A person may sleep more comfortably with her head elevated by several pillows. In some people this is a preference; in others it is an indication that they suffer from orthopnea. The causes of orthopnea can be physical or psychological.
The Facts
Orthopnea is a breathing problem characterized by difficulty breathing while lying down. Most patients who experience orthopnea wake up short of breath during the night. Some patients experience shortness of breath so acutely they need to sleep propped up in a sitting position rather than lying in bed to keep their head elevated in order to breath deeply. Orthopnea can be caused by heart, lung and sleep apnea problems.
Cardiac
Orthopnea may be related to cardiac conditions, including hypertensive heart disease and congestive heart failure. A patient with hypertensive heart disease has a weakened heart that is less capable of pumping blood throughout the body. When he lies down, blood volume is redistributed throughout the body, making it more challenging for the heart to pump blood away from the lungs. This can cause shortness of breath. A patient with congestive heart failure may have a similar experience when lying down and can also awaken breathless because of orthopnea.
Lung
Pulmonary problems can also cause orthopnea, including chronic obstructive pulmonary disease -- COPD. A patient with COPD often experiences swelling of and increase mucus levels in the main airways of the lungs. Pulmonary congestion like that is usually relieved when a patient hold his body erect in a standing or sitting position. When he lies down in bed at night to sleep, congestion worsens, leading to trouble breathing and possibly triggering orthopnea.
Anxiety Disorder
Some patients with anxiety disorders characterized by panic attacks can also experience orthopnea. Symptoms of a panic attack include chest pain, intense feelings of fear, and the sensation that you cannot catch your breath. If a panic attack is triggered at night while a patient is asleep, she may awaken unable to breathe and experiencing orthopnea.
Sleep Apnea
Some of the causes of sleep apnea can also cause orthopnea. In sleep apnea, a patient experiences episodes of stopped breathing during sleep, often lasting longer than 10 seconds. Causes can include nasal obstruction, a narrow airway in the throat and large tonsils. These may also lead to difficulty breathing normally while lying down.
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