Orthopnoea means breathlessness when lying flat; paroxysmal nocturnal dyspnoea means waking after sleep with air hunger. Heart failure is important, but sleep apnoea, lung disease and reflux can also contribute.
Why the Symptom Pattern Matters
- Needing more pillows or improving by sitting up suggests orthopnoea.
- Waking after hours of sleep with air hunger can occur with congestion.
- Loud snoring, witnessed pauses and daytime sleepiness suggest sleep apnoea.
- Wheeze may suggest airway disease; pink frothy sputum is an emergency.
Possible Causes
This list explains possibilities; the symptom alone cannot establish a diagnosis.
- Heart failure and valve disease
- Obstructive or central sleep apnoea
- Asthma, COPD and other lung disease
- Reflux and aspiration
- Night-time arrhythmia
- Panic or anxiety
What the Clinician Will Assess
- Pillow number and time to waking
- Time to relief on sitting
- Snoring and witnessed pauses
- Weight gain, swelling, cough and palpitations
- Evening salt, fluid and medicine pattern
Which Tests May Be Considered?
Not every test is required for every person. Selection depends on examination findings and clinical probability.
- Examination, oxygen level, ECG and chest imaging
- Echocardiography and natriuretic peptides
- Sleep study
- Lung function or rhythm monitoring
What to Record Before the Appointment
- Pillow number and waking time
- Morning weight and swelling
- Night pulse and blood pressure
- Partner observations of snoring or pauses
When to Call Emergency Services
Do not wait for an online reply
- Severe breathlessness that does not improve on sitting
- Pink frothy sputum, blue colour or confusion
- Chest pain, sweating or fainting
- Rapid deterioration
Frequently Asked Questions
Is a higher pillow a solution?
It may provide temporary relief, but new orthopnoea requires evaluation.
Is it always sleep apnoea?
No. Heart failure and lung disease must also be considered.
Does feeling well by day make it harmless?
No. Night symptoms can be an early sign of important disease.
Medical information note
This page provides general information and does not replace examination, diagnosis or an individual treatment plan.