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Breathing difficulty while lying down is an abnormal condition in which a person must keep the head elevated (by sitting or standing) to be able to breathe deeply or comfortably. The condition may also cause a person to wake up suddenly during the night feeling short of breath (paroxysmal nocturnal dyspnea).

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.

• Chronic obstructive pulmonary disease (COPD)
• Cor pulmonale
• Heart failure
• Hypertensive heart disease
• Obesity (does not directly cause difficulty breathing while lying down but often aggravates other conditions)
• Panic disorder
• Sleep apnea
• Snoring

Your health care provider may prescribe treatment for breathing difficulty while lying down. The treatment will depend on the specific illness causing the problem.

Weight loss is generally recommended in people who are obese.

If you have any unexplained difficulty in breathing while lying down, call for an appointment with your health care provider.

The health care provider will perform a physical examination and take your medical history.

Medical history 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 examination will include special attention to the heart and lungs (cardiovascular and respiratory systems).

Diagnostic tests that may be performed include the following:

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

You may need to receive supplemental oxygen.

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

Hess OM, Carroll JD. Clinical assessment of heart failure. In: Libby P, Bonow RO, Mann DL, Zipes DP, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 8th ed. Philadelphia, Pa: Saunders Elsevier;2007:chap 23.

Massie BM. Heart failure: pathophysiology and diagnosis. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier;2007:chap 57.

Updated by: Linda Vorvick, MD, Family Physician, Seattle Site Coordinator, Lecturer, Pathophysiology, MEDEX Northwest Division of Physician Assistant Studies, University of Washington School of Medicine. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.