Marion Sereti
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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.
Can you cough in your sleep? Absolutely. Coughing happens at all times for many people, including throughout the night. A daytime cough is bad enough to deal with. But a nighttime cough can seriously disrupt your sleep and, by extension, harm the quality of life of not just you but your partners and loved ones. In this article we will explore the influence of night cough on sleep and discuss ways you can manage sleeping with a cough.
The relationship between sleep and coughing1 is certainly significant. Healthy people do not cough at night. But around half of people with chronic cough do - in a way that disrupts their sleep. It is important to get enough quality sleep at the right times. This helps protect your mental and physical health, quality of life, and safety. The CDC found2 that approximately 1 in 3 adults in the United States reported not getting enough rest or sleep every day, whether they had a cold or not.
Coughing can lead to even worse levels of sleep. Persistently coughing during sleep can also lead to daytime fatigue as it prevents deeper, more restorative rest from taking place. It can disrupt rapid eye movement (REM) cycles. More often than not, it will leave you nothing short of irritable the next day.
Further, lack of sleep lead to neuropsychiatric disorders.3 Sleep deprivation has been linked to cognitive decline,4 increased Type 2 diabetes incidence,5 decreased vaccination effectiveness,6 cardiovascular risks,7 and an increased likelihood of being obese.8 ]
Finally, insufficient sleep has also been associated with smoking and alcohol use,9 as well as unhealthy dietary patterns and increased sedentary behaviors in children10 and adults. This is in addition to chronic cough’s other negative effects11 on people’s quality of life.
Coughing affects sleep in two ways:
Those with chronic obstructive pulmonary disease (COPD),12 a common cough of cough, report both, and have almost-doubled odds of developing insomnia. This disturbed sleep worsens the prognosis of COPD outcomes.13
Another condition that can lead to waking in the night, or otherwise disturbed sleep, is obstructive sleep apnea14 (OSA). The symptoms of obstructive sleep apnea include episodes of full or partial airway collapse, decreased oxygen saturation, and waking up from sleep. Research shows that a chronic cough is present in a large proportion of OSA cases15 making it another way by which cough can disturb your sleep. What’s worse, there is a higher-than-chance likelihood16 of having both COPD and OSA.
Finally, a cold or the flu, makes it difficult for people to get a good night's sleep, according to 46% of respondents in a global poll.17 In addition, 94% said that when they get a cold or the flu, their symptoms keep them up at night. This is frustrating for the sufferers, as more than 40% of people said that sleeping more than usual helped them recover from colds.
To summarize:
We will now go on to discuss potential causes of coughing at night and then ways you can stop nighttime cough or relieve it.
Various conditions can cause nighttime coughing including illnesses or environmental factors, and they belong to three types: acute, subacute, and chronic. Here is a quick explanation of the difference and a list of the potential causes we’ll examine in this article:
Below is a more detailed rundown of some of the reasons you may cough in your sleep or at night.
A cough can be a symptom of various infections. While annoying, coughs that are productive or chesty are helping get germy mucus out of your lungs when you're sick. Most will go away in a few days.
Other symptoms of infection with a respiratory disease include:
If your cough does not resolve by itself and/or you feel particularly bad, then it may be worth seeing your doctor. If the infection is bad enough, they will test to see if it’s viral, fungal, or bacterial.
You can clear up bacterial infections quicker using antibiotics, but they don’t work on viral or fungal infections. Fungal infections can be treated using antifungal medication. There exist a few antiviral treatments, but these are experimental and only in use for the most extreme cases (such as those most at risk of COVID-19 complications).18
Potential infections include:
Whatever the cause of your sickness, your symptoms, including your cold, may worsen at night and just after you’ve woken up than during the day. This is normal and is due to a combination of your circadian rhythm,19 body position affecting the air pressure in your lungs, and lack of distractions allowing you to focus more on your symptoms.
Home remedies (discussed more below) and sleeping slightly propped up can help.
After a cold or other infection, though, your cough can become nonproducive and dry, and some dry coughs can last for weeks. This is most likely a post-infectious cough.20 Your doctor can confirm this with a chest radiograph.
The exact cause of post-infectious cough is not currently known. But we suspect that excess mucus production or hyper-inflammation of the airways is part of it.
Usually, post-infectious coughs resolve on their own and it's best to treat them through addressing the symptoms. Home remedies will be explored further down in this article, and your doctor may be able to prescribe bronchodilators that help you breathe better.
An allergy is a condition when a person's immune system overreacts to something that is typically harmless. Coughing is common in allergy suffers; your cough reflex is made more sensitive when exposed to something you’re allergic to, plus other environmental triggers such as air pollution make you want to cough even if you don’t physically need to21 – together, this makes coughing one of the most common allergy symptoms. This frequently happens as a result of airway irritation and inflammation brought on by the immune system's reaction to an allergen.
