Shortness of breath lying down

In medicine, there has long been such a concept as orthopnea, literally meaning that a person has shortness of breath lying down: meanwhile, in a standing position, breathing is not difficult. The problem also disappears after the patient assumes a sitting or semi-sitting position, which indicates the elimination of blood stasis in the small circle of blood circulation.

Dyspnea in a horizontal position occurs most often in patients with congestive heart failure, predominantly left ventricular. If a person is standing, his blood is distributed to the lower parts of the body, which helps to reduce venous return and decrease preload.

Why do I get shortness of breath when I lie down?

Dyspnea indicates a discrepancy between the oxygen supply to the blood and the need for it. As a result, the respiratory center is activated, the respiratory rate increases, which in most cases helps to restore oxygen supply to the body tissues.

In general, the causes of dyspnea lying down can be divided into several categories:

• pathological dyspnea associated with blockage of alveoli in bronchial asthma, bronchitis, tumor processes, with pulmonary congestion in heart failure, with anemia in massive blood loss, with complications of CNS pathologies, with heart muscle insufficiency in coronary artery disease, with fluid accumulation in lung inflammation or bronchial asthma;
• Toxicological dyspnea caused by exposure to chemical or biological toxicants, smoking, which is accompanied by general intoxication with the effect of toxins on the respiratory centers;
• Post-traumatic dyspnea, which occurs after traumatic injury to the chest, with violation of the tightness of the pleural cavity, pressure on the lungs;
• dyspnea due to hypodynamia, obesity.

The feeling of shortness of breath in the supine position may have psychosomatic origin - for example, shortness of breath often appears as a result of psycho-emotional overstrain, prolonged experience or feelings of guilt, fear. Such a condition is called mental blockage.

Yet most often, lying dyspnea occurs in patients suffering from diseases of the cardiovascular system - in particular, left ventricular insufficiency, both systolic and diastolic. The problem is caused by increased pressure in the heart chambers and, as a result, increased pressure in the pulmonary vein. In this process, one of the signs of heart failure - hypervolemia - is of considerable importance. Dyspnea of lying down appears and then increases in the case of decompensation:

• in the supine position;
• after falling asleep (aka cardiac asthma).

Decompensated left-sided heart failure is accompanied by typical hypervolemic signs:

• moist pulmonary rales;
• pleural effusion;
• swelling of the external jugular vein;
• swelling.

In some patients decompensation state with bronchial wall edema is complicated by bronchoobstruction with its typical manifestations:

• whistles, dry wheezing;
• external respiratory distress.

Shortness of breath on lying down is often associated with arrhythmias, ventricular extrasystole, bigeminy or trigeminy, short paroxysms of atrial fibrillation. Arrhythmias are not always detected by routine electrocardiography, sometimes requiring Holter daily monitoring.

Less commonly, pulmonary arterial hypertension is the cause of transient shortness of breath lying down.

Other causes of shortness of breath in the supine position:

• lung diseases;
• anemia, thyrotoxicosis;
• Metabolic acidosis (diabetic, renal tubular acidosis with hyperkalemia, toxemic in antifreeze or salicylate poisoning);
• pathologies that are accompanied by extrapulmonary restrictive disorders (severe spinal curvature, pleural thickening, diaphragm diseases, etc.);
• anxiety disorders, neuroses, neurosis-like conditions.

Diagnosis of dyspnea in the supine position

To diagnose the causes of shortness of breath lying down, the specialist conducts an interview, examination, examines the symptomatology, and then may recommend some diagnostic tests and investigations, for example:

• Chest radiography - helps to assess the size of the heart and the location of large-caliber vessels, to determine the likely accumulation of fluid in the pleura and lungs.
• Electrocardiography - allows you to trace the heart rhythm, detect signs of infarction and changes in the volume of the heart chambers.
• Holter monitoring - provides an opportunity to assess the heart rhythm throughout the day, myocardial response to standard physical activity, changes in heart function during night rest.
• Echocardiogram (Echocardiogram, cardiac ultrasound) - helps to find out the size of the heart chambers, assess the function of the valves and the heart as a whole, to identify signs of myocardial infarction.
• Coronarography - provides an opportunity to find out the degree of patency of coronary arterial trunks.
• Stress tests (stress EchoCG, bicycle ergometry) - provides information on cardiac function against the background of physical activity.

Separately, the doctor checks the probability of the presence of such factors in the development of dyspnea lying down, such as diabetes mellitus, coronary heart disease, hypertension, assesses the presence of congestion in the lungs. In addition, the lower extremities are also examined for edema and thrombosis.

