Are coughs worse at night?

Overview

Do you think you are alone if coughing keeps you up at night? Well, you are not…. Colds and flus cause the body to create abnormal amounts of mucus. When laying down, mucus might trickle down the back of the throat, activating cough reflex. Coughing that produces mucus is referred to as a "productive" or wet cough. While the one that does not produce mucus is referred to as "ineffective" or dry cough. Coughing at night may make falling asleep more difficult and can have a negative effect on quality of life.

Types of cough

Dry Cough

This cough sounds just like a dry cough, nothing comes up with it. It may interfere with sleep and cause headaches or even a sore throat, although this is more likely attributable to the cough itself than to an underlying problem. These dry coughs are often triggered by throat discomfort, such as tobacco, allergies, and pollutants. Although dry coughs are often connected with colds or the flu, they may also be caused by allergies, acid reflux, or medicine. These coughs may be indicative of upcoming lower respiratory illnesses (bronchitis, pneumonia), although they often resolve on their own quite soon. Additionally, dry coughs may be caused by laryngitis, sore throat, croup, tonsillitis, sinusitis, asthma, allergies, gastroesophageal reflux disease (GERD), drugs, particularly ACE inhibitors. One of the most prevalent symptoms of COVID-19 is a dry cough. Additionally, COVID-19 symptoms include fever and shortness of breath. If you develop any of the following symptoms (difficulty breathing, chest heaviness/tightness, blue lips, disorientation), seek emergency medical assistance immediately.

Dry cough remedies vary according to the cause and age groups:

• For infants and toddlers: Dry coughs in infants and toddlers are often self-limiting. A humidifier may aid in their comfort. Bring your youngster into a steamy bathroom or outdoors in the cold night air to cure croup breathing. A humidifier will assist older children in preventing their respiratory system from drying up. Cough drops may also be used to ease sore throats in older children. If their ailment persists for more than 3 weeks, see your doctor regarding possible other reasons. Antibiotics, antihistamines, or asthma treatments may be necessary for your youngster. 
• For adults: A chronic, long-lasting dry cough may have a wide variety of reasons. Inform your doctor of any discomfort or heartburn you are experiencing. You may need antibiotics, antacids, or asthma drugs, as well as more tests. 

Wet Cough

A wet cough is one that generates mucus when you cough. If possible, spit this mucus out, since ingesting it might result in a stomachache or vomiting. Wet coughs are typically caused by an infection, such as a cold or the flu, and are your body's way of eliminating excess mucus produced by the infection. While asthma may sometimes produce a wet cough, if you also have congestion, a runny nose, a sore throat, or a fever, it is reasonable to assume you are suffering from a cold or respiratory infection. Chronic obstructive pulmonary disease (COPD) is often accompanied with a wet cough, which may occur even when the lungs are not particularly inflamed. 

Cure for a wet cough in:

• Infants and toddlers: Utilise a cool-mist humidifier to alleviate symptoms. Additionally, you may use saline drops in the nasal passages followed by a bulb syringe to wipe the nose. Give no cough or cold medicine over-the-counter (OTC) to infants or toddlers under the age of two. 
• Children: In a clinical research, it was shown that giving 1.5 tablespoons of honey half an hour before bedtime lowers coughing and promotes better sleep in children aged 1 and older. At night, use a humidifier to provide moisture to the air. Consult your doctor before taking OTC cough and cold drugs as a therapy. 
• Adults: Acute wet coughs may be treated with over-the-counter cough and cold symptom relievers or honey. If a cough lasts more than three weeks, antibiotics or other treatments may be necessary.

Croup

Children are more likely than adults to get croup, which causes a barking sound during the cough. It is caused by a viral infection and often results in swelling and inflammation of the windpipe, which produces the unmistakable croup cough sound. Croup is often associated with a hoarse voice, difficulty breathing, and, in certain cases, a fever. Although croup may seem frightening, it normally does not need a doctor's visit; however, if you are worried that your kid is having difficulty breathing, you should bring him or her to your nearest TrueCare location. Croup is often best treated by sitting in a hot bathtub and performing other activities that help alleviate inflammation and open up the airways. 

Croup is normally self-limiting and does not need treatment. Croup cough remedies include placing a cool-mist humidifier in their bedroom, bringing the child into a steam-filled bathroom for up to ten minutes, taking the child outside to breathe cool air, taking the child for a ride in a car with the windows partially open to allow for cooler air, giving children's acetaminophen (Tylenol) for fever as directed by a paediatrician, ensuring your child drinks plenty of fluids and gets plenty of rest. 

