What is Orthopnea?
Orthopnea is a medical condition caused by air being trapped inside your lungs. When you breathe out, it causes the air to expand and push against the small space between your chest wall and rib cage. This pressure forces air into your lungs which are full of gas (oxygen). However, when you exhale, there is less room for expansion because the lung has too much volume. This results in a sudden drop in blood oxygen levels.
The main cause of orthopnea is abnormal breathing patterns. These include:
Shortness of breath due to tight muscles or poor posture.
Breathing through your mouth rather than nose, resulting in excess mucus production and increased acidity of the stomach. This leads to abdominal pain and bloating. It may lead to vomiting if not treated promptly with medication such as anti-emetics or laxatives.
Excessive coughing or phlegm production.
Coughing up blood from the sputum, which contains bacteria and other foreign material. If left untreated, this will result in infection and scarring of the lungs.
Inhaling large amounts of carbon dioxide during exercise. This results in increased heart rate and blood pressure. It leads to increased risk of heart attack or stroke.
These breathing disarray changes the position of the organs inside the chest. It causes the heart and lungs to move closer towards the front of the chest. This makes your lungs more susceptible to orthopnea symptoms. (1)
What are the causes of Orthopnea?
Orthopnea is caused by dysfunctional breathing habits or respiratory conditions. These can be genetic or acquired from other illnesses or surgical procedures.
The main causes of orthopnea include:
These include diseases such as:
Diseases affecting the lungs (such as emphysema or asthma). This occurs when there is an increase in pressure inside the lung, which in turn increases the volume of air between the chest wall and ribs. It also puts pressure on the heart and causes it to work harder.
Heart conditions such as congestive heart failure.
Sitting in the same position for an extended period of time. It causes the lungs to collapse and reduces lung capacity.
Neuromuscular problems (such as Lou Gehrig’s disease). This affects the central nervous system and causes loss of muscle strength. These changes affect the diaphragm and other respiratory muscles. (2)
Smoking. This causes damage to the lungs and other respiratory organs, which in turn increases pressure inside the chest.
Swelling of the liver or spleen.
Stress from psychological conditions or trauma. (2)
What are the risk factors of Orthopnea?
Orthopnea may be caused by various factors such as:
Having a family history of heart disease or lung disorders.
What are the symptoms of Orthopnea?
Orthopnea causes a variety of symptoms, including:
Difficulty breathing or shortness of breath while lying down or sitting (in severe cases).
Dizziness and lightheadedness. This occurs due to low oxygen levels in the blood.
Fatigue and weakness. (2)
How is Orthopnea diagnosed?
Orthopnea is usually diagnosed through a physical examination of the patient by a Doctor. They will ask you about your medical history and symptoms, then perform a physical examination. This will include a biopsy of the lungs if they suspect lung cancer or other diseases. (2)
These are the diagnostic tests that your doctor may recommend:
Chest x-ray. This is a non-invasive, low-risk procedure that can identify lung cancer or other disorders of the lungs or chest wall.
EKG (Electrocardiogram). This test can identify irregular heart rhythms or other heart conditions.
Holter monitor. This is a portable device that records your heart rhythm over a 24 hour period. (3)
How is Orthopnea treated?
Treatment depends on what is causing the condition. Treatment options include:
Surgery (if the cause is identified).
Anti-anxiety drugs. These can be used to increase respiration rate, improve oxygen flow and reduce episodes of lightheadedness. (4)
Lifestyle changes and avoiding factors that trigger attacks (such as smoking).
Learn the signs and symptoms of the condition and seek immediate medical attention if an attack occurs. (3)
What is the prognosis of Orthopnea?
The prognosis of orthopnea is good in most cases. A change in behavior can reverse or slow down the effects of the condition. (3)
How can Orthopnea be prevented?
Orthopnea may be caused by a variety of factors and so the best way to prevent the condition from developing in the first place is to avoid these factors. These include: (2)
Eating a healthy diet and maintaining a healthy weight.
Avoiding exposure to second-hand tobacco smoke.
How long does Orthopnea last?
If left untreated, the effects of orthopnea can be permanent. In mild cases, the condition may resolve itself or become less severe over time. (2)
However, in some cases the condition may worsen and require medical attention. On average, orthopnea has a life expectancy of eight years. (3)
In more severe cases, the life expectancy is lower due to the higher risk of developing lung cancer or another illness. (2)
Orthopnea: Key Points
Orthopnea is a condition where a person experiences shortness of breath or difficulty breathing while lying down or sitting. This occurs due to low blood oxygen levels or an increase in fluid retention within the lungs. It is most common in older adults or people who smoke.