Treatment of dyspnea in the supine position

Patients suffering from heart failure are characterized by periodic shortness of breath at night lying down. Unpleasant breathing difficulty often occurs suddenly, forcing you to wake up. Some people have shortness of breath lying on the stomach, or intensifies in this position. Based on the law of gravity, it can be understood that in the horizontal position of the body, fluid (phlegm) begins to accumulate, processes of pulmonary stasis develop. This can be avoided by timely contacting doctors and treatment in accordance with the detected cause of the unpleasant symptom.

In some relatively mild cases - for example, if the shortness of breath is mild, infrequent and related to heart failure - it may be possible to elevate the upper body with pillows to facilitate breathing. In other situations, however, it is important to get an extended consultation with a medical professional.

Once the doctor determines the underlying cause of shortness of breath, he or she prescribes treatment aimed at eliminating this cause. Sometimes it is necessary to consult not only physician, but also cardiologist, pulmonologist, endocrinologist and others.

Most often the cause of shortness of breath lying down is heart failure, when it is detected, a number of drugs are prescribed to normalize cardiac function. These may include:

• β-blockers (Atenolol, Metoprolol);
• ACE inhibitors (Captopril, Enalapril);
• anticoagulants (Warfarin);
• Diuretics (Furosemide, Spironolactone);
• statins (Simvastatin, Atorvastatin);
• peripheral vasodilators (organic nitrates).

If respiratory failure is diagnosed lying on the back, on the side, associated with infectious diseases, the patient may require intensive antibiotic therapy. Chronic obstructive pulmonary disease requires mandatory smoking cessation. Additionally prescribe drugs to liquefy sputum (Acetylcysteine), bronchodilators (Salbutamol), xanthines (Eufillin).

If we are talking about acute respiratory failure associated with pulmonary embolism, it requires emergency intensive care in an intensive care unit. Stress dyspnea may be an indication for sedatives, antidepressants (Amitriptyline, Fluoxetine, etc.).

Patients with bronchial asthma, patients with a tendency to allergic reactions are prescribed, in particular, antihistamines, recommended to avoid contact with potential allergens.

How to deal with shortness of breath in the supine position?

A patient with shortness of breath lying down needs qualified diagnostics to determine the cause of breathing difficulties. You can relieve yourself at home with the help of:

• special diet, which involves limiting the use of salt, animal fats, cholesterol;
• getting rid of bad habits (smoking, drinking alcohol);
• physical therapy;
• development of stress resistance (you can combine breathing exercises with meditation, yoga);
• regular monitoring of body weight, normalization of weight;
• systematic outdoor activities.

The most simple yet effective exercise to gradually eliminate shortness of breath lying down is daily walking. Regular walks force the muscles that act as muscle pumps and facilitate the function of the heart. Daily and active walking, a person begins to breathe more deeply and rhythmically, which provides both muscle training and uniformity of pulmonary ventilation. You can walk at any time of the day, about 1-1.5 hours after eating. In the process of walking it is allowed to stop for a few minutes for rest and breathing exercises:

• Put your feet shoulder-width apart, hands on your waist. Raise your arms up to the sides - inhale, lower them down and lean forward - exhale. Repeat 5-8 times.
• Put your feet shoulder-width apart, hands on your waist. Bend to the back - inhale, bend with a turn of the body to the left and right - exhale. Palms touch the opposite thigh. Repeat 5-8 times in each direction.
• Put your feet shoulder-width apart, bring your hands to your shoulders. Bend to the back, take the leg back and put it on the toe - inhale. Arms are stretched forward, chin is lowered to the chest, put a foot - exhale. Repeat the exercise 5-8 times.

At home, when it is not possible to leave the house, it is recommended to walk in place with a high rise of the hips, vigorously bending the legs in the knee joints. No less useful are such exercises as "bicycle" alternately with each leg and two legs in succession, torso turns with a straight arm to the side.

Are there any medications for shortness of breath in the supine position?

There is no specific remedy for shortness of breath, as it is only a symptom and not a specific disease. Dyspnea on the bed always has specific causes, and the treatment is aimed at eliminating them.

If the diagnostic process reveals signs of heart failure, the doctor may prescribe:

• Angiotensin-converting enzyme (ACE) inhibitors help with shortness of breath lying down caused by systolic heart failure. The drugs belong to the group of vasodilators, contribute to the dilation of coronary vessels, reduce the load on the heart and normalize blood pressure, eliminate blood stasis.
• Angiotensin II receptor blockers are appropriate for patients who cannot use ACE inhibitors for any reason.
• β-adrenoblockers contribute to slowing down the contractile activity of the heart, lower blood pressure, reduce the risk of arrhythmia, generally improve the work of the organ.
• Diuretics help if the shortness of breath lying down is caused by increased fluid accumulation in the body.
• Aldosterone antagonists (potassium-saving diuretics) reduce congestion and lower blood pressure. They are often prescribed as part of the complex treatment of coronary heart disease.
• Cardiotonics - drugs that have a positive inotropic effect, increase the force of myocardial contraction.

