What Causes Shortness Of Breath At Night?

Ever wondered why you might experience shortness of breath at night, especially when lying down? This symptom, known as orthopnea, can indicate underlying health issues that may require medical attention. So in this blog, we discuss all-things orthopnea, including the best sleeping position for when you experience these symptoms.

Let’s dive in!

What Causes Shortness Of Breath At Night?

Shortness of breath at night, particularly when lying down, can be caused by various medical conditions. Causes of orthopnea include:

Heart Failure

• Fluid Retention: Heart failure can lead to fluid buildup in the lungs (pulmonary congestion) when lying down, making it difficult to breathe.
• Decreased Cardiac Output: The heart’s inability to pump effectively can cause shortness of breath due to inadequate blood flow and oxygen delivery to the body. 

Pneumonia

• Infection: Inflammation and infection of the lungs cause fluid or pus to fill the air sacs, leading to difficulty breathing.
• Reduced Lung Function: The infection can impair the lungs' ability to exchange gasses, causing shortness of breath. 

Chronic Obstructive Pulmonary Disease (COPD)

• Airway Obstruction: COPD, including chronic bronchitis and emphysema, causes the airways to narrow, leading to difficulty breathing, especially when lying flat.
• Hyperinflation of Lungs: The inability to fully exhale trapped air can cause shortness of breath, which becomes more noticeable at night. 

Fluid Accumulation

• Pleural Effusion: Fluid between the layers of tissue lining the lungs and chest cavity can compress the lungs and reduce their capacity, causing breathlessness.
• Pressure on Lungs: The increased pressure from the fluid can make it difficult to breathe deeply when lying down. 

Ascites

• Abdominal Fluid: Accumulation of fluid in the abdomen can push against the diaphragm and reduce lung capacity.
• Increased Pressure: The increased intra-abdominal pressure can make it harder to breathe, especially when lying flat. 

Obesity

• Pressure on the Diaphragm: Excess weight, especially around the abdomen, can exert pressure on the diaphragm, making it harder to breathe when lying down.
• Obstructive Sleep Apnea (OSA): Obesity is a significant risk factor for OSA, which can cause breathing interruptions during sleep. 

Sleep Apnea

• Airway Collapse: OSA involves repeated collapse of the upper airway during sleep, leading to intermittent breathing pauses and shortness of breath.
• Hypoxia: Reduced oxygen levels during apneic episodes can cause a feeling of breathlessness upon awakening. 

Diaphragm Paralysis

• Muscle Weakness: Paralysis or severe weakness of the diaphragm can impair its ability to contract and relax, making breathing difficult, especially in a lying position.
• Reduced Lung Expansion: Inability to fully expand the lungs leads to decreased oxygen intake and shortness of breath. 

Anxiety and Panic Disorder

• Hyperventilation: Anxiety and panic attacks can lead to rapid, shallow breathing (hyperventilation), which can feel like shortness of breath.
• Psychological Factors: The sensation of not being able to breathe properly can be exacerbated by anxiety and panic disorders. 

Now, let’s look at why sitting up right typically helps resolve shortness of breath.

Why Is It Easier To Breathe When Sitting Up?

Breathing can often be easier when sitting up due to several physiological and mechanical reasons:

1. Improved Lung Expansion: Sitting up allows the diaphragm to move more freely, enabling better lung expansion and more effective inhalation. When lying down, abdominal organs can press against the diaphragm, limiting its movement and lung expansion.

2. Airway Patency: Sitting up helps keep the airways open, reducing the likelihood of airway collapse, especially in conditions like obstructive sleep apnea (OSA). Sitting reduces the blood volume in the lungs, decreasing pulmonary congestion and improving airflow.

3. Reduced Fluid Accumulation: In heart failure, sitting up helps prevent fluid from pooling in the lungs (pulmonary edema), which can cause shortness of breath when lying down. Sitting up can also reduce the pressure exerted by pleural fluid on the lungs, allowing for easier breathing.

4. Less Compression of Chest: Excess weight, particularly in the abdomen, can compress the chest and diaphragm when lying down, making it harder to breathe. Sitting up reduces this compression. Fluid accumulation in the abdomen can exert pressure on the diaphragm, and sitting up helps alleviate this pressure.

4. Neurological Factors: Sitting up can provide a psychological sense of control and relief during anxiety or panic attacks, reducing the sensation of breathlessness.

In light of this, we discuss the most recommended sleeping posture for those of us who tend to experience orthopnea.

The Best Sleeping Position For Breathing

Choosing the right sleeping position can significantly improve breathing and overall sleep quality for sleepers experiencing shortness of breath. Here are some recommended positions and tips:

1. Side-sleeping: Lying on your side, especially the left side, can help keep your airway open and reduce snoring and OSA symptoms. This position can also help reduce acid reflux, which can exacerbate breathing problems.

2. Elevating the Upper Body: A bolster pillow can elevate your head and upper torso, reducing the risk of airway obstruction and improving lung expansion. You can also consider getting an adjustable bed that raises the head of the bed and can provide similar benefits.

3. Semi-Fowler Position: This posture, with the upper body elevated at approximately 45 degrees, is particularly beneficial for sleepers with heart failure or COPD. It also helps to use multiple pillows to maintain this position comfortably.

