Orthopnea: Causes, Related Symptoms, Types and Treatment

Definition: is the name used by doctors to define the symptom of dyspnea (difficulty breathing) that occurs when a person is lying down.

Orthopnea is considered an important symptom, mainly because it is often a sign of worsening heart failure, but it can also be caused by other medical conditions.

For this reason, anyone who undergoes orthopnea should always be evaluated by a doctor.

The word orthopnea is derived from a Greek work that means “direct breath”. In the medical field, this type of disorder is characterized by having shortness of breath due to improper posture.

The person is also likely to use several pillows just to be able to breathe perfectly at night.

Since this condition causes the person to have a serious problem in breathing, having this type of disorder is very dangerous, since it can kill the person during their sleep.

Orthopnea can be a subtle condition, in which a person notices that sleep is more comfortable with several pillows under their head, or a more severe condition in which the person can breathe deeply and comfortably only when sitting or standing.

It can occur along with swelling of the feet or ankles.

Orthopnea is a sign of heart failure. It is caused by congestion in the lungs – and perhaps accompanied by the accumulation of excess fluid in the lungs (pulmonary edema) – which occurs as a result of left heart failure.


When someone lies down, gravity causes a redistribution of fluid within the body.

Orthopnea is caused by the accumulation of too much fluid in the lungs (pulmonary congestion or fluid overload) when a person lies down.

In a prone position, the volume of blood from the feet and legs is redistributed to the lungs, which does not cause a problem for people whose heart is pumping normally.

However, in people with heart failure, excess blood in the lungs can cause breathing problems or shortness of breath.

Typically, part of the fluid in the lower part of the body, particularly the legs and organs of the abdomen, gravitates in the chest area.

This redistribution of fluid is usually quite minor, and in most people it has no effect on breathing.

However, in people with congestive heart failure , the heart may be unable to accommodate this extra fluid, and can not perform the additional work necessary to keep this extra fluid from accumulating in the lungs.

As a result, pulmonary congestion – and early pulmonary edema – can occur and also shortness of breath. In addition to dyspnea, some people will also experience coughing or wheezing at bedtime.

These types of breathing difficulties caused by assuming the recumbent position are called orthopnea.

When a person experiences orthopnea, sitting or raising the head reverses some of the redistribution of fluid that has occurred, and relieves lung congestion.

Symptoms typically improve quickly by simply changing the position.

Heart failure is not the only cause of orthopnea, but it is by far the most common cause. Sometimes people with asthma or chronic bronchitis will have more breathing problems at bedtime.

The symptoms of wheezing and shortness of breath that occur with these conditions, however, do not usually disappear as quickly after sitting down, but take more time to resolve.

Sleep apnea can also produce symptoms similar to orthopnea, or more often, to paroxysmal nocturnal dyspnea.

Related symptoms

Another symptom strongly associated with heart failure is paroxysmal nocturnal dyspnea.

It is also related to the redistribution of fluids that occurs during sleep, but it is a more complex condition than “simple” orthopnea.

Generally, people with this condition do not notice dyspnea immediately after going to bed.

On the contrary, they are awakened from sleep with an episode of severe respiratory distress that makes them sit immediately to find relief.

In addition to dyspnea, patients often also experience palpitations, severe wheezing and a sense of panic.

Clearly, it is a very dramatic event.

It is thought that some additional mechanism (apart from the simple redistribution of fluids) is present in people with this disease, perhaps related to changes in the respiratory center of the brain that may be associated with heart failure.

Recently, doctors have recognized another type of symptom in people with heart failure that is also related to redistribution of fluids – “bendopnea,” or dyspnea caused by flexion.

Types of orthopnea

There are different types, and to know some of them, please refer to the following information below:

  • Pediatric Orthopnea

This condition occurs in babies of children under 12 years old. The same reason – children are having difficulty breathing due to the incorrect position of lying down.

  • Orthopnea during pregnancy.

The common cause of having orthopnea in pregnant women are the following: congestive heart failure, intravenous fluid overload, myocardial infarction, peripartum cardiomyopathy and severe anemia.

Both are just some of the most common types of orthopnea. But in reality, there is still more.

Treatment to treat fluid overload

If excess fluid is causing respiratory problems such as orthopnea or paroxysmal nocturnal dyspnea , doctors may recommend that the patient eat a diet low in sodium, because too much sodium can contribute to fluid overload.

They can also prescribe diuretics, medications that help the body eliminate excess sodium and water.

However, diuretics sometimes become less effective over time, so after a while, many people with fluid overload must be hospitalized for additional treatment.

This treatment may include intravenous medications such as diuretics, vasodilator drugs (drugs that increase the diameter of the blood vessels to increase blood flow), and inotropic drugs (drugs that cause the heart to pump more blood with each contraction).

If these medications do not work to relieve fluid overload, doctors may prescribe a procedure known as ultrafiltration, in which blood is passed through a small machine that filters excess fluid.