Breathing difficulty - lying down

Alternative names
Waking at night short of breath; Paroxysmal nocturnal dyspnea; PND; Difficulty breathing while lying down; Orthopnea

Definition
Breathing difficulty while lying down is an abnormal condition in which a person must keep the head elevated (such as by sitting or standing) to be able to breathe deeply or comfortably (orthopnea), or the person awakens suddenly during the night feeling short of breath (paroxysmal nocturnal dyspnea).

Considerations
For people with some types of heart or lung problems, this is a common complaint. Sometimes the problem is subtle and is only noticed when the person realizes that sleep is more comfortable with lots of pillows under the head or in a propped up position.

Common Causes

• Heart failure
  
• Chronic obstructive pulmonary disease (COPD)
  
• Panic disorder
  
• Hypertensive heart disease
  
• Obesity (does not directly cause difficulty breathing while lying down but often aggravates other conditions)
  
• Sleep apnea
  
• Snoring
  
• Cor pulmonale

Your health care provider may prescribe therapy to treat breathing difficulty while lying down.

Weight reduction is generally recommended in cases of obesity.

Call your health care provider if

If you have any unexplained difficulty in breathing while lying down, call for an appointment with your health care provider.

What to expect at your health care provider’s office

The health care provider will perform a physical examination and will obtain your medical history.

Medical history questions documenting nocturnal dyspnea include the following:

• Ttime pattern
  o Did this develop suddenly or slowly?
  o Is it getting worse (progressive)?
  
• Quality
  o How bad is it?
  o How many pillows are required to breathe comfortably?
  
• Aggravating factors
  o Is there any ankle, feet, and leg swelling?
  o Does the person have difficulty breathing at other times?
  o How tall is the person? How much do they weigh?
  
• What other symptoms are also present?

Diagnostic tests that may be performed include the following:

• ECG
  
• Pulmonary function tests
  
• Chest X-ray

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