Health Information

Breathing difficulty - lying down

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.

I Would Like to Learn About:

  • 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

    • Chronic obstructive pulmonary disease (COPD)
    • Cor pulmonale
    • Heart failure
    • Obesity (does not directly cause difficulty breathing while lying down but often aggravates 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 is suggested for people who are obese and have difficulty breathing while lying down.

  • When to Contact a Medical Professional

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

  • What to Expect at Your Office Visit

    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).

    Tests that may be performed include the following:

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

    Your health care provider may prescribe treatment for your breathing difficulty. Treatment depends on the cause.

    You may need to receive supplemental oxygen.

Related Information



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.


Review Date: 1/22/2013  

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. Also reviewed by A.D.A.M. Health Solutions, Ebix, Inc., Editorial Team: David Zieve, MD, MHA, David R. Eltz, Stephanie Slon, and Nissi Wang.

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