It’s generally recommended that you steer clear of the back sleeping position. Lying on your back can cause the tongue and soft tissues to collapse into the airway, exacerbating OSA and snoring. This position can also worsen acid reflux, contributing to breathing difficulties.

Let’s now turn to general tips you can keep in mind when planning your sleep hygiene, if you’re someone who experiences shortness of breath when lying down.

• Create a Comfortable Sleep Environment: Ensure your bedroom is cool, quiet, and free of allergens that could affect your breathing.
• Use a Humidifier: Adding moisture to the air can help ease breathing, especially if dry air irritates your respiratory system.
• Practice Breathing Exercises: Techniques such as diaphragmatic breathing before bed can help manage anxiety and improve lung function.
• Avoid Alcohol and Smoking: Both can exacerbate respiratory issues and should be avoided, especially before bedtime.
• Use Relaxing Sleep Aids: A weighted blanket like our Cotton Napper can provide a sense of security and relaxation, which may help reduce anxiety-related breathing difficulties. It’s crucial to choose a weighted blanket that does not restrict movement or apply excessive pressure on the chest. 

In the next section, we turn to remedies for shortness of breath, especially things you can take care of within the comfort of your home.

Remedies for Shortness of Breath

Shortness of breath, or dyspnea, can be distressing and may have various underlying causes. Implementing home solutions can help alleviate symptoms and improve breathing. Here are some effective strategies:

1. Maintain a Healthy Weight: Reducing excess weight can decrease pressure on the diaphragm and lungs, making breathing easier.
2. Exercise Regularly: Engaging in moderate physical activity can improve cardiovascular and respiratory health, enhancing overall lung function.
3. Practice Breathing Exercises: Techniques like pursed-lip breathing can strengthen respiratory muscles and improve oxygen exchange.
4. Stay Hydrated: Drinking plenty of fluids helps thin mucus, making it easier to clear the airways.
5. Avoid Allergens and Pollutants: Keep your home free of dust, pet dander, and other allergens that can trigger respiratory issues leading to allergic reactions that worsen at night. Use air purifiers to maintain clean air. 

Next, let’s look at some tell-tale signs indicating that it’s time to speak to a medical professional about your experiences of orthopnea.

When To See A Doctor

It’s essential to seek medical attention if you experience any of the following

• Persistent or Severe Symptoms: Continuous shortness of breath that does not improve with home remedies.
• Chest Pain: Accompanied by shortness of breath, it could indicate a heart problem or another serious condition.
• Bluish Lips or Fingertips: These are signs of insufficient oxygen.
• Swelling in Legs or Feet: This could be an indication of heart failure.
• Wheezing or High-Pitched Breathing: Could signify an asthma attack or airway obstruction.
• Fever and Cough: Possible signs of infection such as pneumonia.
• Rapid Heartbeat: Coupled with shortness of breath, it may indicate cardiovascular issues. 

Diagnosis of shortness of breath involves a thorough evaluation by a healthcare provider, including:

• Medical History and Physical Exam: Discussing symptoms, medical history, and conducting a physical examination.
• Pulse Oximetry: Measures the oxygen level in your blood.
• Chest X-ray or CT Scan: Imaging tests to visualize the lungs and chest structures.
• Spirometry: A lung function test to measure how much air you can inhale and exhale.
• Electrocardiogram (ECG): Evaluates heart function and detects any abnormalities.
• Blood Tests: Identify potential infections, anemia, or other underlying conditions.
• Echocardiogram: An ultrasound of the heart to assess its structure and function.
• Arterial Blood Gas (ABG) Test: Measures oxygen and carbon dioxide levels in the blood. 

Treatment for shortness of breath depends on the underlying cause, so it could involve the following:

Medications

• Bronchodilators: For asthma and COPD to open the airways.
• Diuretics: For heart failure to reduce fluid buildup.
• Steroids: To reduce inflammation in conditions like asthma or COPD.
• Antibiotics: For bacterial infections such as pneumonia.
• Anxiolytics: For anxiety-related shortness of breath. 

Therapies

• Pulmonary Rehabilitation: A program for people with chronic respiratory diseases to improve their lung function and quality of life.
• Oxygen Therapy: For those with low blood oxygen levels, supplemental oxygen can help improve breathing. 

Lifestyle Modifications

• Smoking Cessation: To prevent further lung damage.
• Weight Management: Reducing excess weight can alleviate pressure on the lungs and diaphragm.
• Exercise: Regular physical activity can enhance respiratory and cardiovascular health. 

Surgical Interventions

• Thoracentesis: For pleural effusion, where fluid is removed from around the lungs.
• Lung Volume Reduction Surgery: For severe COPD to remove damaged lung tissue.
• Cardiac Surgery: For severe heart conditions that cause shortness of breath. 

Conclusion

Experiencing shortness of breath at night can be distressing and disruptive to your sleep. Understanding the potential causes—from cardiovascular issues and COPD to anxiety and obesity—can help you take proactive steps toward better management and treatment.

Adjusting your sleeping position, creating a comfortable sleep environment, and incorporating breathing exercises into your routine can significantly alleviate symptoms. However, persistent or severe symptoms should always prompt a visit to a healthcare provider to ensure proper diagnosis and treatment.