Wheezing at Night When Lying Down

When your airway is partially blocked, you may wheeze. Wheezing refers to the sound you make when it is difficult to breathe, oftentimes sounding hoarse and rattled. Sometimes the wheezing noise is clear and obvious, and other times it requires detection via a stethoscope(1).

Some individuals may wheeze during normal day-to-day activities, while others may find that they only wheeze at night when they lay down. In the medical field, healthcare professionals refer to wheezing when lying down as orthopnea. If you find that you only start wheezing when you are lying down, you may have a condition that requires medical attention(2).

This article will discuss reasons why you may experience wheezing when lying down and potential solutions to treating this phenomenon.

Is wheezing normal when lying down?

Wheezing is not normal when lying down. Several medical conditions can cause you to wheeze, some specifically when lying down. While some of these conditions are manageable, other conditions may be serious and require treatment.

Is it normal to wheeze at night?

It is also not normal to wheeze at night. Wheezing that worsens or happens exclusively in the evening can also indicate an underlying medical problem.

Why do I wheeze when I lay down?

Wheezing occurs when something is blocking your airway. While this can be the result of something like a physical object, it can also be due to an underlying disease that causes blockage. When part of your airway is obstructed, the airway becomes narrower. This makes it difficult for you to take a full breath, leading to wheezing.

The extent and duration of wheezing will depend on what is causing you difficulty breathing and what part of your airway is blocked. There are several reasons why you may wheeze when you lay down. These include but are not limited to:

  • Nocturnal asthma
  • Heart failure
  • Chronic obstructive pulmonary disease (COPD)
  • Obesity and/or sleep apnea (3)

The next section will discuss each of these causes and why they may cause wheezing.

What causes wheezing at night when lying down?

Nocturnal asthma

Asthma is a condition that causes wheezing, chest tightness, coughing, and shortness of breath. Oftentimes, these symptoms occur early in the morning or at night(4). If you have asthma and experience trouble breathing at night, you likely have nocturnal asthma.

Nocturnal asthma presents as wheezing, shortness of breath, or coughing that causes sleep disturbances. Likewise, it may be a reason you experience wheezing when lying down. Nocturnal asthma is a common condition(5). In fact 30 to 70 percent of asthma patients experience nocturnal asthma(6).

Heart failure

Heart failure occurs when your heart cannot pump enough blood throughout your body. When not enough blood circulates, fluid can accumulate in certain parts of your body. This can lead to swelling and symptoms such as weakness and shortness of breath.

Heart failure could be a reason why you wheeze when lying down. If you experience swelling in your legs and then lay down, the blood that accumulated in your legs to cause the swelling starts to distribute elsewhere in the body. This can lead to buildup of fluid in the lungs, causing wheezing a few hours after lying down. Shortness of breath while lying down can indicate severe cases of heart failure(7).

Chronic obstructive pulmonary disease (COPD)

COPD is a condition involving airflow obstruction due to inflammation in the lungs and airway. It is different from asthma, and it is frequently caused by smoking, air pollution, or other environmental irritants.

COPD patients may have symptoms of shortness of breath, cough, and mucus production. Likewise, a sign of COPD is wheezing when lying down. However, it differs from heart failure in that breathing difficulty starts almost immediately upon lying down(8).

Obesity and/or sleep apnea

Obesity is defined as a body mass index (BMI) of equal to or greater than 30, and overweight is defined as a BMI of greater than or equal to 259. Overweight or obese patients may experience reduced pulmonary function, making breathing more difficult. Specifically, obese patients may have reduced expiratory flow compared to individuals of a healthy weight. This reduced expiratory flow may present as wheezing, which can become more pronounced upon lying down(10).

Overweight patients are also more likely to have a condition known as obstructive sleep apnea (OSA). OSA occurs when your breathing gets cut off during sleep. This reduces the amount of oxygen available to your body, which can contribute to several other diseases. It can also cause sleep disturbances 9.

