Orthopnea: Definition, Causes & Symptoms

Instructor: Bethany Lieberman

Bethany is a certified OB/GYN nurse who has a master's degree in Nursing Education.

Sometimes patients can exhibit subtle symptoms of potentially big problems. In this lesson you will learn about a condition called orthopnea, which can occur with patients who are experiencing difficulty breathing only while lying in a flat position. While orthopnea may seem minor, it might indicate a serious problem.

Breathing Concerns

Marcy is a home health nurse who visits clients in their own homes to perform nursing care. When she visits her first client, Mr. Case, she notices his bed looks the same way she left it a week ago; it looks like he hasn't slept in it at all. Upon questioning, he admits that he's been sleeping in his recliner chair. He says he feels breathless when he is lying flat in the bed and hasn't had a good night's sleep in days. He says the feelings wake him up at night and start to go away when he sits up for a while. Marcy suspects that he is suffering from orthopnea.

What Is Orthopnea?

Marcy places a call to Mr. Case's doctor's office to express her concern. She explains that Mr. Case is displaying symptoms of orthopnea and needs to be seen. Orthopnea occurs when a person experiences difficulty breathing lying down and has to sit or stand up in order to breathe better. It is usually accompanied by another condition called paroxysmal nocturnal dyspnea, which is a fancy way of describing waking up after only a couple hours of sleep due to feelings of shortness of breath.


A nurse or other caretaker may notice or hear that a patient is having difficulty breathing while lying down, or she may observe more subtle signs of the condition. For example, she may see multiple pillows stacked underneath the patient while in bed, or the patient may only want to sit up in a chair or a recliner. It is important to notice small things in a patient's environment and small behaviors and ask about them about it, just as Marcy did. When Marcy calls Mr. Case's doctor, she has also discovered something else--when she listened to Mr. Case's lungs with a stethoscope, she heard a crackling noise over the base of his lungs. Crackles are lung sounds that can be described as a crackling or rubbing sound that often indicates that fluid may be collecting in his lungs. The fluid makes it difficult for for a patient to breathe and receive oxygen. This information is also important when reporting suspected orthopnea to a doctor.

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