Orthopnea can cause a variety of symptoms, including fatigue, dizziness and lightheadedness. It can also be life-threatening in severe cases.
Orthopnea is often caused by medical conditions such as heart problems, lung cancer, chronic obstructive pulmonary disease (COPD) or emphysema. It can also be caused by lifestyle factors such as smoking or obesity.
Orthopnea is diagnosed based on a medical history and physical examination. In some cases, further tests may be needed to identify the underlying cause.
Treatment for orthopnea is often targeted at the underlying cause of the condition. For example, quitting smoking or taking prescription medication.
Orthopnea can be prevented by avoiding lifestyle factors that may contribute to the condition and seeking immediate medical attention for any pre-existing conditions.
Orthopnea can often be reversed or slowed down with lifestyle changes and medical treatment.
Orthopnea: Related Terms
Apnea: A condition where a person stops breathing for long periods of time during sleep.
Atelectasis: A condition where lung tissue collapses due to the lungs not being inflated properly.
Atherosclerosis: A condition where the arteries become narrowed, reducing blood flow to organs and tissues.
Emphysema: A chronic lung disease that causes shortness of breath and a need to take deeper breaths.
Heart failure: A condition where the heart is unable to pump enough blood around the body, leading to shortness of breath and fatigue.
Pleural effusion: A buildup of fluid in the pleural space between the lungs and chest wall.
Pneumonia: An infection of one or both of the lungs.
Restrictive lung disease: A condition where multiple areas of the lung are unable to expand and fill with air properly.
Stable angina: A type of angina where the chest pain and discomfort is predictable and will go away with rest or medication.
Unstable angina: A type of angina where the chest pain and discomfort is unpredictable and can happen at rest or during activity. It is also known as a ‘migratory’ chest pain.
Fatty liver disease: A condition where excess fat is stored in the liver, leading to inflammation and liver damage.
Pulmonary embolism: A condition where a blood clot travels through the bloodstream and gets stuck in the lung arteries, blocking blood flow to part of the lung.
Orthopnea: A condition where a person experiences shortness of breath or difficulty breathing while lying down or sitting.
Orthopnea: Additional Information
Orthopnea is a common condition that causes shortness of breath when lying down or sitting. It can contribute to a lack of sleep, and in severe or advanced cases, it can lead to daytime fatigue and drowsiness.
Orthopnea is caused by an increased amount of pressure on the lungs when in the lying down position. Although there are no known medical conditions that directly cause or trigger orthopnea, it is often a symptom of other conditions such as heart disease, lung disease or obesity. Other contributing factors can include cigarette smoking, severe coughing or the consumption of large meals during or before bedtime.
A person with orthopnea experiences shortness of breath when lying down. This may cause them to wake up in the middle of the night to change position. As a result, sleep is interrupted and not as restful. In severe or advanced cases, a lack of sleep caused by orthopnea can lead to daytime fatigue and drowsiness.
During sleep, a person’s body naturally assumes the most comfortable position. Most people prefer to sleep on their back or front, and experience discomfort if forced to sleep in another position. When a person has heart or lung disease, this natural preference for a particular sleeping position can cause shortness of breath and other symptoms when in that position.
Orthopnea usually causes most discomfort when lying down. It can cause shortness of breath, chest pain and cough. In some cases, it can also cause dizziness, fainting and other symptoms that affect the nervous system. A person with orthopnea often experiences less of these symptoms when sitting or standing, and most experience relief when lying down in a position other than their usual sleeping position.
Orthopnea can also be a side effect of some medical conditions. Conditions such as heart or lung disease, fluid build up and obesity are all possible causes.
Orthopnea is typically diagnosed with the help of a healthcare provider after taking a detailed medical history and performing a physical examination. If necessary, the medical professional may also request other diagnostic tests such as blood pressure readings, electrocardiogram (ECG/EKG) or chest X-rays.
Orthopnea is not typically treated as there are no known cures. However, it can usually be prevented or lessened with lifestyle changes and in some cases medication.
Lifestyle changes such as quitting smoking, losing weight and adjusting eating habits can all help prevent and relieve symptoms of orthopnea by improving a person’s overall health.
Bed rest is not recommended as a treatment for orthopnea and can actually worsen other conditions such as heart failure.
If you think you may have orthopnea or are concerned about your sleeping position, it’s best to consult a medical professional.
