A cough that persists or worsens at night can be very disruptive and prevent you from getting adequate rest. Coughing serves an important protective role, helping clear irritants or secretions from the airways. However, excessive coughing at night suggests an underlying problem that needs treatment. Understanding the common causes and aggravating factors of nighttime coughs can help you get to the root of the issue and find relief.
What causes coughing at night?
There are several possible causes of nighttime cough including:
Postnasal drip
Postnasal drip describes mucus drainage from the sinuses into the throat. It can cause cough by trickling down and irritating the delicate tissues of the throat and airways. Postnasal drip often worsens at night when you are lying down, allowing mucus to accumulate in the back of the throat. Infections, allergies, dust exposure, dry air, smoke, and certain medications can all increase postnasal drip.
Asthma
Asthma is a chronic condition characterized by swelling and narrowing of the bronchial airways, making breathing difficult. Nighttime coughing and wheezing are classic signs of asthma. For many asthmatics, symptoms get worse in the middle of the night or early morning as airway inflammation builds up. Exercise, allergens, irritants, stress, and respiratory infections can trigger asthma flare-ups and worsen coughing at night.
Gastroesophageal reflux disease (GERD)
GERD occurs when stomach acid backs up into the esophagus and throat, causing irritation. Lying down allows refluxed acid to travel more easily out of the stomach. The irritation triggers a cough reflex to prevent aspiration. Coughing usually worsens after meals and when lying flat at night.
Chronic bronchitis
Chronic bronchitis causes persistent inflammation and excess mucus production in the bronchial tubes. Heavy coughing is needed to clear away thickened mucus. Symptoms often worsen at night and after physical activity. Chronic bronchitis is commonly caused by cigarette smoking and long-term exposure to air pollution or dust.
Pertussis
Pertussis, also called whooping cough, is a very contagious respiratory infection caused by the bacteria Bordetella pertussis. It causes severe, intermittent coughing spells, which can recur for weeks. Pertussis coughing spells are usually worst at night and can disrupt sleep.
Medications
ACE inhibitors used for high blood pressure are notorious for causing a dry, persistent cough for some people. The cough tends to be worse during the night and when lying down. Certain other blood pressure medications, pregabalin used for nerve pain, and some cancer drugs can also cause cough.
What makes coughs worse at night?
There are a few reasons why coughs often aggravate and persist at night:
Mucus drainage
When lying down, mucus is able to drain more posteriorly and pool in the back of the throat, triggering cough receptors. Increased mucus production overnight can further worsen cough due to asthma, bronchitis, respiratory infection, or allergies.
Airway inflammation
Many conditions cause chronic airway inflammation and sensitization of cough receptors. The inflammation can worsen at night and make cough receptors even more sensitive. Asthma is a prime example of this phenomenon.
Reduced cough suppression
Studies show that our ability to voluntarily suppress coughing decreases significantly during sleep. This allows coughs to persist rather than being temporarily suppressed.
Irritant exposure
Allergens or irritants in the bedroom environment are often more concentrated at night with less air circulation. This exposure can exacerbate sensitive airways. Examples include dust mites, pet dander, and perfumes.
Medication effects
Some medications cause dry mouth or thickened mucus secretion as side effects, which can worsen coughing at night. Examples include antihistamines, antidepressants, diuretics, muscle relaxants, and opioids.
Change in breathing pattern
Shallower breathing during sleep may allow more mucus accumulation in airways. Snoring or mild obstructive sleep apnea can further aggravate airway irritation and cough receptors.
How to prevent nighttime coughing
Try these self-care steps to prevent nighttime coughing:
Use a humidifier
Dry irritable airways worsen cough. Running a humidifier at night, especially in winter, can help keep airways moist and less sensitive.
Elevate the head when sleeping
Use extra pillows to keep the head elevated. This reduces postnasal drip and irritation by mucus pooling in the throat at night.
