What Is Orthopnea?

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Orthopnea is the symptom of experiencing shortness of breath (dyspnea) when lying down. With orthopnea, your shortness of breath improves when you sit or stand.

Orthopnea may occur in a variety of health conditions including heart failure and respiratory conditions.

Once a healthcare provider determines the underlying cause, you can receive treatment that helps you breathe deeply and comfortably when lying down.

Orthopnea Symptoms

If you have orthopnea, you have trouble breathing normally while lying down. You will be short of breath, which may feel like you can’t breathe deeply enough or that you have trouble breathing. You might also feel like your chest is tight, making breathing difficult. Your breathing troubles should go away as you sit or stand up.

Sometimes orthopnea might not be so obvious. In these cases, you might realize that you have breathing difficulty when lying down after recognizing that it’s easier for you to lie down when your head is propped up.

Orthopnea is a symptom of an underlying condition. On top of orthopnea, you may experience other symptoms of whatever condition is causing your troubled breathing. 

Editor’s Note: Orthopnea is different from paroxysmal nocturnal dyspnea. With paroxysmal nocturnal dyspnea, you suddenly wake up in the middle of the night from shortness of breath. With orthopnea, the shortness of breath begins upon lying down.

What Causes Orthopnea?

When you lie down, your lungs have to work harder than usual to bring in air. This extra effort is what can lead to orthopnea in people with certain conditions.

Heart Failure

In heart failure, your heart muscles cannot pump the oxygen-rich blood into different tissues and organs of your body. As heart muscles don't pump the blood effectively, fluid starts to back up in your lungs.

The extra fluid makes it difficult to breathe, particularly when lying down. Sitting and standing up releases some of the fluid in your lungs back into your body, which helps in making it easier to breathe. 

Pulmonary Hypertension

Pulmonary hypertension is a pressure increase in the blood vessels of your lungs. It's difficult for your heart to pump blood against the higher pressure in your lungs so the fluids start to accumulate in the lungs. Orthopnea is a potential symptom of some cases of pulmonary hypertension.


Chronic obstructive pulmonary disease, or COPD, can lead to orthopnea.

COPD is a group of conditions that cause reduced airflow, making it hard to breathe. One condition under the COPD umbrella is emphysema, which makes it hard for your lungs to move air out of your body. Another COPD condition is chronic bronchitis, which is when mucus forms in the airways and makes it hard to breathe.

Shortness of breath is a common symptom of COPD, and that shortness of breath can get worse when you lie down.

Editor’s Note: Obesity itself is not believed to cause orthopnea. Rather, obesity can worsen conditions that cause orthopnea or worsen orthopnea.

How Is Orthopnea Diagnosed?

A healthcare provider can determine you have orthopnea by asking questions about the breathing issues you’re having. They might ask whether the shortness of breath when lying down started gradually or suddenly, if it’s gotten worse, and how many pillows you need to prop yourself up to comfortably breathe.

The healthcare provider will also measure or ask for your weight and height. They’ll also listen to your heart and lungs.

To help determine the underlying cause of the orthopnea, the healthcare provider may ask about any other symptoms you may be having, such as swelling in the lower extremities—a sign of heart failure. They’ll also ask whether it’s difficult to breathe during any other time.

As part of their diagnosis, the healthcare provider might also have you undergo imaging or testing. This can include:

  • Chest X-ray
  • Electrocardiogram, a test that measures the heart’s electrical activity 
  • Echocardiogram, an ultrasound of the heart
  • Pulmonary function test

As a variety of health conditions can cause orthopnea, diagnosis of the underlying cause is important for proper treatment and management of the disease. 

How Is Orthopnea Treated?

Treatment of orthopnea mainly depends on the underlying cause. If heart failure is leading to fluid in your lungs and causing your orthopnea, your healthcare provider may prescribe diuretics. These medications take excess fluid from your body and pass it into the urine. They also take excess fluid from your lungs which will help ease the symptoms.

In cases where COPD or another lung issue is causing orthopnea, you may also be prescribed oxygen therapy. Since your lungs are no longer effectively delivering oxygen to your blood, oxygen therapy can help improve the symptoms. In COPD, you may also be given drugs to open airways and reduce some of the inflammation in your lungs which also helps with breathing.

Your healthcare provider may advise you to use pillows and elevate your head while you sleep as it can lower the amount of fluid and pressure in the lungs and help with breathing. If you are overweight, it may also be recommended that you lose weight.

A Quick Review

Orthopnea is the term used to describe the symptom of difficulty breathing while you lie down that improves as you sit or stand up. Orthopnea can occur in a variety of health conditions, including heart failure, COPD, and pulmonary hypertension. Typically, it’s difficult for people with these conditions to breathe while lying down because it takes more effort for your lungs to function properly in that position. Fluid buildup in your lungs can also increase as you lie down, making it difficult to breathe. Treatment of orthopnea mainly includes treating the underlying cause. Talk to your healthcare provider about what's causing orthopnea and the treatment options that are available. 

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11 Sources
Health.com uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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