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When a person is recumbent, or is lying down, blood is redistributed from the lower extremities and abdominal cavity (splanchnic circulation) to the lungs. [5] Failure to accommodate this redistribution results in decreased vital capacity and pulmonary compliance , further causing the shortness of breath experienced in PND.
Patients with trepopnea in most lung diseases prefer to lie and sleep on the opposite side of the diseased lung, as the gravitation increases perfusion of the lower lung. Increased perfusion in diseased lung would increase shunting and hypoxemia , resulting in worsening shortness of breath when lying on the affected lung.
Orthopnea or orthopnoea [1] is shortness of breath (dyspnea) that occurs when lying flat, [2] causing the person to have to sleep propped up in bed or sitting in a chair. It is commonly seen as a late manifestation of heart failure, resulting from fluid redistribution into the central circulation, causing an increase in pulmonary capillary pressure and causing difficulty in breathing.
Although not recommended for long-term use beyond this, [45] low-dose melatonin is generally safer, and a better alternative, than many prescription and over-the-counter sleep aids if a sleeping medication must be used for an extended period of time.
Both modalities stent open the alveoli in the lungs and thus recruit more of the lung surface area for ventilation. However, while PEEP refers to devices that impose positive pressure only at the end of the exhalation , CPAP devices apply continuous positive airway pressure throughout the breathing cycle.
Zolpidem, sold under the brand name Ambien among others, is a medication primarily used for the short-term treatment of sleeping problems. [11] [16] Guidelines recommend that it be used only after cognitive behavioral therapy for insomnia and after behavioral changes, such as sleep hygiene, have been tried.
Obstructive sleep apnea does occur even more frequently in people with Down syndrome than in the general population. A little over 50% of all people with Down syndrome experience obstructive sleep apnea, [59] and some physicians advocate routine testing of this group. [60]
Suvorexant is used for the treatment of insomnia, characterized by difficulties with sleep onset and/or sleep maintenance, in adults. [2] [6] At a dose of 15 to 20 mg and in terms of treatment–placebo difference, it reduces time to sleep onset by up to 10 minutes, reduces time awake after sleep onset by about 15 to 30 minutes, and increases total sleep time by about 10 to 20 minutes. [2]