Symptoms of wheezing when lying down

 If you wheeze when you lay down, you may experience:

  • Shortness of breath when lying down
  • Relief from wheezing when sitting up or standing(11)

Chest congestion when lying down

Wheezing when lying down on your left side

There have been a few reports of individuals with heart failure avoiding lying down on their left side. Experts have a few theories as to why this occurs. One reason may be because heart failure patients experience shortness of breath in this position. Shortness of breath in this position is a result of changing pressures in the lungs and consequent swelling of the lungs. If you tend to avoid lying on your left side, this may be a sign you have heart failure(12).

Wheezing when lying on your right side

If you experience wheezing on your right side, this may be a sign of nocturnal asthma. Research from 1990 suggests that nocturnal asthma symptoms worsen when lying on your right side. This is because the right side causes airway resistance in your lungs due to changes in your nervous system(13).

Wheezing when lying on back

If you experience wheezing when lying on your back, it could mean several different things. One study found that patients with heart failure experienced airway resistance when lying on their backs for five minutes14. Another study indicated that morbidly obese patients frequently experience shortness of breath when lying down on their backs(15). Therefore, if you experience wheezing on your back, it could be due to multiple causes.

How to stop wheezing when lying down?

Elevate your head

One study analyzed the results of 43 other studies evaluating the effect of body position on breathing ability. The study concluded that a more erect position improved pulmonary function in healthy individuals and individuals with lung disease, heart disease, obesity, and neuromuscular diseases(16).

Therefore, elevating your head or the upper half of your body can help relieve wheezing. This is because elevating your head opens the airway, decreasing obstruction and allowing more air to pass through. To elevate your head, utilize a few pillows or a reclining bed.

Weight loss

Being overweight or obese is linked to worse sleep quality and quantity compared with non-obese patients. It can also contribute to breathing difficulties during sleep like OSA. Thus, if you are overweight or obese and experience wheezing upon lying down, losing weight may help to alleviate symptoms. You can achieve weight loss through a combination of diet changes, regular physical activity, and/or medications9.

Seek treatment and adhere to your medications

Seeking advice from a medical professional can help you to manage your wheezing symptoms. If you have an underlying condition that is causing your symptoms, you may benefit from medication. You will receive different treatment depending on the condition you have. Examples of what your doctor may prescribe include:

  • Inhalers and nebulizers for asthma
  • Certain oral medications (e.g., diuretics and blood pressure medications) for heart failure
  • Inhalers, steroids, and antibiotics for COPD
  • Certain oral medications for obesity

How do I know if my wheezing is serious?

Wheezing when lying down could indicate a serious condition. You should seek treatment from a medical professional if you experience:

  • Wheezing that keeps coming back
  • Shortness of breath
  • Chest tightness or pain
  • Coughing
  • Swelling in your legs, feet, or tongue
  • Rapid or shallow breathing
  • Losing your voice
  • Fever
  • A blue color around your mouth, nails, or skin1

When should you go to the doctor for wheezing?

If you experience wheezing when lying down, it could indicate a serious condition such as asthma, heart failure, COPD, or obesity. These conditions can lead to health complications, so it is important that you take them seriously. Therefore, you should seek medical attention if you experience wheezing when lying down.

Get help from an online doctor

Online doctor service DrHouse can provide you a quick and convenient way to access a healthcare professional from the comfort of your own home. With DrHouse you can see a board-certified clinician in less than 15 minutes or schedule a same-day in-person visit in a clinic nearby. If you experience wheezing when lying down, book an appointment with us today.

Key Takeaways

If you wheeze upon lying down, you could have a serious underlying condition. Such conditions may include asthma, heart failure, COPD, obesity, or other diseases. Therefore, you should seek treatment from a medical professional to avoid discomfort and complications. Consider booking a virtual appointment with us today to discuss your symptoms.

