Orthopnea: Symptoms & Signs

Medically Reviewed on 4/26/2022

Orthopnea is the sensation of difficulty breathing when lying down that is relieved by assuming an upright position. Orthopnea is ultimately caused by increased pressure in the blood vessels of the lungs, and this most often occurs in relation to heart failure. Heart failure can have many causes, all of which can cause the symptom of orthopnea. Orthopnea may range from mild to severe. In certain cases, diseases of the lungs can also cause orthopnea, such as when excess fluid or mucus is present.

The symptom of orthopnea is sometimes described in terms of the number of pillows needed to sleep comfortably or to prop oneself up to improve breathing. For example, "three pillow orthopnea" means that a person requires three pillows' worth of support to restore comfortable breathing. Other associated symptoms, depending on the cause of the orthopnea, can include swelling of the feet and ankles, coughing, wheezing, chest pain, fatigue, weight gain, and waking up feeling breathless or short of breath.

Other causes of orthopnea

  • Drug Overdose or Reaction
  • High-Altitude Pulmonary Edema
  • Large Goiter
  • Paralysis of the Diaphragm Muscle

Jameson, J. Larry, et al. Harrison's Principles of Internal Medicine, 20th Ed. New York: McGraw-Hill Education, 2018.