Orthopnea: Why do we find it difficult to breathe in certain positions?

Orthopnea is a medical ailment that causes breathing problems when lying down. It is a typical symptom in those with underlying respiratory or cardiovascular issues. Gravity causes blood flow to the heart and lungs to rise when a person with orthopnea lies down, increasing the demand for these organs. This added workload is manageable when the heart and lungs are in good condition. However, lying flat can lead to fluid buildup in the lungs in patients with specific medical disorders, such as heart failure, chronic obstructive pulmonary disease (COPD), or severe obesity, which makes breathing difficult.

When lying down, people with orthopnea frequently feel out of breath or shortness of breath, which is remedied by sitting or standing up. Other signs of orthopnea may include anxiousness, fast breathing, wheezing, coughing, and wheezing.

A healthcare provider would typically review the patient’s medical history, perform a physical examination, and may also recommend additional testing such as chest X-rays, echocardiograms, or pulmonary function tests in order to identify orthopnea. The goal of orthopnea treatment is to control the underlying illness causing the symptom. This may entail the use of supporting devices like continuous positive airway pressure (CPAP) machines for sleep-related breathing difficulties, lifestyle changes like weight loss and quitting smoking, and drugs to reduce fluid buildup.

Orthopnea-causing factors

  • When the heart cannot adequately pump blood, it results in heart failure, which causes fluid to build up in the body’s organs and lungs. Orthopnea may occur from this fluid buildup.
  • Chronic bronchitis and emphysema are two lung conditions that are part of the chronic obstructive pulmonary disease (COPD) group of illnesses. Breathing is challenging with COPD due to the narrowing of the airways. A compromised lung ability can lead to orthopnea.
  • Obesity: Carrying around too much weight can put a strain on the chest and belly, making it more difficult for the lungs and diaphragm to expand fully. In particular, when lying flat, this may cause breathing problems.
  • Asthma: Asthma is a long-term inflammatory disorder that affects the airways, causing them to constrict and swell. The greater breathing effort required when lying down can cause orthopnea in those with severe asthma.
  • An accumulation of fluid in the lungs is referred to as pulmonary edema. Heart failure, kidney issues, or severe lung infections are just a few of the illnesses that may be to blame. Symptoms of pulmonary edema frequently include orthopnea.
  • Sleep apnea: A sleeping disorder known for breathing pauses while you’re asleep. Orthopnea is a breathing difficulty when lying down that some people with sleep apnea may have as a result of the collapse of the airways during sleep.
  • Pregnancy: In the later stages of pregnancy, hormonal changes, an increase in blood volume, and pressure from the expanding uterus can compromise lung function and cause orthopnea.

Effects of Orthopnea

  • Orthopnea has the potential to seriously impair sleep habits. In order to feel more comfortable, people with orthopnea frequently find it difficult to sleep in a supine posture and may need to use several pillows or sleep in a recliner. Insufficient sleep can result in daytime weariness, impaired cognitive function, and a general decline in well-being.
  • Reduced capacity for exercise: Orthopnea can restrict one’s capacity for exercise and physical activity. Even light exercise might cause people to feel out of breath and exhausted. This may result in a sedentary lifestyle, further endangering the health of your heart and lungs.
  • Chronic respiratory problems can exacerbate anxiety and mental distress. The persistent worry about shortness of breath and the requirement to change postures to relieve symptoms can lead to severe psychological stress and have an adverse effect on mental health.
  • Orthopnea can have a substantial negative impact on everyday activities and quality of life. Simple activities like relaxing, obtaining a good night’s sleep, or exercising can become difficult and irritating. This may result in a decreased sense of well-being and a decreased capacity to take pleasure in typical daily activities.
  • Complications of underlying conditions: Orthopnea is frequently a sign of underlying heart or lung problems, such as COPD, pulmonary edema, or heart failure. These problems can deteriorate and cause further issues, like fluid overload, respiratory infections, and organ malfunction if they are not treated.
Effects of orthopnea

Symptoms of Orthopnea

  • Breathlessness: People with orthopnea frequently feel as though they can’t take in enough air or are out of breath. Because more fluid accumulates in the lungs when you’re lying down, this sensation can get worse.
  • When airflow in the respiratory passageways is blocked, wheezing—a high-pitched whistling sound—occurs. It may be present in those who have orthopnea, particularly if the etiology is a respiratory disorder like asthma or COPD.
  • Coughing: Some people with orthopnea could have a chronic cough, especially when they’re lying down. Depending on the underlying disease, the cough may be dry or productive.
  • Anxiety and restlessness: People with orthopnea who have trouble breathing while resting flat may experience anxiety, restlessness, or a sensation of panic. Feelings of uneasiness may be exacerbated by the desire to switch positions frequently in order to find relief.
  • Swelling: Fluid retention can result in swelling in the legs, ankles, or belly in cases when orthopnea is brought on by heart failure. The accumulation of fluid in the human tissues leads to this swelling, known medically as edema.
  • Rapid breathing: As the body tries to make up for low oxygen levels, orthopnea can cause an increase in respiratory rate. Even when at rest, this may cause a quicker breathing rhythm.