Understanding Sleep Apnea
Find a Sleeping Position That Suits You
Snoring and Sleep Apnea
How to Get a Good Night’s Sleep
COPD and Emphysema
Heart Disease and Stroke
Learn more about your breathing
Sleep Disorders Center
A shift in the way we sleep
Most of us don’t get as much sleep as we need, and the quality of that sleep may be less than ideal. While many of us are familiar with the occasional night of poor sleep (or we’re currently experiencing it), ongoing disturbances in your sleep patterns could be a sign of a more serious condition known as a sleep disorder.
A sleep disorder is any problem that prevents you from getting quality sleep.
There are several factors that can contribute to the development of a sleep disorder. They range from lifestyle factors such as diet, exercise and stress to health conditions and medications. According to the National Heart, Lung, and Blood Institute (NHLBI), more than 30 million Americans suffer from a sleep or wakefulness disorder.1 Some of the more common sleep disorders include:
Insomnia: The main symptom is trouble falling asleep, staying asleep, or waking up too early and not being able to get back to sleep.
Sleep Apnea: This disorder occurs when a person’s breathing is interrupted repeatedly during sleep. This can be temporary, or the breathing can cease altogether, sometimes for up to several minutes.
Restless Leg Syndrome (RLS): An uncontrollable need to move the legs. This disorder is believed to be caused by a lack of certain nutrients in the body or by anemia. Nighttime leg movement disrupts sleep and causes extreme fatigue during the day.
Narcolepsy: A day disorder that causes a person to fall asleep at random times without any warning. Narcoleptics will suddenly experience an overwhelming need to sleep that is difficult to resist.
Jet Lag: A group of symptoms that include fatigue, insomnia, dizziness and disorientation that occurs when traveling over several time zones.
Shift Work Sleep Disorder: Occurs in people who have daytime jobs that interrupt their normal sleep schedule. Symptoms include sleepiness, fatigue, trouble concentrating, weight gain and increased risk of diabetes.
Sleep Apnea and Sleep Deprivation
Sleep apnea is a condition that affects more than 18 million Americans.2 It causes you to stop breathing repeatedly during the night, sometimes for up to several minutes at a time. This can lead to serious consequences for your overall health.
Sometimes sleep apnea causes you to:
Breathe through the mouth
Snore louder and longer than usual
Be restless during sleep
Gasp for air
Wake up with a dry throat and mouth, sometimes feeling like you are choking
Feel tired or sleepy during the day
Provoke depression, irritability, memory loss, and even confusion
While not dangerous in all cases, sleep apnea may lead to a higher risk of:
High blood pressure
Depression and decreased quality of life
Sleep apnea is believed to be caused by a number of factors, including:
Being overweight or having a large neck circumference
Having a family history of the disorder
Grinding or snoring loudly during sleep
Sedatives, anesthetics or alcohol
Most cases of sleep apnea can be treated, but most of these treatments are not complete solutions and can have side effects. For this reason, the NHLBI recommends that anyone who suspects they may suffer from sleep apnea consult their physician immediately.
Melatonin and Sleep Disorders
Melatonin is a naturally occurring hormone that helps regulate your sleep-wake cycle, also known as your circadian rhythm. It is secreted by the pineal gland and is heavily influenced by light. Darkness causes the body to produce more melatonin, which makes you feel sleepy. Daylight restricts the production of melatonin, which makes you feel more alert.
Melatonin is sold over-the-counter (OTC) and it is the only OTC hormone available in the United States. This has caused some people to misuse it as a sleeping pill. However, studies have shown that melatonin only helps people fall asleep faster, not stay asleep. It also does not cure the root cause of the sleep disorder.
Melatonin can also cause nausea, headaches and other mild side effects in some people.
Natural Supplements for Sleep Disorders
Natural supplements can help people with sleeping disorders get to sleep faster and stay asleep through the night. However, they do not address the root cause of the problem. Without treating the root cause, a person is likely to relapse into their old sleeping patterns when they stop taking the supplements. This is why most doctors recommend taking natural sleeping supplements in addition to treatment for the underlying issue.
Melatonin is a naturally-occurring hormone that regulates sleep. It makes you feel sleepy in the presence of darkness, and keeps you from feeling sleepy in the presence of light. Since melatonin is available OTC in supplement form, many people with sleeping disorders use it to try to cure their condition. There is some evidence that melatonin can help people fall asleep faster and increase the amount of time they spend asleep.
However, it does not increase the quality of sleep and does not cure the underlying cause of the sleeping disorder.
Also known as valeriana officinalis, valerian root has been used medicinally for centuries. It is still one of the leading ingredients in many sedatives and sleep aids available today. Valerian root improves sleep quality and may make falling asleep faster, but it also increases the time it takes to fall asleep. It can also cause drowsiness and mild withdrawal symptoms.