Uncontrolled Coughing

Uncontrolled, or paroxysmal, coughing refers to fits of coughing that are often uncontrollable, forceful, and painful. While whooping cough comes within this group, paroxysmal coughing may also be caused by asthma, COPD, tuberculosis, or pneumonia. Whooping cough, also known as pertussis, is the most severe of these coughs; it is characterised by rapid, deep coughing that worsens at night and is followed by a deep inhalation that often produces a "whoop" sound. As a result of the uncontrollable coughing fits caused by whooping cough, people may experience oxygen deprivation. Whatever the source of your uncontrolled coughing fits, seeing a doctor is critical to conquering your condition and finding relief and healing from your cough. Babies are more likely to get whooping cough and suffer more catastrophic problems. For them, whooping cough may be fatal. The easiest approach to prevent acquiring pertussis is to be vaccinated at the age of 2 months and older. 

People of all ages need antibiotic therapy for whooping cough. Due to the high contagiousness of whooping cough, family members and caregivers of someone who has whooping cough should also be treated. The sooner whooping cough is diagnosed and treated, the better.

Causes¹

Infections caused by viruses

The majority of dry coughs are caused by illnesses (common cold or flu). Cold and flu symptoms normally last about a week, but some individuals endure persistent symptoms. When cold and flu symptoms irritate the upper airway, the resulting damage may take some time to recover. Due to the open and sensitive nature of the airways, virtually anything might provoke a cough. This is particularly true at night, when the throat is most parched. Dry coughs might persist for weeks after your cold or flu symptoms have subsided. 

Asthma

Asthma is a disorder in which the airways enlarge and constrict, making breathing difficult. Coughing that persists for an extended period of time is a frequent symptom (although seldom the sole one) might be productive or ineffective. Coughing is often severe at night and in the early morning hours. The majority of persons also suffer one or more of the following symptoms: wheezing, shortness of breath, tightness (chest discomfort), coughing (wheezing bouts), and whistling sound on exhale. 

Gastroesophageal reflux disease (GERD)

Gastroesophageal reflux disease (GERD) is a kind of acid reflux occurring on a chronic basis; as a result of stomach acid rising into the oesophagus. Acid in the stomach might irritate the oesophagus and activate the cough reflex. Additional GERD symptoms include heartburn, chest discomfort, regurgitation of food/sour liquid, lump in the back of the throat, chronic coughing, chronic sore throat, slight hoarseness, and trouble swallowing. 

Drip postnasal

Postnasal drip occurs when mucus runs down into the throat from nasal passages. It occurs most often at night, when laying down and normally happens when the body produces an abnormal amount of mucus. It may occur as a result of a cold, flu, or allergy. Mucus that drops down the throat might activate cough reflex, resulting in midnight coughing. Other postnasal drip symptoms include hurting throat, lump in the back of the throat, difficulty swallowing, and runny nose. There are a few more possible causes of nighttime coughing; dry coughing at night is less prevalent due to environmental irritants, ACE inhibitors, and whooping cough. 

Is cough worse at night?

Why is the cough worse at night?²

Gravity

Gravity is the single most important component that contributes to nighttime coughing. When we lay down, mucus inevitably starts to collect. Elevation is the most effective technique to offset this gravitational force. Elevation of the head will prevent mucus from accumulating in the back of the throat. Whether your cough is caused by postnasal drip or acid reflux, laying down will make it worse. To fight this, sleep with pillows raised up to avoid mucus from gathering in the back of the throat. If having acid reflux, do the same thing with the pillows, and avoid late-night munching. Eating before sleep may aggravate GERD, which in turn aggravates nocturnal coughing. 

A dry, indoor setting

Dry air may worsen an already inflamed nose and throat, exacerbating coughing. Using humidifiers to provide moisture back into the air makes it easier to breathe if having a dry air cough, but be sure to take good care of the device. However, humidifiers are not always safe. If the used water is not sterile, you risk cycling bacteria back into the air or spawning new illnesses. Bacterial infections may occur. Many flu-related fatalities are caused by pneumonia, which strikes after patients believe they have recovered from the virus.

Is dry cough or wet cough common during the night?

Dry coughs seem to be more frequent as a result of decreased saliva production during sleep, which results in a drier throat than normal. When the throat is dry, it is more susceptible to airborne irritants that might provoke a coughing fit.

What does chronic nighttime cough indicate?

If left untreated, a persistent dry cough may become a hazard to the entire health. It has the potential to exacerbate any existing problems, such as IPF, further scarring lung tissue. Additionally, it may make everyday living more challenging, causing pain and possible injury. At the moment, there is no proof that a dry cough is harmful. However, some experts believe it might be harmful owing to the immense power and pressure generated by a cough. 

According to the American Lung Association, some of the hazards associated with a persistent dry cough include exhaustion/low energy, headaches, nausea, vomiting, chest and muscular pains, sore throat, hoarseness, fractured ribs, and incontinence. If the issue is bad enough, patients may find themselves avoiding social events entirely, resulting in worry, frustration, and melancholy. While persistent dry coughing is not usually indicative of a life-threatening condition, it may be damaging. As such, it is critical to treat it immediately.