Prevention of orthopnea

  • It’s important to adhere to treatment programs recommended by your doctor if you have an underlying illness like heart failure, COPD, asthma, or sleep apnea. This could involve taking drugs, making lifestyle changes, or utilizing equipment like CPAP machines to treat sleep apnea. Following your treatment plan religiously can aid in symptom management and orthopnea episode prevention.
  • Maintain a healthy weight since obesity puts more strain on the chest and lungs, which can make orthopnea worse. If you are overweight or obese, reducing your weight with a balanced diet and consistent exercise can aid with symptom relief and enhance overall respiratory function.
  • Quit smoking: Asthma and COPD are two respiratory disorders that are significantly increased by smoking. By giving up smoking, one can lessen inflammation, enhance lung capacity, and minimize the risk of developing orthopnea.
  • Manage your fluid intake: If fluid retention is a cause of orthopnea, it’s critical to keep an eye on and control your fluid intake. The recommended daily fluid intake to avoid fluid excess may be suggested by your healthcare physician. Additionally, since too much salt can cause fluid retention, they might suggest dietary changes to lower sodium intake.
  • Adjusting sleep postures may be helpful for people who have orthopnea brought on by sleep apnea or positional discomfort. Symptoms can be eased and improved breathing during sleep can be achieved by elevating the upper body with pillows or by utilizing an adjustable bed.
  • Exercise on a regular basis: Physical activity on a regular basis can enhance respiratory and cardiovascular health. Exercise helps to improve lung capacity, the heart and lungs’ strength, and general fitness. Before beginning any fitness program, check with your healthcare practitioner to be sure it is secure and appropriate for your condition.
  • Control your tension and worry because they can make breathing problems worse. Adopting stress-relieving practices like meditation, deep breathing exercises, and relaxation methods might help people control their worries and possibly lessen the frequency of orthopnea episodes.
Prevention of orthopnea

Natural remedies for Orthopnea

  • Deep breathing exercises: Performing breathing exercises regularly can assist in boosting oxygen intake, improving lung function, and alleviating stress. Techniques like alternate nostril breathing, pursed lip breathing, and diaphragmatic breathing can be beneficial. To learn the right breathing techniques, speak with a respiratory therapist or other certified specialist.
  • Gargling with warm salt water can help to remove mucus, reduce inflammation, and soothe the throat. Gargle several times daily with warm water and a half teaspoon of salt. This might be especially beneficial if coughing or discomfort of the throat accompanies the orthopnea.
  • Herbal remedies: A number of plants have been used traditionally to improve respiratory health. However, before utilizing any herbal medicines, especially if you have underlying medical concerns or are taking medication, it’s crucial to speak with a healthcare provider or herbalist. Herbs like licorice root, mullein, marshmallow root, and ginger are a few that might be taken into consideration.
  • Essential oils: A few essential oils have qualities that can help with congestion and respiratory health. For respiratory support, eucalyptus, peppermint, and lavender oils are frequently utilized. But it’s crucial to utilize essential oils sensibly and adhere to the right dilution and inhalation strategies. For advice, speak with a healthcare provider or aromatherapist.
  • Maintain a healthy lifestyle: Leading a healthy lifestyle can benefit your overall health, including your respiratory system. This involves maintaining a regular exercise schedule, regulating stress levels, eating a balanced diet high in fruits, vegetables, and whole grains, and avoiding environmental irritants and pollutants.

Treatment options for orthopnea 

  • Medications:
  • Diuretics: These drugs lessen the buildup of fluid in the lungs or other areas of the body by encouraging higher urine production, which helps reduce fluid retention.
  • Bronchodilators: To help open up the airways and improve breathing, bronchodilators may be recommended if orthopnea is accompanied by respiratory diseases like asthma or COPD.
  • Medication for underlying heart conditions: If heart failure is the root cause of orthopnea, doctors may recommend beta-blockers, ACE inhibitors, or angiotensin receptor blockers (ARBs) to improve heart function and decrease fluid retention.
  • Oxygen therapy: To ensure adequate oxygen levels and ease breathing difficulties in serious situations, supplementary oxygen may be provided. A healthcare expert may advise using a face mask, nasal cannula, or other apparatus to give oxygen therapy.
  • changes to one’s way of life
  • Weight management: If necessary, losing extra weight helps improve breathing and lessen the stress on the respiratory system.
  • Changing your diet: Reducing your salt consumption can help you control underlying heart issues and lessen fluid retention. A low-sodium diet may be advised by a doctor.
  • Quitting smoking is crucial for enhancing lung health and lowering the risk of developing new difficulties.
  • Position changes for sleep: Using an adjustable bed or raising the upper body with pillows can help alleviate positional or sleep apnea-related orthopnea symptoms.
  • Treat underlying diseases: Effective care of underlying disorders including heart failure, COPD, asthma, or sleep apnea is essential for controlling orthopnea. According to a healthcare professional’s recommendation, this may entail extra therapies unique to each illness, such as dietary changes, physical therapy, or surgical procedures.
  • Continuous positive airway pressure (CPAP) machines or other breathing devices: For those with sleep-related breathing disorders, such as sleep apnea, the use of CPAP machines or other breathing devices during sleep can assist maintain an open airway and improve breathing patterns.

*Disclaimer: This article is for informational purposes only and should not substitute professional medical advice. Please consult a healthcare professional for a thorough evaluation of your symptoms and appropriate treatment.

Author Information

Contributed by

Author Contribution: Reviewed by Dr. Ram Reddy, MD – General Physician, and Rajeshwar Rao, Pharm D.

Add a Comment

Your email address will not be published. Required fields are marked *