Sources

  • Wheezing: Definition, causes & treatment. (n.d.). Cleveland Clinic. Retrieved January 9, 2022, from https://my.clevelandclinic.org/health/symptoms/15203-wheezing
  • Wheezing when lying down. (2021, January 14). PlushCare. https://plushcare.com/blog/wheezing-when-lying-down/
  • Patel, P. H., Mirabile, V. S., & Sharma, S. (2021). Wheezing. In StatPearls. StatPearls Publishing. http://www.ncbi.nlm.nih.gov/books/NBK482454/
  • CDC. (2021, July 1). Learn how to take control of asthma. Centers for Disease Control and Prevention. https://www.cdc.gov/asthma/faqs.htm
  • Mehra, R. (2014). Understanding nocturnal asthma. The plot thickens. American Journal of Respiratory and Critical Care Medicine, 190(3), 243–244. https://doi.org/10.1164/rccm.201406-1130ED
  • Uptodate. (n.d.). Retrieved January 9, 2022, from https://www.uptodate.com/contents/nocturnal-asthma
  • Heart failure symptoms | michigan medicine. (n.d.). Retrieved January 9, 2022, from https://www.uofmhealth.org/health-library/tx4082abc
  • Dewar, M., & Whit R. Curry, J. (2006). Chronic obstructive pulmonary disease: Diagnostic considerations. American Family Physician, 73(4), 669–676.
  • Jehan, S., Zizi, F., Pandi-Perumal, S. R., Wall, S., Auguste, E., Myers, A. K., Jean-Louis, G., & McFarlane, S. I. (2017). Obstructive sleep apnea and obesity: Implications for public health. Sleep Medicine and Disorders : International Journal, 1(4), 00019.
  • Ferretti, A., Giampiccolo, P., Cavalli, A., Milic-Emili, J., & Tantucci, C. (2001). Expiratory flow limitation and orthopnea in massively obese subjects. Chest, 119(5), 1401–1408. https://doi.org/10.1378/chest.119.5.1401
  • Mukerji, V. (1990). Dyspnea, orthopnea, and paroxysmal nocturnal dyspnea. In H. K. Walker, W. D. Hall, & J. W. Hurst (Eds.), Clinical Methods: The History, Physical, and Laboratory Examinations (3rd ed.). Butterworths. http://www.ncbi.nlm.nih.gov/books/NBK213/
  • Leung, R. S. T., Bowman, M. E., Parker, J. D., Newton, G. E., & Bradley, T. D. (2003). Avoidance of the left lateral decubitus position during sleep in patients with heart failure: Relationship to cardiac size and function. Journal of the American College of Cardiology, 41(2), 227–230. https://doi.org/10.1016/S0735-1097(02)02717-1
  • Backon, J., & Kullok, S. (1990). Why asthmatic patients should not sleep in the right lateral decubitus position. The British Journal of Clinical Practice, 44(11), 448–449.
  • Yap, J. C. H., Moore, D. M., Cleland, J. G. F., & Pride, N. B. (2000). Effect of supine posture on respiratory mechanics in chronic left ventricular failure. American Journal of Respiratory and Critical Care Medicine, 162(4), 1285–1291. https://doi.org/10.1164/ajrccm.162.4.9911097
  • Ferretti, A., Giampiccolo, P., Cavalli, A., Milic-Emili, J., & Tantucci, C. (2001). Expiratory flow limitation and orthopnea in massively obese subjects. Chest, 119(5), 1401–1408. https://doi.org/10.1378/chest.119.5.1401
  • Katz, S., Arish, N., Rokach, A., Zaltzman, Y., & Marcus, E.-L. (2018). The effect of body position on pulmonary function: A systematic review. BMC Pulmonary Medicine, 18(1), 159. https://doi.org/10.1186/s12890-018-0723-4

DrHouse articles are written by MDs, NPs, nutritionists and other healthcare professionals. The contents of the DrHouse site are for informational purposes only and are not a substitute for professional medical advice, diagnosis, or treatment. If you are experiencing high fever (>103F/39.4C), shortness of breath, difficulty breathing, chest pain, heart palpitations, abnormal bruising, abnormal bleeding, extreme fatigue, dizziness, new weakness or paralysis, difficulty with speech, confusion, extreme pain in any body part, or inability to remain hydrated or keep down fluids or feel you may have any other life-threatening condition, please go to the emergency department or call 911 immediately.

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