What to do if your cough is keeping you up at night

Dr Louise Wiseman MBBS, BSc (Hons), DRCOG, MRCGP
·7-min read
Photo credit: champja - Getty Images
Photo credit: champja - Getty Images

From Netdoctor

Kept awake all night by a cough? We all know that sleep is the best medicine, especially when it comes to recovering from the common cold. But if a nagging cough interrupts your slumber when you need rest the most, you might start to feel like you will never recover. And it could well mean sleepless nights for your entire family too.

Dr Louise Wiseman shares her expert tips on how to ease your nasty cough at night so you can get some much-needed shut-eye:

Why is your cough worse at night?

Coughs tend to be more troublesome at night because throughout the day, your natural reaction is to swallow frequently, helping the nasal mucus drain down your nose and throat. But when you lie down in bed at night to go to sleep, it becomes more difficult for your body to clear your airways naturally. Mucus can build up in your throat, so your body makes you cough to try and clear it.

Coughing is a naturally protective reflex to stop you from choking and help your body get rid of unwanted substances like dust, allergens or mucus.

Plus, if you're feeling bunged up, you're often forced to breathe through your mouth, rather than your nose. This can make your mouth dry and irritate the nerves at the back of the throat, causing you to cough even more.

Nighttime cough home remedies

If you are suffering from a viral infection, to stop coughing throughout the night and get a good night's sleep try these tips:

1. Use an extra pillow

If lying down makes your cough worse, it stands to reason that sleeping on a slight incline can help, so grab an extra pillow and let gravity do the work. If snoring is a problem you may need to sleep on your side.

2. Gargle salt water

If your cough is caused by a sore throat (like with a cold) then gargling with salt water before bed, ensuring to spit it out afterwards, may help soothe some of the throat inflammation.

3. Try steam power

Steam has historically been recommended to help clear congestion in the nasal passage and chest, so try a warm shower or bath to ease your coughing symptoms.

A plug-in steamer may help but take extra care. A recent study has expressed concern about children being at risk of burns or scalds from steam unsupervised.

Photo credit: staticnak1983 - Getty Images
Photo credit: staticnak1983 - Getty Images

4. Sip water frequently

When you're unwell, it's essential to stay hydrated throughout the day and the night, as sipping water will help soothe the cough reflex and relieve a sore throat. You might also be losing more moisture from your airways if you are mainly breathing through your mouth.

Sip warm, decaffeinated drinks before bedtime and keep a glass of water on your bedside table so you can instantly ease your cough throughout the night. Warm fluids are soothing, can ease congestion and prevent dehydration. Some studies have also shown that ginger tea has anti-inflammatory properties which may help to ease a sore throat.

⚠️ Avoid excess caffeine, alcohol or sugar, which can all impact dehydration levels and further exacerbate your cough.

5. Try lemon and honey

Lemon was historically thought to ease congestion but new evidence has found that honey holds the key to breathing easy. It has natural antimicrobial properties and studies have shown it to be effective at soothing cold and flu symptoms. This could partly be due to its viscosity and ability to coat an inflamed throat.

❗ Honey should never be given to babies under one and used with caution with very young children due to its potential to occasionally cause botulism.

5. Visit the pharmacy

While coughs do tend to get better without treatment, there are a number of over-the-counter products available from the chemist which may help, but always discuss with your pharmacist or doctor first:

✔️ Paracetamol or ibuprofen

Simple paracetamol or ibuprofen can help if there are no contraindications.

✔️ Cough expectorants

Cough medicines can be expectorants (break up or thin mucus) or cough supressants (stop coughing). A chesty cough or one associated with a cold will usually respond well to an expectorant (eg Guanifenesin).

✔️ Cough suppressant

A cough suppressant will work by stopping dry irritative coughs and examples include pholcodine or dextromethorphan. These should only be used with care after discussion with your doctor. This is because of interactions with other medication or if you have other medical (especially breathing) conditions which may mean these medicines could have dangerous side effects. Do not give to children under six and only give to older children under strict medical guidelines.

✔️ Antihistamines

Some medicines contain antihistamines such as diphenhydramine and promethazine which help dry up nasal secretions that drip down the back of the throat and also aid sleep.

✔️ Nasal saline spray

Some people find a nasal saline wash helpful with congestion but you might also find it unpleasant so proceed with caution.

✔️ Decongestants

Decongestants such as pseudoephedrine may not always be recommended for more acute sinus conditions as they can dry and harden secretions excessively and cause long term problems. Discuss potential side-effects with your pharmacist or GP.

When to call the doctor about a cough

If you cough up blood or experience chest pain, fever, mucus (green, yellow) or breathing problems, make an urgent appointment with your doctor. Coughs accompanied by unexplained weight loss or night sweats should also be reported.

Coronavirus cough

If your cough is a continuous dry cough accompanied by a high temperature or fever and you experience a loss or change to your sense of smell or taste, you could have contracted coronavirus (COVID-19). The current government advice outlines that you should arrange to have a test for COVID-19 and stay at home and self-isolate for 10 days from when your symptoms start.

Chronic conditions and coughing

We all get coughs from time to time, but a cough that lasts longer than three weeks could be a sign of something more serious. A persistent nighttime cough could be caused by one of the following chronic conditions. If you're worried, make an appointment with your doctor.

• Asthma

Nocturnal coughing may be the only symptom in certain asthmatic patients. If you have asthma you have ‘sensitive’ airways that are inflamed and ready to react when they come into contact with something they don't like. This can then cause the muscle in the wall of the airways to contract and make the tubes narrower, causing inflammation and tightness, wheezing or coughing.

• Chronic obstructive pulmonary disease (COPD)

Bronchitis and emphysema left untreated can cause nocturnal coughing.

• Heart failure

A persistent cough that may worsen at night is a less common sign of heart failure. It is more common that breathlessness occurs when lying down at night and there may be swelling of legs or ankles where fluid accumulates during the day (oedema).

• Allergies and hayfever

Allergies can cause sneezing and upper airway congestion or simply coughing alone. Pets, pollen, dust and house dust mites are all potential culprits. Giving pets their own bed in the bedroom separate to yours may help along with using hypoallergenic bedding and a HEPA filter vacuum to remove pet dander and house dust mites.

• Gastro-oesophageal reflux disease or indigestion

Sometimes acid reflux can be a cause of chronic coughing at night. It is thought that a quarter of chronic coughs are caused by this and classic heartburn is not apparent in all patients. Patients often self-treat by using extra pillows or a wedge pillow at night to stop the acid draining up the oesophagus. Medicine for treating acid reflux should ease the cough.

• Smoking

Smoking may be a cause of chronic cough- day or night. If you are having trouble stopping smoking visit our quit smoking section.

Last updated: 11-11-20

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