Dealing with a cough is bad enough during the day. But anyone who’s ever had a cold, the flu, or allergies knows that the hacking can get even worse at night—keeping you tossing and turning when you could really use that extra shuteye to, you know, recover.But let’s back up. “When you cough, your body is responding to some type of irritant in your throat or airway, whether it be an allergen like dust or mucus in your throat from a cold,” Diondra Atoyebi, DO, a Georgia-based family medicine physician at Piedmont Physicians Monroe Family Practice, tells Health. Coughing at night is super common, and it's caused by those same irritants.
Why you're coughing at night:
A worsening nighttime cough may happen simply because of how you’re positioned. “When you lie down, you lose the effects of gravity that were present while you were standing,” Kathleen Dass, MD, of the Michigan Allergy, Asthma, and Immunology Center, tells Health. That prone position makes it harder for your body to keep your airways clear.
If you have postnasal drip from a cold or the flu, "laying down can allow the mucus drainage to slide down into your throat, which will active your coughing reflex," says Dr. Dass. "If you have acid reflux or gastroesophageal reflux disease (GERD), that loss of gravity means the acid can come back up your esophagus, which can make you cough.”
Besides a cold, the most common causes of chronic nighttime coughing are GERD, postnasal drip, and asthma, says Dr. Dass. That worsening effect, though, could be due simply to your environment. “Dry air, like in the winter, can irritate your nose, throat, and airway, making it itchy and naturally making you want to cough,” says Dr. Atoyebi. Outside air coming from an open window can trigger asthma symptoms, and allergic reactions to dust mites in mattresses or pillows can keep you coughing into the wee hours, too.
“Regardless of how annoying a nighttime cough may be, it’s not necessarily a bad thing,” says Dr. Atoyebi. “Coughing is actually helping you clear your throat and airway, getting rid of whatever irritant is bugging them in the first place.”
How to ease a nighttime cough:
That's all well and good, but you probably want to stop hacking ASAP so you can function at work the next morning. First, you have to nail down the underlying issue. “If your cough is because of postnasal drainage, controlling your allergies or treating a sinus infection or cold will help you feel better,” says Dr. Dass. If allergies are behind your cough, “treat your allergies through oral or intranasal antihistamines, intranasal steroids, or allergen avoidance," she advises. "For colds and sinus infections, expectorants can help you thin the mucus while cough suppressants can block the cough reflex.”
Asthma can be exacerbated during the day and then wake you up at night with coughing. And “sometimes asthma only presents with a cough, which is known as cough variant asthma,” says Dr. Dass. “If you think you have asthma or your asthma is worsening, you’ll definitely need evaluation. Your doctor may prescribe you an emergency inhaler like albuterol or a daily controller inhaler.”
GERD will usually give you a dry cough that worsens at night, says Dr. Daas. Other symptoms of GERD can include heartburn, a sour or bad taste in your mouth, or even difficulty swallowing. “Avoiding foods that can trigger your GERD—like chocolate, citrus fruits, alcohol, or tomato-based products—can help,” she suggests. “Your doctor may prescribe a proton pump inhibitor (PPI), like omeprazole, or an H2-antagonist, such as famotidine, to reduce the acid. And you may also need a gastrointestinal evaluation.”
What happens if a cough comes on suddenly and just won't let up, and you need relief in the moment? Using a humidifier can increase moisture in the air, and over-the-counter medicines can make the cough more manageable. Warm liquids can also thin out the mucus in your throat, making it easier to cough up, so there's nothing irritating your throat anymore and your cough ceases. One study found that consuming honey before bed is just as effective as taking dextromethorphan (Tussin Cough) or diphenhydramine (Benadryl). Even sleeping in a semi-prone position (using several pillows to prop your chest up, for example) can help prevent mucus buildup in your throat.
The good news is, most coughs go away on their own eventually. “But if you’ve had a nighttime cough for more than a few weeks and it continues to persist or seems to be getting worse, I recommend seeking help from your doctor, as this cough could be a symptom of a health condition that can be treated,” says Dr. Atoyebi. And if it’s been weeks, don’t you just want to sleep through the night already?
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