The symptoms of obesity hypoventilation syndrome (OHS), often called "Pickwickian syndrome," include hypercapnia during the day, sleep-disordered breathing, and obesity overall. An exclusionary diagnosis. A worsening of or a persistent condition of increasing dyspnea might be observed in patients. This case study details the symptoms and management of a 61-year-old female patient who arrived with shortness of breath with physical exercise and was diagnosed with severe obesity (BMI: 51.9 kg/m2). Very high levels of carbon monoxide were detected in the arterial blood gas (ABG) study. Hypertension, diabetes, obesity, dyslipidemia, and hypothyroidism were all present in this patient. After the patient was stabilised, they were quickly treated with non-invasive ventilatory (NIV) support and supportive care. The patient was prescribed NIV to use overnight and was discharged.