28. Needing to Sit Up to Breathe (Orthopnea Progression)
We previously discussed orthopnea, where lying flat causes breathlessness. In advanced heart failure, this symptom worsens to the point where patients cannot lie down at all. They must sit upright to breathe comfortably, sometimes even sleeping in a chair.
This happens because lying flat shifts fluid into the lungs, worsening congestion. Sitting up allows gravity to pull fluid down, easing breathing.
For instance, Mr. Frank, a 70-year-old shopkeeper, told his doctor he hadn’t slept in a bed for weeks. He spent nights propped up in a chair because lying flat left him gasping for air. This was a clear sign of severe heart failure. After treatment with strong diuretics, he was finally able to sleep in bed again.
Families should never dismiss this symptom as “habit.” If a loved one insists on sleeping sitting up, it may mean their heart failure has worsened. This is a sign that urgent medical attention is needed.