Shortness of breath when lying down, also known as orthopnea, can affect individuals when sleeping or awake. When experiencing difficulty breathing or wheezing when lying down, you may also have a cough or heart palpitations. Causes of shortness of breath at night when lying down include heart-related conditions like congestive heart failure, lung-related conditions like bronchitis, or mental health issues that can cause hyperventilation. Read below for more information on causes and treatment options.
Difficulty breathing when lying down explained
Have you ever woken up at night, breathless, and need to sit up for relief? It's like waking up from a nightmare only to find that feeling of being smothered is real. Shortness of breath when lying down is also called "orthopnea," and can happen whether you are sleeping or awake. Orthopnea plagues people with heart and lung conditions and sleep apnea.
Common characteristics of shortness of breath when lying down
In describing their experiences, people with orthopnea have said, "When I lie down, I feel...":
- Like I am hungry for air.
- Uncomfortable when I breathe.
- Like my chest is tightening.
- Like I can't take a deep enough breath.
- I am out of breath.
- I have to work hard to breathe.
- I am being smothered.
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What causes shortness of breath when lying down?
Under the following conditions, the heart is unable to pump effectively, and not enough oxygenated blood reaches your lungs, causing orthopnea.
- Hypertrophic cardiomyopathy
- Aortic valve regurgitation
- Atrial fibrillation
Under these conditions, oxygen is not effectively transferred into your lungs, even if your heart is working well, causing orthopnea.
- Chronic obstructive pulmonary disease (COPD)
- Pulmonary embolism
- Cystic fibrosis
Some other possible conditions that may cause orthopnea include the following.
- Sleep apnea: Sleep apnea is one of the bigger offenders. It is more often seen in men, smokers, people who are overweight or have a sinus abnormality. Sleep apnea is often what causes the snoring, snorting, and restlessness that forces your bedmate to sleep in the guest room.
- Panic disorder
- Nasal congestion
- Gastrointestinal conditions
- Allergies and anaphylaxis
- Traveling to high altitudes
This list does not constitute medical advice and may not accurately represent what you have.
Heart failure is a condition in which the heart is no longer able to effectively pump blood to the rest of the body. Heart failure can affect the right side, left side, or both sides of the heart. It can be subcategorized as "heart failure with preserved ejection f..
Acute or worsening heart failure
Heart failure is a condition in which the heart can't pump enough blood to meet the body's needs. Heart failure does not mean that the heart has stopped or is about to stop working, but rather that the heart is not able to pump blood the way it should. Usually this happens when the heart has been damaged by another medical condition.
Top Symptoms: fatigue, shortness of breath, chest pain, nausea, shortness of breath on exertion
Urgency: Emergency medical service
Hyperventilation syndrome is a type of anxiety or panic attack, where the primary symptom is fast, shallow breathing that leads to a drop in carbon dioxide levels in the blood. This drops changes the body chemistry and causes the discomfort.
Any sort of fear or excitement that might provoke an anxiety attack can bring on hyperventilation syndrome.
Symptoms are worse in some patients than in others, but include anxiety; lightheadedness; pain and constriction in the chest; numbness and tingling of the extremities; and a feeling of suffocation.
It is important to seek treatment for hyperventilation syndrome, because the symptoms can be debilitating and interfere with quality of life.
Diagnosis is made through detailed patient history, as well as a complete physical examination and lab tests to rule out any other conditions.
Treatment involves showing that patient that, during an anxiety attack, simply breathing into a paper bag for a few minutes will ease the symptoms and allow recovery. Psychological counseling, with an emphasis on managing stress, is also helpful.
Top Symptoms: anxiety, shortness of breath, dizziness, racing heart beat, chest pain
Symptoms that always occur with hyperventilation syndrome: rapid, deep breaths
Symptoms that never occur with hyperventilation syndrome: shortness of breath after a few stairs
Urgency: Primary care doctor
Aortic valve regurgitation occurs when the aortic valve one of the four valves in the heart fails to function properly and allows blood to flow backward through it. When some blood flows back from the aorta into the heart, it puts pressure on the heart and..
Restrictive cardiomyopathy is a type of heart disorder in which the walls of the heart become stiff, preventing it from filling with blood normally. The atria become enlarged and blood flow in the heart is gradually reduced, which may lead to heart failure o..
Rarity: Ultra rare
Urgency: Hospital emergency room
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Treatment for trouble breathing at night/when lying down
When to see a doctor
Completely treating orthopnea requires treating the condition that is causing it. The following may specifically be recommended or you can ask your physician about them.
- CPAP: A continuous positive airway pressure machine can help you breathe during sleep.
- Ask if there is a dental device that could help you
Even if your shortness of breath when lying down cannot be cured, there are many steps you can take to limit how severe it is. If you are experiencing relatively benign (not life-threatening) orthopnea, one of the best practices is to avoid sleeping or lying flat on your back. Understandably, this can be a difficult adjustment for back sleepers. You might fall asleep on your side, but that doesn't mean you will stay on your side. An unusual approach to help you stay off your back is to attach tennis balls to the back of your nightshirt. You can actually buy one pre-made if you prefer. You can also try the following.
- Sleep in a semi-reclined position
- Wear nasal strips
- Lose weight: There are many health professionals out there who can help you achieve this goal if you are struggling.
When it is an emergency
Seek immediate medical care if you have orthopnea and any of the following.
Questions your doctor may ask about shortness of breath when lying down
- Have you been feeling more tired than usual, lethargic or fatigued despite sleeping a normal amount?
- Any fever today or during the last week?
- Do you have a cough?
- Do you notice your heart beating hard, rapidly, or irregularly (also called palpitations)?
Self-diagnose with our free Buoy Assistant if you answer yes on any of these questions.
Male, age 31. For about six weeks now I’ve had a persistent cough. I was treated with two antibiotics, and felt better briefly. However, days after the antibiotics ended I developed symptoms again. Currently, I am have difficulty breathing and coughing up yellow mucus, mostly at night while trying to sleep or when I lie down. What could cause such a resistant and persistent cough with these symptoms? Any advice??
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- Shortness of Breath Symptoms, Causes and Risk Factors. American Lung Association. Updated March 13, 2018. American Lung Association Link.
- Roth A, Haranath SP. Learn About Shortness of Breath. Chest Foundation. Updated January 2018. Chest Foundation Link.
- Azagra-Calero E, Espinar-Escalona E, Solano-Reina E, et al. Obstructive Sleep Apnea Syndrome (OSAS). Review of the Literature. Medicina Oral, Patologia Oral y Cirugia Bucal. 2012;17(6):e925-e929. NCBI Link.
- Best Positions to Reduce Shortness of Breath. Lung Institute. Published March 10, 2018. Lung Institute Link.