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
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Causes of Orthopnea
ARDS (Acute Respiratory Distress Syndrome)
Acute respiratory distress syndrome (ARDS) is a lung condition in which trauma to the lungs leads to inflammation of the lungs, accumulation of fluid in the alveolar air sacs, low blood oxygen, and respiratory distress. ARDS can be life-threatening. Signs and symptoms of are shortness of breath and low levels of oxygen in the blood, which can cause your organs to fail. Causes of ARDS include: Pneumonia Aspiration into the lungs Severe blow to the chest Sepsis Severe injury with shock Drug overdose Inflamed pancreas Other lung conditions and infections Burns Sepsis Near drowning Fractures There have been genetic factors linked to ARDS. Treatment for includes supplemental oxygen, and/or medication. According to some studies, survival rates for ARDS depend upon the cause associated with it, but can vary from 48% to 68%.REFERENCES: Harman, EM, MD. "Acute Respiratory Distress Syndrome Clinical Presentation." Medscape. Updated: Aug 11, 2016. Harman, EM, MD. "Acute Respiratory Distress Syndrome." Medscape. Updated: Aug 11, 2016. PubMed Health. "ARDS." Updated: Jun 11, 2014. Reynolds, HN. et al. Acute respiratory distress syndrome: estimated incidence and mortality rate in a 5 million-person population base. Crit Care. 1998; 2(1): 29–34. Published online 1998 Mar 12. doi: 10.1186/cc121
Asthma is a condition in which hyperreactive airways constrict and result in symptoms like wheezing, coughing, and shortness of breath. Causes of asthma include genetics, environmental factors, personal history of allergies, and other factors. Asthma is diagnosed by a physician based on a patient's family history and results from lung function tests and other exams. Inhaled corticosteroids (ICS) and long-acting bronchodilators (LABAs) are used in the treatment of asthma. Generally, the prognosis for a patient with asthma is good. Exposure to allergens found on farms may protect against asthma symptoms.
Dilated Cardiomyopathy is a condition where the heart's ability to pump blood is decreased because the heart's main pumping chamber is enlarged and weakened. Symptoms of dilated cardiomyopathy include chest pain, heart failure, swelling of the lower extremities, fatigue, weight gain, fainting, palpitations, dizziness and blood clots.
Hypertrophic cardiomyopathy (HCM) affects many people today. Many people with HCM have no symptoms or only minor symptoms, and live a normal life. Other people develop symptoms, which progress and worsen as heart function worsens.
Restrictive cardiomyopathy, the rarest form of cardiomyopathy, is a condition in which the walls of the lower chambers of the heart (the ventricles) are abnormally rigid and lack the flexibility to expand as the ventricles fill with blood. The pumping or systolic function of the ventricle may be normal but the diastolic function (the ability of the heart to fill with blood) is abnormal. Therefore, it is harder for the ventricles to fill with blood, and with time, the heart loses the ability to pump blood properly, leading to heart failure.
COPD (Chronic Obstructive Pulmonary Disease)
COPD or chronic obstructive pulmonary disease is a lung condition caused by smoking tobacco, exposure to secondhand smoke, and/or air pollutants. Conditions that accompany COPD include chronic bronchitis, chronic cough, and emphysema. Symptoms of COPD include shortness of breath, wheezing, and chronic cough. Treatment of COPD includes GOLD guidelines, smoking cessation, medications, and surgery. The life expectancy of a person with COPD depends on the stage of the disease.
COPD vs. Asthma (Differences and Similarities)
COPD (chronic obstructive pulmonary disease) and asthma both have common symptoms like coughing, wheezing, shortness of breath, and a tight feeling in the chest. COPD is caused by tobacco smoking, while asthma is caused by your inherited genetic makeup and their interactions with the environment. Risk factors for asthma are obesity, exposure to cigarette smoke (even secondhand smoke), and personal history of hay fever. There is no cure for either disease, but symptoms can be managed with medication. A person with asthma has a better prognosis and life expectancy than someone with COPD.
COPD vs. Emphysema
COPD (chronic obstructive pulmonary disease) is the term doctors and other healthcare professionals use to describe a group of serious, progressive (worsens over time), chronic lung diseases that include emphysema, chronic bronchitis, and sometimes asthma. The number one cause of COPD or emphysema, is smoking, and smoking is the third leading cause of death in the US.
Drug Abuse and Addiction
Drug abuse and addiction is a chronic disease that causes drug-seeking behavior and drug use despite negative consequences to the user and those around him. Though the initial decision to use drugs is voluntary, changes in the brain caused by repeated drug abuse can affect a person's self-control and ability to make the right decisions and increase the urge to take drugs. Drug abuse and addiction are preventable.