When should I see my doctor for shortness of breath in the supine position?

Dyspnea lying down, at rest - this is already a reason to contact doctors. This symptom can indicate many different conditions, mainly cardiac. However, it is important to timely recognize, identify the pathology, distinguish it from other equally dangerous diseases - for example, bronchial asthma, pneumonia, and so on.

Dyspnea lying down can be accompanied by dizziness, a feeling of pressure in the chest, a sense of fear, agitation, weakness, blurred consciousness.

Special attention should be paid to the acute form of shortness of breath lying down, which develops over several minutes, suddenly without any visible stimuli, or under the influence of an allergen, viral infection, etc. Among the possible causes:

• allergic reaction;
• inhalation of a foreign object;
• bronchial asthma;
• exacerbation of chronic obstructive pulmonary disease;
• heart rhythm disturbances;
• heart failure;
• myocardial infarction;
• cardiac tamponade;
• Coronavirus infection;
• pneumonia, bronchitis;
• pulmonary embolism;
• injuries (in particular rib injuries);
• anxiety states.

As for chronic dyspnea lying down, it develops as gradually as possible, over a month, or even a year. Such development of pathology is characteristic of pulmonary hypertension, stable angina pectoris, ischemic heart disease, chronic obstructive pulmonary disease.

If a person has sudden onset of shortness of breath lying down, especially as it increases, it is important to seek medical attention without delay. Other dangerous symptoms that may accompany shortness of breath lying down:

• dry wheezing;
• pain or a feeling of pressure behind the sternum;
• frequent or confused heartbeat;
• severe swelling of the legs;
• Blueing of the fingertips, nasolabial triangle area or lips;
• nausea;
• heavy sweating;
• impaired consciousness;
• fever, chills;
• nighttime cough.

If at least one of the above symptoms appears against the background of dyspnea lying down, you should seek medical help as soon as possible.

Which specialist should you see if:

• except for shortness of breath lying down, no other symptoms are observed - it is recommended to consult a general practitioner, family doctor;
• shortness of breath lying down is accompanied by a feeling of discomfort, pressure, chest pain, arrhythmia - you should visit a cardiologist;
• There are chronic diseases of the respiratory system, thyroid gland, oncology or autoimmune pathologies - it is necessary to consult one of the specialized specialists (pulmonologist, endocrinologist, oncologist, immunologist, hematologist, etc.).

In any case, a doctor's consultation is required if shortness of breath lying down has appeared for the first time. If it is a long-standing chronic pathology, then a visit to the doctor is necessary:

• If there is a severe attack of shortness of breath lying down, not similar to previous episodes, does not go away;
• if the other symptoms listed above occur at the same time;
• If there is no relief despite the use of remedies that have helped before (e.g., inhalers);
• if the color, volume, viscosity of sputum has changed;
• if the dyspnea does not go away in an upright position.

How can I control my shortness of breath in the supine position at home?

As a rule, most cases of dyspnea, including lying down, can be controlled with medications, breathing exercises, physical therapy, sometimes it is necessary to use oxygen therapy. The main condition for successful control of dyspnea is to find out its cause. After diagnostic measures and diagnosis, the doctor prescribes treatment, and the patient gives the following recommendations:

• Carefully take prescribed medicines, strictly following the doctor's prescription. If it is necessary to use an inhaler, learn how to do it correctly (your doctor will help you).
• Practice breathing exercises, use special breathing exercises. For example, patients suffering from chronic obstructive pulmonary disease, successfully use breathing through the lips gathered into a tube, allowing you to reduce the rate of breathing.
• Monitor physical activity during the day. Many patients are afraid of any physical activity, so as not to provoke the appearance of dyspnea lying down during night rest. However, practice shows that hypodynamia only aggravates the situation. It is important to maintain physical fitness, performing moderate, feasible loads.
• Do not attempt to hold your breath.
• Sleep only in a well-ventilated clean room, clean it regularly (including wet cleaning), take care of the most comfortable sleeping conditions.
• If necessary, use a fan or air conditioner that helps reduce the sensation of lack of air in the supine position.
• If shortness of breath lying down does not go away, despite the treatment, it is necessary to inform the doctor about it. In some cases, additional sedatives and painkillers may be indicated.