Why is it that when you have a cold/cough etc., you have to sit up all the time because it’s hard to breathe laying horizontal?
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When you’re ill, your lungs get inflamed and start producing extra mucous which in turn blocks the bronchi and alveoli from moving oxygen efficiently. When you sit up, the mucous moves to the lower parts of the lung, freeing up the passageways. Same when you cough up phlegm, it clears them more and you can breathe a bit easier.
AKA, you’re still getting oxygen, it’s just not being used efficiently making you feel out of breath.
In addition to the explanation given by u/Jax2, there are oher reasons as well.
When you struggle to breath lying flat on your back, this is called “orthopnea” and is also caused by increased blood pressure in the large vessels in your lungs. When stand, the blood pressure and volume in your legs and abdomen increase. When you lie down, that blood from your legs sort of evens out with your upper body and more of it ends up back at your heart and your lungs. In healthy people, this redistribution of blood doesn’t cause any problems.
If your lungs are also inflamed from illnesses like COVID, the flu, or various pneumonia, or you are having asthma, have COPD/emphysema, etc, the increased pressure makes your lungs harder to fill deeply. Congestion, mucus, water on the lung (called a pleural effusion), and lung tissue that has been inflamed a long time and is “soggy” makes it even worse.
If you have heart disease or heart failure, your heart may not be strong enough to pump the extra blood back out of the heart. You know when people have bad hearts and heir ankles swell? Well, your peripheral lung tissue, where the blood vessels (capillaries) are tiny, can have the same problem, because the heart can pump blood out, but isn’t strong enough to pump it back as efficiently. So, fluid collects and eventually leaks out.
Finally, if someone is generally weak, the mechanical expansion of the ribs from the force of the diaphram pulling air into the lungs (though an inflamed airway, to boot) can be very fatiguing, and the flow can be insufficient.
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