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Orthopnea Causes, Symptoms and Treatment

    Have you ever been on vacation, kicking back and just relaxing? Suddenly as you are lying down you feel a sudden shortness of breath. The shortness of breath makes your chest feel tight and your breathing becomes extremely strenuous. As you try to catch your breath, you sit up and slowly revert to your normal breathing process. Well, you could be having Orthopnea.

    What is Orthopnea?

    Orthopnea is a medical disorder that is characterized by a shortness of breath brought on by improper posture. Orthopnea is not a disease as such, but a symptom of disease, usually heart failure. The entomological name for Orthopnea comes from the Greek words “orthos” and “pnoe”, which translates to “straight” and “breathing” respectively. Orthopnea could also be manifested in people with the following conditions:

    • Asthma
    • Pulmonary Edema
    • Emphysema
    • Pneumonia
    • Congestive heart failure
    • Angina Pectoris

    Orthopnea occurs in people of all ages. Children under the age of 12 including infants suffer from Pediatric Orthopnea. A child may experience difficulty breathing when lying down in an inappropriate position.

    Orthopnea is also common in obese individuals with heart problems. In case you are having trouble with weight, these pills can help reduce body fat easily.

    Positions that Orthopnea is experienced

    Orthopnea is basically experienced when lying down. It can be dangerous if the people that have it are not aware. Orthopnea can only be experienced in 3 positions. The following are the 3 main positions that Orthopnea is applicable:

    1. Supine Position – In this position, a person is lying down facing upward.
    2. Left / Right Lateral Recumbent Position – In this position, a person is lying down facing sideways.
    3. Prone Position – A person is lying down facing downward.


    Doctors often ask individuals with Orthopnea how many pillows they use at night while sleeping. People with Orthopnea usually find it easier to sleep while sited in a chair rather than lying down.

    Normally when we are lying down flat on the bed gravity causes a redistribution of fluid within the body. In this position most of the fluids from  lower part of the body which includes our legs and abdomen  gravitates to the chest area. A normal functioning heart redistributes these fluids effectively and there are no breathing problems.

    People with heart failure have a substantial amount of excess fluid from the lower part of the body in the chest cavity. A weak heart is unable to redistribute the additional fluid to the other parts of the body causing accumulation in the lungs, hence making it hard to breathe.

    Orthopnea is can also be caused by increased blood pressure in the veins that connect to the heart to the lungs. The primary role of these veins is to take the oxygenated blood to the heart, where the left ventricle pumps this it to the body.


    The left ventricle’s role is to pump oxygenated blood to the rest body.  The muscular tissue that the left ventricle comprises of is actually that the strongest of all the heart muscles.


    A person with a weakening heart condition, these muscles aren’t strong enough. A heart imbalance occurs, where the right ventricle is pumping more deoxygenated blood compared to the left ventricle’s oxygenated blood into the aorta in order to circulate blood to the rest of the body.


    This imbalance causes higher blood pressure is in the veins that transport blood to the heart from the lungs. The higher blood pressure moves to the lungs, causing shortness of breath.


    When an individual sits up, blood and other bodily fluids are redistributed into the lower body because of gravity. Individuals suffering from orthopnea cannot cope with the increased blood pressure around the lungs that eventually leads to shortness of breath. Individuals may also experience wheezing and coughing.


    Other probable causes of Orthopnea:

    • Panic attacks
    • Asthma
    • Chronic bronchitis
    • Sleep apnea
    • Paralysis of one or both breathing diaphragm muscle
    • Polycystic liver disease
    • Enlarged thyroid glands, which can block airflow in the upper airways when lying down. 
    • Upper respiratory tract Infections – caused by a congested nose and inflamed tonsils.
    • Severe pneumonia
    • Pleural effusion
    • Ascites


    Orthopnea Symptoms


    In case you are not sure if you are having Orthopnea, apart from shortness in breathing, the typical symptoms the most common signs and symptoms of Orthopnea include:

    • Swollen feet.
    • Swollen ankles
    • Persistent coughing
    • Intermittent tightness in the chest region
    • Dysphasia
    • Angina Pectoris
    • Hoarseness
    • Pedal edema
    • Paroxysmal nocturnal dyspnea(waking up suddenly due to shortness of breath that goes away when you sit up.)
    • Cyanosis
    • Regular Palpitations
    • Need for many pillows when sleeping to elevate the upper body

    Once you to notice any of the signs mentioned above, do not hesitate to contact your physician immediately. Orthopnea should be taken very seriously as it can cause death suddenly in your sleep if left untreated.


    Diagnosis involves a thorough physical examination of a patient is carried out to evaluate if symptoms consistent with heart failure. A physician will go through your medical and genetic history. Other common tests include pulmonary function tests as well sleep studies.

    Follow up questions on the number of pillows a patient uses to check progression of the problem. The greater the number of pillows the greater the extent of the problem/


    Orthopnea is usually a sign of underlying heart failure.  Sitting up when an attack occurs only offers a temporary relief. Not a lot of people fancy sleeping in an elevated position all their lives either. The most common treatments include the following

    • Anti-inflammatory medication
    • Pericardiocentesis
    • Open heart surgery.


    Other types of treatment include drugs collectively known Vasodilators, which help increase the width of the veins. They work to relieve pressure in the lungs by increasing the flow of blood in the veins.

    Diuretics are also administered to reduce the accumulation of fluid in the chest cavity. Patients are encouraged to reduce weight in case they are obese and reduce intake of foods rich in sodium.

    Inotropic medications are prescribed in helping the heart (left ventricle) pump more blood to the body. Angiotensin-converting enzyme (ACE) inhibitors help with left-sided heart failure by improving blood flow.

    In case a patient is having excess fluid overload, ultrafiltration may be carried out. Ultrafiltration involves a machine that pumps out excess fluid out of the patient’s blood.