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Bennett Richardson
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We at Hyfe, Inc., are a company devoted to working on tools to better understand the importance of cough. It is Hyfe’s intention in the future to seek regulatory approval for medical products that analyze cough in order that they may be used to diagnose, monitor, and facilitate better treatment of respiratory illnesses.
Whenever we contract an illness, coughing is often one of the most irritating and debilitating symptoms we experience. It is especially frustrating at night, once all of our daily tasks are complete and we’re finally ready to sleep.
In fact, coughs often seem to be worse at night, with the constant hacking keeping us from getting good sleep.
But why is this the case? Is there a reason why coughs seem to be worse at night or is this phenomenon simply a figment of our imaginations?
In this article, we will examine the topic of coughing at night and get to the bottom of this annoying issue.
Interestingly, research seems to support the idea that coughs are often worse at night (particularly for those with conditions like asthma1.
There are a few reasons for this.
One of the factors that can make coughs worse at night is gravity. During the day, we are usually upright (whether we’re mostly sitting or standing). However, once we lay down flat for the evening, gravity can begin to affect us in different ways. Specifically, excess mucous will start to pool in our throat, forcing us to cough in order to clear it.
Additionally, body position can affect the way gravity moves the mucus in our body and how it affects our breathing tubes. The position we sleep in can worsen or improve a cough. Lying on your back can lead to or worsen a difficult-to-treat cough2, likely as a result of the collapse of the airways at the back of the mouth (sleep apnea3).
Asthmatics were found to cough more in the first 30 minutes in bed than the rest of the night, and the researchers theorized this was because of the change in position4.
Furthermore, many people sleep in bedrooms with very dry air. Dry air can irritate many different portions of the respiratory system, such as the throat and upper airway. It can cause a cough by causing the airways to constrict5.
Finally, if your cough is from an infection, your circadian rhythm may be part of the reason it gets worse at night. Symptoms of the flu and colds are at their worst at nighttime and when just waking from sleep, and if you are allergic to pollen you will also be more sensitive to it in the morning and early evening, all due to your circadian rhythm6.
All of these factors can lead to increased cough symptoms at night.
Next, let’s take a look at some of the common causes that can lead to coughing at night.
There are many disease processes that are associated with coughing. In this section, we’ll review some of the most common issues that lead to cough symptoms.
Perhaps the most common reason why people develop short-term coughs is viral infection7. Whether it’s the SARS-COV2 virus, a rhinovirus, or something else entirely, viral infections can wreak havoc on the body.
In most cases, viruses will be dealt with and cleared within a week or two after they’ve been contracted. While you’re fighting off this virus, you may experience many different symptoms such as fatigue, achiness, and various other issues including coughing. You will likely be more tired as your body fights the infection, and this may be worsened if your coughing and other symptoms keep you up at night.
While you are infected, your night-time cough will likely be productive – produce mucus. This is your body clearing out as much of the infection as possible. Your body is most effective at clearing mucus when standing or sitting upright and least effective when lying down8, which is why a cough caused by viral infection may worsen at night.
GERD is an extremely uncomfortable condition that is often associated with the digestive system. Most patients with GERD will experience gastrointestinal symptoms such as heartburn or vomiting after meals. Additionally, GERD can cause symptoms that are worse at night.
Interestingly, GERD can also lead to coughing9. Because the digestive system and the respiratory system share certain organs, symptoms can often crossover between these areas. As a result, coughing at night is a common complication associated with GERD.
When it comes to respiratory conditions, asthma10 is often one of the scariest. When a person with asthma encounters a trigger, their airways constrict, leading the person to gasp for air. In some cases, asthma attacks may necessitate a visit to the hospital or some sort of emergency maneuver in order to save the individual’s life.
At night, asthma sufferers may experience more coughing fits11. This is due to the position assumed by most people during sleep. Lying flat, especially when the person has an infection or a sinus blockage, will often trigger a coughing episode in people with asthma.
Coughing is one of our best methods of clearing fluid and debris from our airways. When we experience postnasal drip, the fluid that drips down into our throats can make it feel like we have to cough12 in order to open our breathing pathways.
As is the case with many of the other issues described previously, coughing at night is common with postnasal drip. Lying down changes the angle of the head and neck, leading to more fluid dripping into the throat. This, in turn, often leads to more coughing. Additionally, experiencing postnasal drip means your cough is likely to last longer13, meaning more nights of disrupted sleep.
Besides diseases, many lifestyle choices can also increase cough symptoms at night.
Especially for those with GERD, eating before bed is one of the lifestyle factors14 that can lead to increased symptoms, including coughing, during the night. If this is a problem for you, and you cough after eating, be sure to stop eating a few hours before bed so that all of the food is further along in the digestive process when you finally lay down for the evening.
For those with dog and cat allergies, allowing pets to sleep in the bedroom is a bad idea. As you sleep, the allergens from your pets flow throughout the room’s air, often causing you to cough with more frequency.
Even if they only sleep in your bedroom during the day, their dander and saliva (common allergy triggers) may be found on your bedding and pillows. You have to wash these at 130°F (54.5°C) in order to remove them15.
Smokers are more likely to have a long-term cough than non-smokers and those who have stopped smoking16.
