What can feel more frustrating than having a cough? Having a cough that happens more often or gets worse at night. It affects how much you can relax, fall and stay asleep, and get much-needed rest for recovery.
“During sleep, the body regulates our production of cytokines, signaling proteins our immune systems produce to fight off invading pathogens such as viruses and bacteria,” says Vontrelle Roundtree, MD, associate chief medical officer at MDLIVE of Evernorth. “If you have a nagging cough that causes you to wake up often throughout the night, it compromises sleep quality, potentially affecting your body’s cytokine regulation and making it difficult for your immune system to combat and recover from sickness.”
Not only does coughing affect your ability to get over any illnesses that may cause the cough, but it may also cause you to have more symptoms that further affect your nighttime rest. “Coughing may also cause dry throat and mouth, postnasal drip, and physical discomfort that makes for a less-than-peaceful sleep experience,” Roundtree says.
Nighttime coughing can happen and feel worse for many reasons. It may be due to problems with your lungs and airways, such as infection, postnasal drip, allergies, and asthma. These can cause coughs that get worse at night, says Samuel Mathis, MD, assistant professor in the Department of Family Medicine at University of Texas Medical Branch. For instance, “with lung infections, lying down helps the cilia [little ‘hairs’ in our lungs] to more effectively move mucus out of the lungs, and the cough reflex is our body’s attempt to get rid of the excess mucus,” he says.
Roundtree says that “moving around during the day makes it easier for the body to loosen trapped mucus. When we lie down to rest at night, this position can make it more challenging for our bodies to naturally clear this mucus, resulting in what we call postnasal drip — nasal secretions that pool in the back of the throat and cause those pesky coughs.”
Nighttime coughs may also be a symptom of gastroesophageal reflux disease (GERD) or acid reflux. “GERD happens when stomach acid flows back into the esophagus, irritating its lining and potentially reaching the back of your throat,” Roundtree says. “The act of lying down can cause the reflux to get worse, and then, of course, you may cough more,” says Sarah McBane, PharmD, associate dean of pharmacy education at the University of California, Irvine School of Pharmacy.
“To combat nighttime cough due to GERD, elevate your body at an incline to prevent the pooling of mucus, allowing for a more peaceful and less interrupted night’s sleep,” she says.
Other conditions that can cause coughing fits include heart failure and sleep apnea, Mathis says.
You may also have a nighttime cough when you’re taking medications such as ACE inhibitors for high blood pressure. These are known to have a dry cough as a side effect, Mathis says.
Our body’s circadian rhythm, the internal clock that helps manage important body functions (including sleep and immune response), may also play a role, Roundtree says. “Some parts of immune function are more active during the nighttime and into the early morning, which explains why you might feel your worst during those hours. While this natural response helps fight off the bacteria making you ill, it may also cause many of our sick symptoms during that time, such as congestion, fever, and increased nighttime coughing.”
How you manage your nighttime cough depends on how serious it is and what’s causing it, Roundtreee says. She advises seeing a doctor if your cough is constant, very bad, and comes with other concerning symptoms.
In the meantime, you can try this expert advice for managing mild coughs at night:
Stay hydrated. This can help loosen mucus and make it easier to get rid of, Roundtree says. Make sure you are providing your body with plenty of fluids. You can do this by drinking water as often as needed and eating water-rich foods like melons, pineapples, strawberries, and oranges. Drink herbal tea with honey and lemon. Mathis recommends teas for cough due to upper respiratory infections, allergies, and postnasal drip. “A simple remedy that’s very effective for coughing is a nighttime herbal tea with honey and lemon,” Mathis says. “Honey helps coat the throat and prevent irritation and the cough reflex. The lemon has anti-inflammatory qualities that may help cough.” You can also try other hot teas since they may be helpful to soothe an irritated throat, Roundtree says. Take honey. It’s a natural cough suppressant that helps reduce how often you cough and how serious the coughing is, Roundtree says. “Consider natural or locally grown honey as a bonus,” she says. Cough drops. These are helpful short-term fixes for soothing an irritated throat and stopping a stubborn, hacking cough, Roundtree says. “They cause the mouth to produce more saliva, thus coating the throat and helping with itching sensations.”Have a steamy shower. Steam from showers adds moisture to the air, which can help open your airways and loosen up secretions in the nose, Roundtree says. Take a steamy shower before bedtime to relieve your cough and help your body relax for a better night’s sleep. Think about what and when you eat. If the nighttime cough is due to GERD, McBane recommends avoiding heavy, spicy, fatty, and late-night meals because they may make your GERD symptoms worse and cause nighttime coughing. Foods high in fiber, water, and alkaline can improve your symptoms. So consider eating those instead at least 3 hours before bedtime. These foods include bananas, brown rice, sweet potatoes, broccoli, watermelon, carrots, cucumber, pineapple, and brothy soups. Try OTC medications for GERD. “Some OTC medication options include antacids like Tums or medications that block the production of acid like famotidine (Pepcid) or omeprazole (Prilosec),” McBane says. “These medications can help with the reflux-related nighttime cough by decreasing the amount of acid irritating the throat and causing the cough.” Take an antihistamine. Antihistamine medications, which help with allergies, may be useful for nighttime cough due to postnasal drip. McBane suggests taking an antihistamine like diphenhydramine (Benadryl) or loratadine (Claritin). She adds that they can help with postnasal drip-related cough by drying up nasal mucus, meaning there will be less fluid to collect in the back of your throat and irritate the tissues there.Lie with your head raised. If your cough is caused by GERD, one of the easiest remedies is to raise the head of your bed by 4-6 inches, Mathis says. “Just a slight tilt is enough to let gravity keep the stomach acid in the stomach.” McBane suggests elevating the head of your bed using bricks or blocks. Use a humidifier. “If the cough is due to dry air, consider a humidifier. Try to keep humidity at 40% to 50%,” Mathis says. “Any more than that could make your cough worse or increase your risk of infection.”Reduce allergens in your home. If your coughing is due to allergies, cutting down the number of allergens around you may help prevent it. A great tip is to clean and dust your home regularly to prevent dust buildup, Mathis says. You can also invest in a HEPA filter to get rid of allergens in the air. If you have pets, have them sleep outside of your bedroom. Wash your bedding regularly, too. Consider over-the-counter (OTC) medication. When all else fails, an over-the-counter cough medicine can provide relief, Roundtree says. “One that contains dextromethorphan would be best to block the cough reflex, while one containing pseudoephedrine can help stop increased nighttime postnasal drip.” Still, she advises talking with a health care professional before starting any medication.
If these tips do not help with your cough, or if the cough lasts more than a couple of weeks, McBane advises seeing a doctor.
Roundtree also recommends seeing a doctor if your cough lasts over a few days and you have other symptoms like chest pain, nausea, wheezing, or high fever. Mathis agrees, saying that if you cough up blood, have shortness of breath, and your legs or feet swell, you should be checked by a doctor. “They can help you identify the cause of your cough and treat the underlying issue.”
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