Shortness of breath is common in pulmonary hypertension (PH), especially with activity. Shortness of breath that happens mainly when lying flat, called orthopnea, may be a symptom of some types of PH, but it’s not a typical symptom of pulmonary arterial hypertension (PAH).

In some people with PH, orthopnea may happen because of another heart or lung condition, fluid overload, sleep apnea, or another contributing factor. If you have PAH and notice new orthopnea, your doctor may want to look for causes beyond PAH itself.

Still, if you notice breathing problems when lying down, it’s important not to ignore them. This article explains what orthopnea is, why it can happen, what other conditions may be involved, and when to talk with your doctor.

Why Does Lying Down Make It Harder To Breathe?

Shortness of breath when lying down that is relieved by sitting up is often called orthopnea. It’s a specific type of breathing problem that happens when you lie flat on your back.

Orthopnea may come with other symptoms like:

• Chest tightness
• A rapid heartbeat or heart palpitations
• Noisy breathing or wheezing
• Coughing

Orthopnea is different from a general shortness of breath, known as dyspnea. Dyspnea can happen at any time, not just when lying flat.

Orthopnea is most often linked to conditions such as left-sided heart failure. Although some people with PH may experience shortness of breath when lying down, orthopnea is not considered a classic symptom of PAH. In people with PAH, this symptom may lead a healthcare provider to check for another cause or a coexisting condition.

How Pulmonary Hypertension Affects Your Breathing When Lying Down

Pulmonary hypertension is a group of conditions that cause high blood pressure in the arteries of the lungs. Over time, PH can make it harder for the heart and lungs to work together and can lead to shortness of breath.

However, orthopnea is not a typical symptom of pulmonary arterial hypertension (PAH), one specific type of PH. If someone with PAH develops orthopnea, doctors may look for other causes or contributing conditions, such as left-sided heart failure, lung disease, sleep apnea, fluid overload, or neuromuscular weakness.

Still, lying flat can make breathing feel worse for several reasons, especially in people who have PH along with another heart, lung, or sleep-related condition.

When you lie down, blood and fluid from your legs and lower body shift toward your chest. In some people, this can increase pressure in the heart and lungs and make breathing feel harder. This is a common reason for orthopnea in conditions such as heart failure and fluid overload.

Some people with PH also have other conditions that affect breathing, including left-sided heart problems or chronic lung disease. These conditions may be more likely than PAH itself to cause shortness of breath when lying flat.

Lying flat can also change how your lungs and diaphragm move. The pressure of abdominal organs against the diaphragm may leave the lungs with less room to expand, which can make breathing feel more uncomfortable in some positions.

Sleep apnea can also contribute to nighttime breathing problems. This sleep disorder can lower oxygen levels during sleep and put added stress on the heart and lungs. Sleep apnea may occur along with PH and can lead to nighttime shortness of breath, poor sleep, and repeated awakenings.

Because orthopnea is not usually expected in PAH, new or worsening shortness of breath when lying down with PAH should be discussed with your healthcare provider.

Other Causes of Shortness of Breath While Lying Down

There are several other causes of shortness of breath when lying down aside from pulmonary hypertension and sleep apnea.

If you have PAH and develop orthopnea, your doctor may consider other possible causes, including:

• Left-sided heart failure or other left-heart problems when the body can’t pump blood throughout the body very well, leading to shortness of breath lying down or awakenings during sleep from shortness of breath
• Chronic lung diseases like pulmonary fibrosis or chronic obstructive pulmonary disease (COPD), which make it harder to breathe and cause sensations of shortness of breath
• Sleep apnea or other sleep-related breathing disorders
• Weakness of the respiratory muscles
• Fluid overload
• A pulmonary embolus, a blockage in the lungs that can lead to chest pain and sudden shortness of breath
• Some medications, such as beta-blockers or statins, which come with side effects like shortness of breath

Warning Signs You Shouldn’t Ignore

Shortness of breath when lying down can signal serious health conditions like heart failure, so it’s important to seek medical care right away.

You should see a healthcare provider immediately if you notice:

• Difficulty breathing that comes on suddenly
• Feelings of breathlessness or like you can’t catch your breath
• Gray or blue nails, lips, or skin
• Heaviness or pain in your chest
• An irregular or fast heartbeat
• Swelling in the feet or ankles

From Sleepless Nights to Easier Breathing

Shortness of breath when lying down can be more than just uncomfortable. It can also be a signal from your body that something more is going on. Conditions like sleep apnea can also make these breathing problems worse, especially at night.

The good news is that there are ways to manage and improve symptoms, including positioning, fluid management, oxygen therapy, and treating underlying causes.

If your symptoms are new, worsening, or severe, don’t ignore them. Getting care early can help protect both your heart and lungs, and help you breathe easier.

Join the Conversation

On MySleepApneaTeam, people share their experiences with sleep apnea, get advice, and find support from others who understand.

Have you found any sleeping positions or nighttime routines that help you breathe more comfortably with pulmonary hypertension? Let others know in the comments below.