SHORTNESS OF BREATH WORSENED BY LYING DOWN

Description and Possible Medical Problems

You’d think that if you had a tendency to become short of breath with slight exertion, sitting or lying down would allow you to catch your breath. Not so for some people; lying down can actually make breathing harder.

If you find yourself to be short of breath when lying down or sitting and you also often have the seemingly unrelated symptom of swollen ankles, you should see your doctor. This is important, especially if you have diabetes or a previous history of heart disease of any kind.

If your shortness of breath is accompanied by wheezing, coughing, and an inability to talk, you will need to seek immediate medical attention.

In the elderly population, shortness of breath that occurs while lying down is usually caused by heart failure. Other times, however, the cause can be as simple as a heavy intake of salt. When I was a young doctor, we saw a group of nursing home residents come to the emergency room with heart failure. They had recently eaten a meal of hot dogs, corned beef, and pastrami, provided as a generous gift by the local deli. These people, who usually ate low-salt diets, could not handle the sudden overload of sodium, and as a result several ended up in the emergency room.

Treatment

If you are short of breath whenever you lie down and your doctor suspects heart failure, he will perform a total medical evaluation, which will include an electrocardiogram and an echocardiogram, among other tests. The ensuing treatment will depend on the degree of the heart failure.

The condition might actually require only a simple change in diet— limiting salt intake. Fat consumption should be reduced, and, if you’re overweight, you’ll probably need to lose some weight.

If your condition requires it, your doctor may prescribe a diuretic such as hydrochlorothiazide to reduce your blood pressure and take some of the strain off your heart. The ACE inhibitors digoxin and Lasix may also be used on an individual basis.

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