Breathing difficulty while lying down is an abnormal condition. A person with this condition 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).

For people with some types of heart or lung problems, this is a common complaint. Sometimes the problem is subtle and is only noticed when the person realizes that sleep is more comfortable with lots of pillows under the head, or 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 to treat breathing difficulty while lying down. The treatment will depend on the specific illness causing the problem.

Weight reduction is generally recommended in cases of obesity.

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 will obtain your medical history.

Medical history questions documenting nocturnal dyspnea include the following:

• 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 are also present?

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:

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