An allergic person may be hypersensitive22 to many things, including certain drugs, a food ingredient, or an insect sting. Some common triggers that may bring on an allergy cough at night include;
Pollen levels are at their highest in the morning and early evening, and your circadian rhythm23 also makes you more sensitive to allergens at these times. So, if you have a pollen allergy, you might find that you cough more in the evening or at night.
The best way to rid yourself of a cough caused by allergies or an environmental trigger is to change your environment to remove the offending source. Cleaning, particularly of bed sheets and in high moisture areas, often works, as it gets rid of things like pet dander, urine, and mold.
Where you can't remove or avoid the trigger (such as for hay fever or if you are visiting someone else’s house), taking an antihistamine to reduce your immune system’s response is the best first step. Your doctor may be able to prescribe something stronger than OTC ones. Then follow the home remedies listed below for further relief.
Upper airway cough syndrome used to be called postnasal drip (PND), and many sources still call it such. However, the American College of Chest Physicians renamed it in 2006. PND is now a symptom of UACS, rather than the whole syndrome itself.
Your airways should have a number of glands that are constantly producing mucus. The main function of this mucus is to lubricate the airway and filter out extraneous objects that would otherwise find their way into the respiratory tract. However, PND is the sensation of producing too much mucus, which runs down the back of your throat.
PND might cause a dry, lingering cough. Lying down can exacerbate this sensation. The majority of the time, coughing is noticed most at night when the mucus tends to collect in the throat and cause an attack.
Other symptoms that may accompany UACS include:
Treating UACS can be tricky as the specific cause is not yet known. However, strong antihistamines are usually prescribed,24 and sometimes speech therapy25 can help.
Gastroesophageal reflux disease (GERD) symptoms include heartburn or acid regurgitation happening weekly or more often. The sphincters between the stomach and the esophagus gets weaker, and stomach acid can make it way through and irritate your throat. Although the mechanism is unclear,26 people with GERD often experience a chronic cough.
Symptoms of GERD include:
This condition has often been linked to poor sleep quality27 (and, making a vicious circle, when you sleep badly you’re more likely to have a reflux incident). Sleeping can worsen acid reflux in two ways: muscle relaxtion in the sphincters and the swallowing muscles, and body position.
While you cannot stop your body from relaxing during sleep, you can change the position you sleep in to relieve GERD symptoms. Since acid can irritate your airways while you’re lying flat, the best way to sleep with a cough is to prop yourself up on a pillow. Using pillows as a support can help to keep your airways open. Alternatively, if pillows do not work for you, consider raising the head of the bed 6 to 8 inches, using wooden blocks under the bedposts.
Otherways to control GERD symptoms include behavior and lifestyle changes:28
Coughing is a common symptom of asthma. The likelihood of developing asthma symptoms increases as you sleep, and some people only experience asthma symptoms at night.29
Although the exact cause of asthma attacks during sleep is unknown, there are several explanations,30 including increased allergen exposure, airway cooling, being in a reclining position, and hormone releases related to the circadian rhythm. Additionally, similar to GERD, acid reflux is thought to be another contributing factor to nocturnal asthma.
Some common symptoms of asthma include:
Treating asthma usually requires prescription drugs, such as bronchodilators and corticosteroids. Timing the dosage31 can make the medicine more effective. There is constant research into new drugs to help with asthma, so further breakthroughs may be made in the future.
But what can you do about a night cough? Everyone knows a nocturnal cough can be bothersome. Luckily there are numerous effective therapies that can reduce its intensity and length so you can sleep more soundly.
While for some people there could be more serious underlying conditions and you should consult your medical practitioner for any cough lasting more than three weeks, there is a good chance your nighttime coughing can be eased by changing your habits. Below are a few home remedies to consider.
People who do not drink enough tend to cough more.32 Multiple glasses of water consumed throughout the day can aid in moisturizing the nasal passages and reducing nasal congestion symptoms.
Some people find that drinking herbal tea before bed is relaxing; some caffeine-free varieties, like chamomile,33 may even help you sleep better. Hot liquids, such as chicken soup or tea, can also relax the throat, easing the pain from a cough.
To avoid midnight bathroom visits that disrupt sleep,34 remember to cease drinking liquids about an hour before going to bed.
Cough drops, also referred to as throat lozenges, work to relieve throat pain and reduce reflexive coughing. The Mayo Clinic35 suggests sucking on a cough drop or hard candy before bed to relieve a dry cough and relax your throat. Constistent swallowing, prompted by cough drops, relieves the urge to cough in many people.36
Menthol (an organic substance created from oils of mint, including peppermint and eucalyptus) is an ingredient frequently found in cough drops. Peppermint and eucalyptus oils can have painkilling effects,37 which is another way they can relieve coughs and sore throats.