Emphysema, Chronic Bronchitis, and Colds
If you have a COPD such as emphysema, avoiding chronic bronchitis and colds is important to avoid a more severe respiratory infection such as pneumonia. Avoiding cigarette smoking, practice good hygeine, stay away from crowds, and alerting your healthcare provider if you have a sinus infection or cold or cough that becomes worse. Treatment options depend upon the severity of the emphysema, bronchitis, or cold combination.
Heart failure (congestive) is caused by many conditions including coronary artery disease, heart attack, cardiomyopathy, and conditions that overwork the heart. Symptoms of heart failure include congested lungs, fluid and water retention, dizziness, fatigue and weakness, and rapid or irregular heartbeats. There are two types of congestive heart failure, systolic or left-sided heart failure; and diastolic or right-sided heart failure. Treatment, prognosis, and life-expectancy for a person with congestive heart failure depends upon the stage of the disease.
Heart Valve Disease
Heart valve disease occurs when the heart valves do not work the way they should. Symptoms of valve disease include shortness of breath, weakness or dizziness, discomfort in your chest, palpitations, swelling of your ankles, feet or abdomen, and rapid weight gain.
High Blood Pressure (Hypertension)
High blood pressure (hypertension) is a disease in which pressure within the arteries of the body is elevated. About 75 million people in the US have hypertension (1 in 3 adults), and only half of them are able to manage it. Many people do not know that they have high blood pressure because it often has no has no warning signs or symptoms. Systolic and diastolic are the two readings in which blood pressure is measured. The American College of Cardiology released new guidelines for high blood pressure in 2017. The guidelines now state that blood normal blood pressure is 120/80 mmHg. If either one of those numbers is higher, you have high blood pressure. The American Academy of Cardiology defines high blood pressure slightly differently. The AAC considers 130/80 mm Hg. or greater (either number) stage 1 hypertension. Stage 2 hypertension is considered 140/90 mm Hg. or greater. If you have high blood pressure you are at risk of developing life threatening diseases like stroke and heart attack.REFERENCE: CDC. High Blood Pressure. Updated: Nov 13, 2017.
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Pleural Effusion (Fluid in the Pleural Space)
Pleural effusion is a buildup of fluid in the chest or on the lungs. There are two types of pleural effusion, transudate and exudate. Causes of transudate pleural effusion include congestive heart failure, kidney failure, and cirrhosis. Exudate pleural effusion can be caused by malignancy (cancer) or lung infection. Typically, transudate pleural effusion is more easily treatable. Symptoms of pleural effusion include chest pain, pain when breathing, difficulty breathing, and cough. Treatment depends on the source or cause of the pleural effusion.
Pneumonia is inflammation of the lungs caused by fungi, bacteria, or viruses. Symptoms and signs include cough, fever, shortness of breath, and chills. Antibiotics treat pneumonia, and the choice of the antibiotic depends upon the cause of the infection.
Pulmonary edema, or fluid in the lungs, can cause symptoms such as shortness of breath. Learn about causes, diagnosis complications, treatment, and prevention.
Pulmonary Embolism (Blood Clot in the Lung)
A pulmonary embolism (PE) occurs when a piece of a blood clot from deep vein thrombosis (DVT) breaks off and travels to an artery in the lung where it blocks the artery and damages the lung. The most common symptoms of a pulmonary embolism are shortness of breath, chest pain, and a rapid heart rate. Causes of pulmonary embolism include prolonged immobilization, certain medications, smoking, cancer, pregnancy, and surgery. Pulmonary embolism can cause death if not treated promptly.
Sleep apnea is defined as a reduction or cessation of breathing during sleep. The three types of sleep apnea are central apnea, obstructive apnea (OSA), and a mixture of central and obstructive apnea. Central sleep apnea is caused by a failure of the brain to activate the muscles of breathing during sleep. OSA is caused by the collapse of the airway during sleep. OSA is diagnosed and evaluated through patient history, physical examination and polysomnography. There are many complications related to obstructive sleep apnea. Treatments are surgical and non-surgical.
What Does Orthopnea Mean?
When you find it difficult to breathe while lying down because of the accumulation of fluids in your lungs, it is known as orthopnea. Usually, it takes time to have a sudden onset. You may wake up from sleep because of lack of oxygen.
Examples of Medications for Orthopnea
- ACE Inhibitors (Side Effects, List of Names, Uses, and Dosage)
- bisoprolol (Zebeta)
- captopril (Capoten)
- enalapril (Vasotec, Epaned)
- furosemide (Lasix)
- lisinopril (Zestril, Prinivil, Qbrelis) ACE Inhibitor
- metoprolol (Lopressor, Toprol XL)
- nadolol (Corgard)
- propranolol, Inderal, Inderal LA, Innopran XL