Are you not able to get a good night’s sleep because of a nasty cough? Coughing often intensifies when we get into bed, leaving us wondering, Why do I cough at night? or Why is my cough worse at night? The culprit is gravity—lying down increases the amount of mucus that drains from the sinuses into the throat, a common cause of coughs. For some people, lying down also increases the amount of stomach acid that finds its way up into the throat
Bottom Line Personal asked professor of internal medicine Jonathan P. Parsons, MD, MSc, FCCP, to explain why we cough more at night…and, more important, how to make it stop.
Colds, flu and other viral and bacterial upper-respiratory tract infections are the most obvious reasons for nighttime coughing—the infection causes sinus congestion, and the mucus from those stuffy sinuses drains into the throat when we lie down. But that’s just one possible explanation for a cough that intensifies at night. Among the other potential causes*…
If your lower esophageal sphincter—the ring of muscle where your esophagus meets your stomach—isn’t functioning properly, stomach acid can get into your esophagus and throat, a well-known health problem known as acid reflux. While the most recognized symptom of acid reflux is an uncomfortable burning sensation in the chest—that’s why acid reflux is sometimes called “heartburn”— stomach acid finding its way into the throat also can cause coughing. Acid reflux symptoms often get worse at night because when we lie down, gravity no longer helps keep stomach acid down in the stomach where it belongs. Some people who have acid reflux don’t even realize it, because they don’t experience the burning sensation. This is known as “silent acid reflux”—and while people who have silent acid reflux don’t endure the burning sensation, they often do get the chronic cough.
What to do: If you suspect your nighttime coughing could be caused by acid reflux, try not eating for at least the two hours before bedtime—this will reduce the amount of acid in your stomach when you lie down. Avoid drinking soda or alcohol during these pre-bedtime hours, too. Caffeine and alcohol are stimulants to acid production. If your coughing decreases or disappears after a few weeks of doing this, you’ve found the likely cause and should continue these strategies. If that fails to fully control the condition, also take an over-the-counter (OTC) acid reflux medication, such as an H2 blocker or a proton pump inhibitor, such as Prilosec, Nexium or Pepcid.
The coughing caused by these conditions could intensify at night—particularly if your bedroom contains high concentrations of an allergen. Examples: If you’re allergic to pet hair, then sharing a bedroom with your pet could lead to nighttime coughing…or if you have seasonal allergies, your coughing might increase if you sleep with a window open but spend most of your daytime hours in climate-controlled spaces. When coughing is allergy-related, it typically is accompanied by other allergy symptoms, such as watery and/or itchy eyes.
What to do: If nighttime coughing might be allergen-related, reduce your exposure to allergens. That might include sleeping with the bedroom window closed and/or with the pets out of the bedroom or at least off the bed. OTC allergy-control medications or prescription asthma medications could help as well.
If you’re taking a medication to control a health issue that’s linked to coughing, such as asthma, acid reflux or allergies, missing a dose can lead to worsening cough. People are more likely to accidentally miss evening medication doses than morning doses, according to several studies, including one published in 2021 by researchers at Iowa State University and Hofstra University’s Zucker School of Medicine. Our schedules tend to be less structured in the evening and we are more likely to be fatigued, both of which make missed doses more common.
What to do: Even if you are usually good at remembering things, create a reliable reminder system, such as an alarm in your phone, to ensure you don’t forget evening medication doses.
Chronic coughing is among the potential symptoms of congestive heart failure (CHF), and heart-failure-related coughing can intensify when people lie down. But when a cough is caused by CHF, it’s usually accompanied by easier-to-identify symptoms, such as swollen legs, shortness of breath and extreme fatigue.
What to do: See a doctor promptly if you exhibit the symptoms of CHF.
Three more steps that may help control nighttime coughing, even though they don’t treat the underlying cause…
Prop your upper body up on a wedge pillow or on several normal pillows…or buy an adjustable bed or position the legs at the head of a non-adjustable bed on sturdy supports. Sleeping with your head and upper body slightly elevated allows gravity to work to your advantage, decreasing the coughing caused by reclining. Sleeping at an unfamiliar angle might feel unnatural, but it’s better than a chronic nighttime cough.
Decongestants, expectorants and saline sprays can provide some cough relief. But read their packaging carefully and/or speak with your pharmacist or health-care provider before taking these. Some decongestants can increase blood pressure and heart rate…some OTC cough-control medications have a stimulating effect that can make it difficult to fall asleep…some of these drugs should not be used more than a few days in a row because they could cause a rebound effect that actually makes congestion worse…and, like any medicine, these OTC drugs might not interact well with other medications that you’re taking.
There’s no shortage of home remedies for coughs and the irritated throats that coughing cause. Consider drinking caffeinated tea…eating honey or ginger…using a humidifier…and taking hot showers before bed. These strategies tend to provide only modest benefits—but that is better than nothing.
When to see your doctor: If you’re coughing up blood…your cough is accompanied by significant weight loss or the CHF symptoms described above…or you’ve been coughing for three to four weeks or longer and can’t pinpoint the cause.
*The list of common coughing causes also includes smoking, chronic obstructive pulmonary disease (COPD) and taking ACE inhibitors, but these causes typically are not linked to coughing that becomes significantly worse at night.
