Why Your Coughing Gets Worse at Night, According to MDs

2 weeks ago 12

Winter can be a hotbed for illness, which means getting good sleep is more important than ever. But it's not always easy when your cough wakes you up every couple of minutes. If a pesky nighttime cough is getting in the way of your slumber, know that you're not alone. According to MDs, bedtime is actually a common trigger for coughing storms (especially if you don't know what to do about it). From the positioning of your pillow to the amount of moisture in the air, there's many reasons why coughing gets worse at night. Luckily, experts say there are ways to find a little reprieve.

In order to stop uncontrollable coughing at night, we asked doctors to explain why coughing gets worse in the evening (and spoiler alert: the cause may vary depending on your specific circumstances). Once you understand the likely cause for your cough, it may be easier to figure out a fix. For some, that may mean investing in cough suppressants and a new humidifier, but for more severe cases, it could be time for medical intervention.

To figure out where to start, our doctors shared their best recommendations for coughs that get worse at night. This includes tried-and-true advice to reduce symptoms leading up to bedtime and tips for creating a more restful sleeping space. Read on to learn how to stop dry coughing at night, set yourself up for better sleep, and recover faster than ever.

Experts Featured in This Article:

Akua Ampadu, MD, is a board-certified internal medicine doctor and advisory board member for PS's Condition Center.

Payel Gupta, MD, is a triple board-certified allergy, asthma, and immunology specialist, and an assistant clinical professor at both SUNY Downstate Medical Center and Mt. Sinai Medical Center.

Why Do Coughs Get Worse at Night?

Your cough may be worsening at night for a number of reasons. Some have to do with your own body, while others involve the world around you. Take a look at some of the most common culprits:

Sleeping Position: One of the main reasons your cough may get worse at night has to do with how your body is positioned in bed, says Akua Ampadu, MD. While sinus drainage is not thought to be entirely dependent on your sleeping position, lying flat on your back does exacerbate things like postnasal drip, which tends to increase coughing. Dr. Ampadu adds that supine sleeping positions also allow stomach acid to enter the esophagus, which can result in acid reflux and worsen your cough.
Postnasal Drip: Think of postnasal drip as the excess gunk that drains from your nose and down your throat. This drip can tickle the hairlike structures in your throat called "cilia" which keep mucus moving. "Mucus within the respiratory tract — from postnasal drip or the upper respiratory tract — can pool into the back of the throat, causing you to cough," Dr. Ampadu tells PS. Along with nighttime coughing, the excess mucus can also cause you to feel hoarse or leave you with a sore throat.
Asthma: Asthma also tends to flare up at night, which can result in wheezing, coughing, and difficulty breathing, says Payel Gupta, MD. This is because asthma can cause inflamed and narrowed airways, making it harder for air to flow out when you breathe, per the National Heart, Lung, and Blood Institute.
Environment: Other factors for nighttime coughing are purely environmental, including dry air, allergens, and mold. Especially in the winter, cold weather can irritate the throat and dehydrate your nasal passages, while seasonal allergies and airborne irritants often lead to excess mucus and postnasal drip, according to research from Harvard Medical School. This includes mold allergies, which can lead to red eyes, chest tightness, and a persistent cough year-round, per the Cleveland Clinic. Smoke also makes coughing worse at night, so experts recommend keeping it out of the bedroom.
Respiratory Conditions: Dr. Ampadu says underlying conditions like emphysema, bronchitis, or even heart failure could also explain why your cough gets worse at night. Without proper treatment, these coughs may sound slightly different. The Cleveland Clinic describes a bronchitis cough as a "whistling or rattling sound" versus the more hollow sound that's often heard through a stethoscope in people with emphysema. For the most personalized medical advice, consult with a professional healthcare provider.
Medications: Certain medications may be the reason why your cough gets worse at night. The Cleveland Clinic reports that birth control and blood pressure drugs can increase postnasal drip, which can trigger nighttime coughing. The American Academy of Allergy, Asthma & Immunology adds that angiotensin-converting enzyme (ACE) inhibitors, beta blockers, and non-steroidal anti-inflammatory drugs (NSAIDs) can all cause asthma symptoms to flare up — nighttime coughs included.

How to Stop Coughing at Night

Rest assured, for all the potential reasons your cough may get worse at night, there are also treatments to help. The following are some expert-approved ways to address the root cause of nighttime coughing. As a note, always check with your doctor before starting any new medications, and schedule an appointment if your coughing persists, gets worse, or is accompanied by other concerning symptoms.

Change Your Sleeping Position: To combat postnasal drip, Dr. Ampadu suggests elevating your head at least 30 degrees, which can usually be done with the help of an extra pillow. You might also consider turning to the side so that mucus can't pool as easily.
Over-the-Counter Medication: "Postnasal drip can be controlled with the proper use of nasal sprays, but they need to be used as prescribed in order to help," Dr. Gupta says. Over-the-counter saline nasal sprays with sodium chloride are ideal, since they can rinse mucus out of the sinuses and nasal passages. For people with severe allergies, steroid nasal sprays may also be prescribed. To quell further coughing, Dr. Ampadu also recommends an over-the-counter antitussive medication (meaning cough suppressants like Robitussin or Mucinex).
Adjust Your Diet: If you suspect acid reflux is making your cough worse at night, Dr. Gupta advises patients to stop eating and drinking alcohol one to two hours before bedtime, avoiding anything excessively greasy, spicy, or caffeinated. You can also be proactive about your cough by staying hydrated throughout the day to prevent dry nasal passages.
Switch Up Your Nighttime Routine: For a more restful sleep, consider taking a hot shower or applying a topical ointment like Vicks VapoRub to clear up your airways. Dr. Ampadu says sleeping near a humidifier can also combat dry air and allow for less nighttime coughing.

When to Seek Medical Treatment

"If your cough is not improving or worsening, then it is time to seek medical care," Dr. Gupta says. As far as a specific timeline, Dr. Ampadu says persistent coughing for three weeks is a red flag. Other warning signs may include fevers, chills, night sweats, fatigue, unintentional weight loss, bloody or discolored mucus, and difficulty breathing.

Chandler Plante is an assistant editor for PS Health and Fitness. She has over four years of professional journalism experience, previously working as an editorial assistant for People magazine and contributing to Ladygunn, Millie, and Bustle Digital Group. In her free time, she enjoys finding new ways to rock her 18(!) different eye patches, and making videos about chronic illness, beauty, and disability.

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