Even those who do not smoke themselves but live with smokers are more likely to develop a chronic cough than those not exposed to tobacco smoke at al17l. This means smokers and those regularly exposed to second-hand smoke are more likely to cough at night.
There are many benefits to stopping smoking, such as lower risk of and increased survival of lung cancer18, and a significant reduction in coughing is another19.
If you take ACE inhibitors for your high blood pressure or other heart problems, you may find that you have developed a dry cough since starting them. This is a known side-effect. The prevalence of cough in ACE-inhibitor users is 5–35%20, although these rates may be higher than the actual incidence21.
Taking a necessary medication is not typically thought of as a “lifestyle choice”; however, it is a factor that must be considered when trying to ascertain the cause of a pesky nighttime cough. Always talk to your doctor before stopping any medication that you take.
Thus far, we’ve discussed the many causes of nighttime coughing. Now, we will outline some of the best treatments and strategies for combating this issue
Lying flat on your back is a big contributor to having a cough at night, as we’ve demonstrated thus far. Therefore, using extra pillows to prop yourself up so that you are more upright can go a long way towards reducing symptoms of cough at night, if it is caused by airway collapse or the related sleep apnea.
If you’re allergic to pets, dust, pollen, or anything else in your environment, you need to eliminate these substances from your bedroom.
Wash bed sheets and pillowcases at 130°F (54.5°C) to significantly reduce the levels of allergens present in them22 and also wash your actual duvets and pillows if possible (perhaps by taking them to a laundrette) or replace them if they are very old and dusty.
Check the materials they are stuffed with – if it includes natural materials such as wool or feathers, consider whether these may contribute to your allergic reaction.
Consider installing air filters, either filtering the air for your whole home or at least for your sleeping areas. High-quality (HEPA) air filters remove allergens from the air and trap them so that you no longer breathe them in. Whole-house filtration is much more effective than using portable room filters but portable filters are better than nothing23.
When you are cleaning your air filter, wear a face mask so you do not breathe in the allergens trapped within it.
If you sleep with your windows open, you may reconsider this. Many irritants can enter through open windows, leading to nighttime coughs. Keeping your windows closed blocks these out and keeps your airways clear. Air conditioning units can be installed with filters to keep the air in your home cool but not bring in unfettered allergens from outside.
By taking these steps, you will reduce the irritants that are causing you to cough at night.
Humidifiers add moisture to the air. This can help if you live in an area with dry air, as dry air, as well as cold air, are known cough triggers24. Humidifying the air creates a more comfortable environment for our airways.
However, you must ensure that you regularly clean your humidifier. If you do not, fungi and bacteria can develop in the warm, humid environment inside of it, worsening your cough25 and potentially leading to an infection. Additionally, if your cough is caused or worsened by certain allergies, leading to allergic rhinitis, humidifying your air may actually make it worse26. This is why it is important to consider the cause of your cough before taking actions to relieve it.
Knowing what is causing your cough will allow you to attack it at its source and not just treat the symptoms.
If you have a disease that’s causing you to cough at night, you need to treat said disease. Your primary care practitioner should be your first port of call to ascertain if your cough is caused by an infection, and if so whether there is medication they can give you. If it is a bacterial or fungal infection, antibiotics and antifungicides may be prescribed. If it is a viral infection, such as the flu, the common cold, or COVID-19, then those won’t work; you may be given antiviral medication if the infection becomes particularly nasty, but you will likely be in hospital at this point.
But, if it’s a chronic condition that can’t be “cured”, at the very least, you must find ways to effectively manage it. These techniques could include medicinal treatments, dietary changes, or a host of other options. For example, GERD and its related cough can be managed through lifestyle change, medication, and surgery27.
If your cough is caused by a build-up of mucus in your sinuses, by post-nasal drip28, or by allergies, a quick cleanout of the airways can help significantly with nighttime coughs for some people. Removing the mucus from your system removes the coughing trigger for a while (until it builds up again).
This can be done by blowing the nose, gargling with salt water, and nasal rinsing (particularly for allergy-induced coughs)29. If you feel like your airways are constantly clogged up, try some of the aforementioned airway clearance methods to see if they work for you!
Medicine bought over-the-counter can help to decrease cough symptoms during the night. For example, if you are congested, which has led to your coughing at night, a decongestant may improve your symptoms.
However, products marketed as cough medicine may not be any more effective than honey in a warm drink30 (and likely cost more), and many of them are unregulated by the FDA and unsuitable for use in young children31.
Additionally, if you are trying to improve your GERD-related cough symptoms by using cough medicine, you will likely not have much luck. This is because the medicine you take must be appropriate for the cause of your cough. An OTC cough syrup or decongestant won’t help a GERD-caused cough just like antibiotics will not help a cough caused by a cold, and none of these will help an allergic cough.
This is why it’s important to know the cause of your cough before you start taking medication for it.
We all need a good night’s sleep. Unfortunately, pesky coughs often prevent us from achieving our eight hours.
If you’ve been experiencing a cough that’s keeping you up at night, try some of the techniques outlined above and see what you think!
References[↩]
Bennett Richardson is a physical therapist and writer out of Pittsburgh, PA. He treats a variety of conditions and writes about a number of topics in the health field. In his free time, Bennett enjoys exercising, reading, and philosophizing with anyone he can trick into having a conversation with him.
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