L-theanine is an amino acid found in green tea. It helps improve mood, concentration and promote relaxation without causing drowsiness. It has also been shown to help people fall asleep faster and increase the quality of sleep. However, it does not cure the root cause of the sleep disorder.
Melatonin Pills vs. Natural Sleep Remedies
Taking melatonin pills or other natural sleep remedies is a great way to help you get to sleep faster and stay asleep through the night. It can also increase the quality of your sleep and help you wake up feeling refreshed in the morning. However, it doesn’t address the underlying cause of your sleeping disorder. If you stop taking melatonin or other sleep remedies, you are likely to relapse into your old sleeping patterns.
If you continue to take the supplements, you may develop a reliance on them and find it difficult to sleep when you stop taking them.
At-Home Sleep Tests
Insomnia is a sleeping disorder that causes people to have difficulty falling asleep, staying asleep or waking up feeling unrefreshed. It can have many different causes such as stress, depression, pain, certain medications and other factors. Some people experience short-term insomnia that lasts only a few nights. Others have long-term insomnia that lasts months or even years.
Insomnia is a common disorder. In fact, studies suggest that about 30% of people in the U.S. experience at least one episode of insomnia in any given year.
As many as 10% of adults have chronic insomnia that lasts for more than a few weeks. This number increases with age and by the time you are in your 70s, almost 40% of people suffer from this condition.
There are many different types of insomnia. The two most common types of this disorder are Sleep Onset Insomnia and Maintenance Insomnia.
Sleep Onset Insomnia means that you have difficulty falling asleep. You might feel sleepy, but it takes a very long time for you to actually fall asleep. This can last from a few weeks to a few months.
Maintenance Insomnia is when you fall asleep relatively fast, but wake up after only a few hours of sleep. You might have a hard time getting back to sleep and when you do you only get a few hours of sleep before waking up again.
While these types of insomnia are the most common, there are many others that are less common such as Free Running Disorder, Nighttime Eating Syndrome, Shift Work Sleep Disorder, Circadian Rhythm Sleep Disorder and more.
Insomnia is also categorized based on its cause. These include:
Deprivation Insomnia – this occurs when you don’t get enough sleep on a regular basis. This can be caused by not allowing yourself enough time to sleep, or by sleeping during the day and being awake at night (as can happen with shift workers).
Mood-Dependent Insomnia – this type of insomnia only occurs in people who have a particular mood before going to sleep. For example, a person with depression might only experience insomnia when they are in the depths of their depression.
Medication-Induced Insomnia – this can occur when you take sleep aids such as Ambien or Lunesta. These drugs can cause you to have insomnia for days after you stop taking them. They can also sometimes cause a rebound effect where you begin to have even more problems falling asleep without the drug than you did before taking it.
Aging-Induced Insomnia – As people get older, there is a tendency for them to require more sleep. This might mean that they need to sleep longer than usual on the weekends to make up for during the week when they are limiting their sleep to only 4 or 5 hours per night instead of their normal 7 or 8.
With so many different types and causes of insomnia, it’s no wonder there are so many different types of treatments. In the next section, we will discuss some of them.
Sources & references used in this article:
Expiratory flow limitation and orthopnea in massively obese subjects by A Ferretti, P Giampiccolo, A Cavalli, J Milic-Emili… – Chest, 2001 – Elsevier
Expiratory flow limitation as a determinant of orthopnea in acute left heart failure by A Duguet, C Tantucci, O Lozinguez… – Journal of the …, 2000 – onlinejacc.org
Orthopnea by CD CHRISTIE, AJ BEAMS – Archives of Internal Medicine, 1923 – jamanetwork.com
Mechanism of the postural reduction in vital capacity in relation to orthopnea and storage of blood in the lungs by WF Hamilton, AB Morgan – American Journal of Physiology …, 1932 – journals.physiology.org
Orthopnea and tidal expiratory flow limitation in patients with stable COPD by L Eltayara, H Ghezzo, J Milic-Emili – Chest, 2001 – Elsevier
Orthopnea and tidal expiratory flow limitation in patients with euthyroid goiter by R Torchio, C Gulotta, A Perboni, C Ciacco… – Chest, 2003 – Elsevier
Persistent orthopnea and the prognosis of patients in the heart failure clinic by LB Da Silva, L Mielniczuk, M Laberge… – Congestive Heart …, 2004 – Wiley Online Library
Orthopnea and inspiratory effort in chronic heart failure patients by S Nava, MT Larovere, F Fanfulla, P Navalesi… – Respiratory …, 2003 – Elsevier