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Breathing difficulty - lying down

Waking at night short of breath; Paroxysmal nocturnal dyspnea; PND; Difficulty breathing while lying down; Orthopnea

 

Breathing difficulty while lying down is an abnormal condition in which a person must keep the head raised by sitting or standing to be able to breathe deeply or comfortably.

A type of breathing difficulty while lying down is paroxysmal nocturnal dyspnea. This condition causes a person to wake up suddenly during the night feeling short of breath.

Considerations

 

This is a common complaint in people with some types of heart or lung problems. Sometimes the problem is subtle. People may only notice it when they realize that sleep is more comfortable with lots of pillows under their head, or their head in a propped-up position.

 

Causes

 

Causes may include:

  • Chronic obstructive pulmonary disease (COPD)
  • Cor pulmonale
  • Heart failure
  • Obesity (does not directly cause difficulty breathing while lying down but often worsens other conditions that lead to it)
  • Panic disorder
  • Sleep apnea
  • Snoring

 

Home Care

 

Your health care provider may recommend self-care measures. For example, weight loss may be suggested if you are obese.

 

When to Contact a Medical Professional

 

If you have any unexplained difficulty in breathing while lying down, call your provider.

 

 

The provider will perform a physical exam and ask questions about the problem.

Questions may include:

  • Did this problem develop suddenly or slowly?
  • Is it getting worse (progressive)?
  • How bad is it?
  • How many pillows do you need to help you breathe comfortably?
  • Is there any ankle, feet, and leg swelling?
  • Do you have difficulty breathing at other times?
  • How tall are you? How much do you weigh?
  • What other symptoms do you have?

The physical exam will include special attention to the heart and lungs (cardiovascular and respiratory systems).

Tests that may be performed include the following:

  • Chest x-ray
  • ECG
  • Echocardiogram
  • Pulmonary function tests

Treatment depends on the cause of the breathing problem.

You may need to use oxygen.

 

 

References

Massie BM. Heart failure: pathophysiology and diagnosis. In: Goldman L, Ausiello D, eds. Goldman's Cecil Medicine. 24th ed. Philadelphia, PA: Elsevier Saunders; 2011:chap 58.

Schraufnagel DE, Murray JF. History and physical examination. In: Mason RJ, Broaddus VC, Martin TR, et al., eds. Murray and Nadel's Textbook of Respiratory Medicine. 5th ed. Philadelphia, PA: Elsevier Saunders; 2010:chap 17.

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          Review Date: 1/31/2015

          Reviewed By: Linda J. Vorvick, MD, Medical Director and Director of didactic curriculum, MEDEX Northwest Division of Physician Assistant Studies, Department of Family Medicine, UW Medicine, School of Medicine, University of Washington, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

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