Try sucking on a cough drop before you go to sleep with a cough , but make sure it’s finished before you doze off so you don’t choke.
Adding honey to warm liquids such as water or tea, or simply taking a spoonful or two, may reduce the urge to cough.38 It works by coating the sensory nerves in the throat that trigger the urge to cough, as well as encouraging saliva production (making the throat less dry) and swallowing.
The World Health Organization39 cites honey as a potential treatment for coughing and sore throats. Honey may even be better than some OTC drugs at reducing cough symptoms in children.40 It has a positive effect41 on many people’s coughs and sore throats, with little downsides.
Plus, honey tastes good and can be a little pick-me-up in the evening.
Do always remember: honey is not suitable for children under the age of one year.
Your coughing may get worse at night if you have dry airways. Dry air triggers cough by causing your airways to constrict.42 Therefore, taking actions to increase the humidity of your home’s air can make your breathing easier and reduce coughing at night. Two ways to do this are to have warm showers and running an air humidifier.
Taking a warm shower immediately before bed not only helps you regulate your core body temperature to help you get to sleep more quickly43 but also provides warm steam that moisturizes your nasal passages. Hence it is advisable to soak up some moisture in a steamy bathroom before going to bed.
You may also be able to breathe more easily while sleeping by using a humidifier44 to gently inhale steam. They can increase the air humidity in your bedroom, as well as being a method to inhale useful essential oils, like menthol,45 to reduce coughing. Humidifiers reduce sore throat and coughing even after throat surgery.46 Surgery is a major irritant to the throat, so imagine what they can do for you in your everyday life.
However, while humidifiers are effective, if you don't properly maintain them or if the humidity level is too high, they might become Petri dishes for bacteria that can make you sick. Make sure to keep an eye on the humidity levels in your home and to clean your humidifier regularly47 and stop using the humidifier if you discover that it makes your allergies or asthma symptoms worse.
Consider giving pets their cuddles only during the day and keep them out of your bedroom at night if you potentially have an allergy to pet dander or saliva. This will reduce the amount of the allergen in your bedroom at night, meaning you will be less likely to cough.
Regularly wash your blankets, pillowcases, mattress covers, and sheets once a week in hot water that is 130°F (54.4°C) or higher.48
There are myriad over-the-counter (OTC) and prescription drugs that can help with night cough and the conditions that cause it. Most OTC medications are also available in a prescription form, which is usually stronger. If the OTC formulas are not providing you with relief, your doctor may write you a prescription for these stronger medications. The treatment will depend on the cause of your nighttime cough.
When the lining of your nose swells as a result of viruses like the flu and the common cold, it may become difficult to breathe. Decongestants work by reducing blood flow to the swollen tissue by constricting blood vessels. Without that blood, the swollen tissue contracts, making breathing easier.
Not struggling to breathe through your nose will make you less likely to breathe through your mouth. Mouths don’t have the filtration capabilities as noses, so you may breathe in more irritants through your mouth. Also, mouths do not warm or moisten air the way that noses do, making the air you breathe in colder and drier and so more likely to trigger coughs.
However, decongestants must not be administered to kids under the age of two, since they may result in severe effects,49 and are not recommended for children under six.50
As we mentioned above, sometimes acid reflux can cause you to cough, and this can get worse at night because you are lying down. If this is the reason for your night cough, your healthcare provider may prescribe acid-reducing medications – antacids can help neutralize your stomach acid – however, they do not help to treat the irritation already caused to your esophagus.
Antitussives,51 commonly referred to as cough suppressants, restrict your cough reflex from working through various methods. This stops you from coughing.
Productive coughs should not be suppressed, because they are how your body clears itself of sickness-containing mucus. Dry nocturnal coughs may benefit from them as they may prevent your cough reflex from being activated while you sleep.
You shouldn’t ignore nighttime coughing if you suffer from it, given its detrimental effects on the quality of sleep. Additionally, while its cause is likely benign, it can be a symptom of a serious underlying condition that shouldn’t be left untreated. Luckily, there are both home remedies and medication (OTC and prescription) that can help you stop coughing at night.
One challenge that many night coughers face is being able to accurately describe their cough to their doctor. After all, you are tired and/or sleeping. So it’s not truly possible to be exact about when your coughing starts or how much you actually cough. You can't know if it ever stops during the night.
References
Marion is a freelance health and wellness writer with a passion for all things digital health. She loves diving deep into the latest research and trends in the industry and distilling them down into fun, relatable pieces that people can relate to. Whether you're a health nut or a tech geek, she is always looking for new and interesting ways to help readers access quality and evidence-based information.
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