Avoid irritants and allergens
Secondhand smoke, strong scents, dust, and pet dander should be kept out of the bedroom to prevent airway irritation. Consider using an air purifier as well.
Take a hot shower before bed
Inhaling steam can help clear excess mucus from airways and provide relief from coughing.
Use throat lozenges
Cough drops, throat sprays, or other over-the-counter medications can temporarily numb throat irritation and dampen the cough reflex.
Try honey
Drinking warm milk mixed with honey before bed can coat and soothe an irritated throat. Studies show honey reduces nighttime cough in children.
Use saline nasal irrigation
Rinsing the nasal passages with a saltwater solution can help clear mucus and flush out allergens or irritants. This may reduce postnasal drip triggering cough at night.
Take medications as needed
Cough suppressants, mucus thinners, antihistamines, decongestants, and asthma inhalers can all help control symptoms at night if cough is severe. But check with your doctor first.
Get adequate rest
Fatigue can make airways more sensitive. Prioritize sleep and rest to help minimize nighttime coughing episodes.
Medical treatments for nighttime cough
If self-care strategies aren’t working, talk to your doctor. Prescription medications or further evaluation may be needed depending on the cause:
Asthma medications
Asthma is commonly treated with bronchodilators to open airways and inhaled steroids to reduce inflammation. This can prevent coughing at night.
Antibiotics
If a bacterial infection like bronchitis or pertussis is causing the cough, an antibiotic may be prescribed to clear the infection.
Acid-reducing medications
These include antacids, H2 blockers like famotidine, and proton pump inhibitors like omeprazole to reduce stomach acid production in GERD.
Gabapentin
For reducing cough from lung damage or irritation not improved by inhalers, gabapentin calms overactive cough receptors.
Opiates
Cough suppressant opiates like low-dose codeine or hydrocodone can temporarily dampen the cough reflex at night.
Pulmonary function testing
Breathing tests can help diagnose respiratory problems exacerbating cough, like asthma or chronic bronchitis
Endoscopy
This visualizes the esophagus to check for signs of GERD, like erosions or ulcers that may be causing cough.
Imaging
A chest X-ray or CT scan of the chest helps identify lung abnormalities responsible for chronic cough, like infections, bronchiectasis, or cancer.
When to see a doctor
You should seek medical attention if you have:
– Cough persisting more than 8 weeks without improvement
– Cough with wheezing, difficulty breathing, or chest pain
– Cough that interrupts sleep or daily activities
– Unexplained weight loss, fever, or night sweats along with cough
– Cough with blood-tinged sputum
Any of these could indicate an underlying medical problem needing diagnosis and treatment. Sudden development of a cough at night in someone over age 65 also warrants medical evaluation.
Diagnosing the cause
To determine what’s causing your nighttime cough, the doctor will ask about your symptoms and medical history. Important clues are when coughing started, if it has any triggers, and if you have other symptoms of illness.
Your doctor will examine your throat and lungs. They may order tests like:
| Chest X-ray | Looks for signs of infection or inflammation in lungs |
| Pulmonary function tests | Measures how well you exhale and airflow to detect asthma or other lung problems |
| CT scan of chest | Provides detailed views of lung structures to assess for issues like fibrosis or bronchiectasis |
| Sputum analysis | Checks for abnormal bacteria, fungi, or cells |
| Allergy testing | Identifies potential environmental triggers of cough like pollens or pet dander |
| pH monitoring | Measures acidity in esophagus to diagnose reflux |
| Laryngoscopy | Views vocal cords and larynx to assess postnasal drip, reflux, or irritation |
Conclusion
Nighttime coughing can have many causes, ranging from temporary viral infections to chronic lung disease. Paying attention to factors that worsen cough at night helps determine the source. Avoiding irritants, using cough suppressants, and proper head elevation may provide relief in the short term. But chronic uncontrolled night cough needs medical assessment. Testing helps diagnose specific conditions like asthma, bronchitis, or GERD that require targeted treatment to resolve sleep-disrupting cough.