What is Orthopnea?

Madeleine A.

Typically, orthopnea refers to symptoms where shortness of breath happens when lying down. This may cause individuals to awaken during the night because they are experiencing difficulty breathing. Frequently, orthopnea signals an existing underlying medical condition such as congestive heart failure, or CHF. Frequently, difficulty breathing can cause significant anxiety, which tends to exacerbate the condition. Dyspnea, or difficulty breathing, is managed better when the patient remains calm.

Orthopnea may occur as a result of congestive heart failure.
Orthopnea may occur as a result of congestive heart failure.

Congestive heart failure occurs when the pumping action of the cardiac muscle cannot effectively perform its function. Generally, symptoms of heart failure include edema or swelling, orthopnea, and fatigue. In addition, weakness, dizziness, and insomnia can occur. Sometimes, fluid may be present in the lungs, which may worsen the disorder and cause a smothering sensation.

Orthopnea is a respiratory illness associated with shortness of breath.
Orthopnea is a respiratory illness associated with shortness of breath.

Another cause may include a medical condition called cor pulmonale. This cardiac condition refers to when the right sided heart starts to fail because of high blood pressure in the arteries of the lung. Typically, high blood pressure in the pulmonary arteries can contribute to difficulty breathing because it can causes wheezing and coughing. Sometimes oxygen therapy may be indicated to assist with breathing, greatly relieving orthopnea.

Orthopnea often requires help breathing, such as from supplemental oxygen or a CPAP machine.
Orthopnea often requires help breathing, such as from supplemental oxygen or a CPAP machine.

Occasionally, breathing difficulty may be the result of chronic obstructive pulmonary disease, or COPD. This condition is a group of respiratory illnesses that include emphysema and bronchitis. Frequently, COPD makes orthopnea increasingly difficult, while producing wheezing, chronic cough and yellow sputum. In addition, COPD can predispose patients to respiratory infections and hospitalizations. Generally, treating COPD related respiratory distress includes the use of bronchodilators, oxygen and sometimes steroids.

COPD makes orthopnea increasingly difficult, while producing wheezing, chronic cough and yellow sputum.
COPD makes orthopnea increasingly difficult, while producing wheezing, chronic cough and yellow sputum.

Treating nocturnal shortness of breath can be challenging. Lying flat when sleeping tends to make breathing more difficult in the patient experiencing respiratory distress. When this occurs, the patient may be advised to sleep propped up on a few pillows instead of lying flat. In addition, raising the head of the bed with blocks may provide profound relief from shortness of breath by preventing fluid accumulation in the lungs.

Generally, when breathing difficulty occurs when lying flat, the physician may recommend the use of supplemental oxygen therapy. Patients who receive oxygen, either via face mask or nasal cannula prongs, may a find that breathing and anxiety is much improved. Sometimes, it may be recommended that the patient take diuretics to reduce fluid buildup in the lungs, which can worsen night time dyspnea. Diuretics also help lower blood pressure, which can also contribute to heart, lung, and breathing difficulties.

Individuals who are morbidly obese may experience orthopnea.
Individuals who are morbidly obese may experience orthopnea.

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Discussion Comments


I have COPD and can relate to sobbing and panicking. I also suffer swollen legs but have an adjustable bed which helps with breathing. My sleep is intermittent, with me waking several times. My moms side of the family all died with heart related problems so I will check orthopnea out.


@momothree - The story about two of your patients who were misdiagnosed with sleep apnea instead of orthopnea with congestive heart failure was interesting. They were put on C-PAP machines, which didn't help at all. I wonder if they had a sleep study or if the first doctor just made a quick diagnosis.

Getting the head of the bed inclined or using several pillows really reduces the chances of suffering from orthopnea.


My mother, who is in her mid nineties, has had congestive heart failure for about 15 years. Frequent appointments with her doctor, medication and nubulizing has kept her condition pretty well under control.

On several occasions, she has had problems with orthopnea. She wakes up suddenly, in a panic, and one time she fell out of bed and hit her head on the bedside table.

I think the one thing that has helped her avoid the breathing difficulty while lying down, is that she uses an inclined foam pillow plus one or two regular pillows.

Hopefully, this set-up will continue to work.


@KaBoom - I can see how anything that interrupts breathing could cause anxiety. We need to breathe to live after all!

It's interesting that something so simple as propping your head up can help orthopnea though! I think I'm going to try this next time I get a respiratory infection.


I don't have orthopnea, but I do have asthma. I agree with what the article said about difficulty breathing causing anxiety.

In addition to having asthma, I also have generalized anxiety disorder. This basically means I get panic attacks every now and then. Shortness of breath is a symptom of a panic attack, as well as an asthma attack.

Sometimes I have trouble differentiating between the two. And also, sometimes when I have an asthma attack I end up having an anxiety attack also. Definitely not a fun situation, and I can totally identify with people who have orthopnea and their feelings of anxiety!


I work at a nursing home as an RN and have seen many patients with orthopnea. A couple of the patients in particular were misdiagnosed as having sleep apnea and were placed on C-PAP machines. Their conditions did not improve at all. A family member of one of the patients demanded a second opinion and had another doctor come in to assess the patient.

She (the patient) had been diagnosed with congestive heart failure a few years ago. When the new doctor came in, he almost immediately diagnosed her with orthopnea. We changed out her bed with one that is more versatile. She had been sleeping on her back, lying flat. We added pillows and the doctor put her on a nasal cannula at 2 liters.

Now, she is doing great and the family was right about getting a second opinion.


My mother in law has battled with COPD for a while now, but just recently it has developed to where she has trouble breathing even in her sleep which I now gather is what orthopnea means.

Luckily Medicare has been a great thing to allow her to get various medicines and treatments. Most recently she has acquired a huge oxygen machine (I say huge because it seems large when she travels to see us, but in actuality it might just be about 2 feet tall and one foot deep).

This machine has really helped her gain some normalcy back to her life as she sleeps better; however she is still not able to go outside during the hot summer months and secondary to her thriving social life (even COPD has difficulty slowing down her social life) this makes her a bit sad.


During the last few years of my grandmother's life she suffered from orthopnea cause by congestive heart failure. It was really tragic to watch her go from being so full of life to tired all the time. She could barely sleep from her fear of not being able to wake up.

Sometimes my grandmother would wake up in the night in a panic because she couldn't breathe very well. It was scary for the whole family. We actually ended up investing in a hospital bed with a high incline so that my grandmother's orthopnea wouldn't be a problem.


I have struggled with asthma for years and I often get bronchitis which can be a huge problem when it comes time to sleep. With all of the congestion in my chest I often suffer from orthopnea which can make it very difficult to sleep.

The one thing that I find that helps the most is to sleep with a few pillows so you are propped up and not resting flat on your back. I can barely breath why laying flat if I have bronchitis.

Orthopnea can be really scary and if it persists go to your doctor. Although it can take awhile for doctors to beat your bronchitis with antibiotics they can recommend other things to help you breath at night.

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