Breathing difficulty - lying downWaking at night short of breath; Paroxysmal nocturnal dyspnea; PND; Difficulty breathing while lying down; Orthopnea; Heart failure - orthopnea
Breathing difficulty while lying down is an abnormal condition in which a person has a problem breathing normally when lying flat. The head must be raised by sitting or standing to be able to breathe deeply or comfortably.
A type of breathing difficulty while lying down is paroxysmal nocturnal dyspnea. This condition causes a person to wake up suddenly during the night feeling short of breath.
This is a common complaint in people with some types of heart or lung problems. Sometimes the problem is subtle. People may only notice it when they realize that sleep is more comfortable with lots of pillows under their head, or their head in a propped-up position.
Causes may include:
- Chronic obstructive pulmonary disease (COPD)
- Cor pulmonale
- Heart failure
- Obesity (does not directly cause difficulty breathing while lying down but often worsens other conditions that lead to it)
- Panic disorder
- Sleep apnea
Your health care provider may recommend self-care measures. For example, weight loss may be suggested if you are obese.
When to Contact a Medical Professional
If you have any unexplained difficulty in breathing while lying down, call your provider.
What to Expect at Your Office Visit
The provider will perform a physical exam and ask questions about the problem.
Questions may include:
- Did this problem develop suddenly or slowly?
- Is it getting worse (progressive)?
- How bad is it?
- How many pillows do you need to help you breathe comfortably?
- Is there any ankle, foot, or leg swelling?
- Do you have difficulty breathing at other times?
- How tall are you? How much do you weigh? Has your weight changed recently?
- What other symptoms do you have?
Tests that may be performed include the following:
Treatment depends on the cause of the breathing problem.
You may need to use oxygen.
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Davis JL, Murray JF. History and physical examination. In: Broaddus VC, Mason RJ, Ernst JD, et al, eds. Murray and Nadel's Textbook of Respiratory Medicine. 6th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 16.
Januzzi JL, Mann DL. Approach to the patient with heart failure. In: Zipes DP, Libby P, Bonow RO, Mann DL, et al. eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 11th ed. Philadelphia, PA: Elsevier; 2019:chap 21.
O'Connor CM, Rogers JG. Heart failure: pathophysiology and diagnosis. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 58.
Review Date: 1/19/2019
Reviewed By: David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.