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, or is awakened 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.

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

Your health care provider may prescribe therapy to treat breathing difficulty while lying down.

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 develop suddenly or slowly?
• Is it getting worse (progressive)?
• How bad is it?
• How many pillows are required to breathe comfortably?
• Is there any ankle, feet, and leg swelling?
• Does the person have difficulty breathing at other times?
• How tall is the person? How much do they 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