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.
Orthopnea is different from sleep apnea. Sleep apnea occurs when your throat muscles relax while you are sleeping and obstruct the airway passage. However, orthopnea is mostly noticed when you are awake but in a lying position.
If you have orthopnea, you may:
- Wheeze when you lie down.
- Have dry or frothy cough.
- Have cough and wheezing that ameliorate when you sit or stand.
- Have difficulty breathing while exercising or during any daily activities.
- Feel breathless on waking up.
- Feel more tired than usual.
- Have swelling on the feet and ankles.
- Gain excessive weight suddenly.
Why do you get orthopnea?
- A heart disease.
- Cardiomyopathy (diseases of the heart muscles).
- High blood pressure and other problems.
Heart failure may cause the accumulation of fluids in the lower lung spaces that eventually seep into the air sacs. When you lie down, the fluid moves to the upper airways making you breathless.
When you lie down, the blood moves from your legs to your chest and belly. As your weak heart cannot pump out the extra blood required, your lungs absorb even more fluid than when you were standing. Some nonheart-related causes that cause the accumulation of fluids in the lungs:
- Acute respiratory distress syndrome (ARDS) due to
- High-altitude pulmonary edema (HAPE; lung swelling): It may occur due to failure or lack of acclimatization. When you travel suddenly to a high-altitude area over 8,000 feet without becoming accustomed to that new climate condition, it may increase the rate and depth of your breathing.
- Nervous system trauma because of
- Brain surgery.
- Drug reaction to the usage of an illegal drug such as cocaine or heroin or over the counter medications (aspirin)
- Toxins such as smoke or other heavy metals
- Pulmonary embolism (blood clot in the lungs): When a clot travels from your leg to your lungs, it may cause swelling and the accumulation of fluids.
How will your doctor diagnose orthopnea?
Your doctor will evaluate you clinically. They will ask questions pertaining to coughing and wheezing while lying down, getting better by standing, worsening of symptoms over time, and the total number of pillows you require while sleeping and thus estimate the severity of your condition. If your doctor suspects any heart-related condition during clinical examination, then they will order several tests to determine the exact reason:
- Blood tests to check the level of oxygen and carbon dioxide in your blood
Higher B-type natriuretic peptide (BNP) may suggest a heart condition that is causing the accumulation of fluids in the lungs.
What are the treatment options for orthopnea?
For a short time, you can ameliorate your symptoms by standing and sitting upright or raising your upper body with pillows.
Your doctors may
- Put intranasal tubes (tubes into your nose) through which you will be provided oxygen.
- Prescribe some diuretics (water pills) to get rid of extra fluid in your body.
For long-term cure, you should consult a cardiologist about your heart health, the condition that might be causing your orthopnea, and treatment options.
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