortness of breath when lying down. Other than difficulty breathing, orthopnea symptoms include:

  • Swollen feet and ankles
  • Frequent coughing
  • The desire to have many pillows while sleeping, or wanting to sleep with the upper body elevated
  • Intermittent chest pain
  • Regular palpitations
  • Cyanosis—a bluish cast to the mucous membranes and skin
  • Dysphasia—a condition that leads to writing, reading, and speaking impairments

Why to Diagnose Orthopnea?

An orthopnea diagnosis is important to consider, especially when your doctor suspects heart failure. Early intervention for orthopnea can help you avoid heart failure and prevent hospitalization.

For this reason, your doctor should ask whether you experience shortness of breath after lying down. When orthopnea worsens, it is often a sign of a heart problem like heart failure.

Interestingly, on a subconscious level, people with orthopnea may add a pillow or two to deal with the issue. The person may even be unaware that they experience shortness of breath when lying down. Maybe they just feel more comfortable with their head in an elevated position.

This is why doctors may ask a heart failure patient how many pillows they use. The doctor will then make a note that the patient is experiencing two-pillow orthopnea or three-pillow orthopnea.

Orthopnea Treatment

There are a number of orthopnea treatment options available. For starters, your doctor will suggest that you sleep in a more upright position, such as placing a couple of pillows under your head. You could also adjust the height of the head of the bed.

Though these methods do not treat the underlying condition, they can treat orthopnea symptoms. Supplemental oxygen may also help you sleep while breathing.

You will get treated once your doctor diagnoses your orthopnea. Medications used to relieve orthopnea in those with heart failure include beta-blockers, diuretics, and angiotensin-converting enzyme (ACE) inhibitors.

Diuretics are able to prevent fluid buildup in your body. ACE inhibitors, on the other hand, help improve blood flow and prevent the heart from being overworked. ACE inhibitors are often recommended for left-sided heart failure. Beta-blockers are also often used for heart failure.

If you have COPD, drugs used to reduce lung inflammation and relax the airways include inhaled steroids, bronchodilators, and a combination of both bronchodilators and inhaled steroids.

Final Thoughts on Orthopnea

Orthopnea is simply shortness of breath or difficulty breathing when lying down. Other orthopnea symptoms include swollen feet and ankles, frequent coughing, regular palpitations, intermittent chest pain, cyanosis, and dysphasia.

There are a number of conditions that cause orthopnea, and the treatment will depend on the severity of your condition. This symptom can be a sign of several conditions, such as heart failure, COPD, pulmonary edema, or pulmonary heart disease.

It is important to diagnose orthopnea, especially when your doctor considers heart failure to be a cause of the symptom. In such instances, potential orthopnea treatment options include ACE inhibitors, diuretics, and beta-blockers.

Also read:

Article Sources (+)

Mukerji, V., “Chapter 11: Dyspnea, Orthopnea, and Paroxysmal Nocturnal Dyspnea,” Clinical Methods; https://www.ncbi.nlm.nih.gov/books/NBK213/, last accessed July 30, 2018.
“What Is Orthopnea?” Find a Top Doc.com; https://www.findatopdoc.com/Healthy-Living/what-is-orthopnea, last accessed July 30, 2018.