Ways to reduce a nighttime cough²

Home remedies

Menthol cough drops

Menthol cough drops are medicinal throat lozenges providing a cooling, calming sensation. Sucking on one before bedtime may assist in lubricating the throat and preventing irritation throughout the night. They are accessible at most pharmacies, and should never be taken while laying down due to choking threat. 

Humidifier

Humidifiers increase air humidity. Because of generating less saliva when sleeping, the throat is drier than normal. When the throat is dry, it is more susceptible to airborne irritants that might provoke a coughing fit. While sleeping, humidifiers will help keep the throat moist, protecting it from irritants and allowing it to recover. 

Rest

If coughing is interfering with your sleeping, attempt shifting yourself. Gravity draws the mucus in your nasal passageways down into the throat when lying down. While thick mucus may elicit the cough reflex on its own, even regular mucus can create issues due to allergens and irritants it may contain. To prevent this issue, raise the body up on numerous cushions at a 45-degree angle. Consider doing this for a few nights to allow the throat to recover. 

Avoid irritants

All day and night, irritants like dust, pet hair, and pollen may circulate throughout the home. If anybody in the family smokes or if you are heating your home with a wood-burning fireplace, keep the door to the bedroom locked at all times. Take additional measures: e.g. do not allow dogs in the bedroom and ensure to close windows during allergy season. In the bedroom, HEPA air purifier may help reduce cough-inducing allergens. Additionally, seek for hypoallergenic bedding and mattress coverings. 

Honey

Honey is an anti-inflammatory and cough suppressant that is naturally occurring. A study discovered that it was more helpful than OTC cough treatment in reducing overnight coughing in youngsters.³ To ease a sore throat, add a spoonful of raw honey to tea or warm water. Alternatively, take it directly. 

Drink lots of fluids

Hydration is more critical than most people realise. Keeping hydrated helps maintain the moisture level in the neck, critical for protecting it from irritants. Aim to consume around eight big glasses of water every day. When ill, it is beneficial to drink extra water. Consider enhancing the food with herbal tea or warm lemon water. 

Manage GERD

If suspecting of having GERD, you should see a physician about treatment options. Meanwhile, the following OTC drugs may help avoid symptoms like nocturnal cough: omeprazole (Prilosec OTC), lansoprazole (Prevacid), and esomeprazole (Nexium).

Cough medicines

Occasionally, home cures are insufficient. As a result, there are various dry cough at night therapy medications available. If looking to be a little more assertive, consider the following pharmaceutical solutions. 

Decongestants 

Decongestants are OTC drugs used to alleviate congestion. Viruses such as common cold and flu expand the lining of the nose, making breathing difficult. Decongestants operate by restricting blood arteries, preventing blood from flowing to bloated tissue. Without that blood, bloated tissue contracts, making breathing easier. 

Antitussives and expectorants

OTC cough medications are classified as cough suppressants or expectorants. Cough suppressants (antitussives) work by inhibiting the cough reflex. Expectorants work by thinning the mucus in the airway, making coughing easier. Cough suppressants are more appropriate for dry nocturnal coughs, since they prevent cough reflex from being activated while sleeping.

When to talk to a doctor

According to Morice at al., acute or short-lived coughs, typically accompanying upper respiratory tract illnesses like the common cold, generally go away on their own without therapy.⁴ If your cough lasts longer than a week, seeing a doctor is recommended. According to the Cleveland Clinic, if your cough is caused by an infection, a specialist may prescribe an antibiotic/antiviral drug. 

Do not wait until symptoms worsen in children. Make an appointment as soon as possible, and be on the lookout for indicators of an emergency, such as blue skin, trouble breathing, fever with rash, and so on. If experiencing any of the following symptoms, visit a specialist: temperature of more than 38.3°C, coughing for more than a week, coughing up blood, wheezing, chest discomfort, or difficulty breathing.

Consult a physician if coughing has not cleared up after 18 days or three weeks. If worsening and is accompanied by additional symptoms (e.g. fever, persistent congestion), see an urgent care centre. Mayo Clinic informs that a longer-lasting (chronic) cough might be the consequence of another health issue (allergies, GERD, asthma, COPD, chronic sinusitis, etc.). Chronic bronchitis might potentially be the culprit, so schedule an appointment with your doctor if your cough does not improve.

Summary

Coughing is a necessary preventive and defensive reflex the body employs to clear mucus, noxious chemicals, and irritants from larynx, trachea, and bronchi. Hindered or missing cough reflexes may be harmful. Nocturnal coughs are widespread and may be caused by a number of different factors.⁵ The intensity of midnight coughing will vary according to its underlying cause. For instance, nocturnal coughing caused by a normal cold often resolves within 1 or 2 weeks. If coughing is caused by a persistent lung illness, it may be more difficult to control. Individuals who suffer from allergies, asthma and/or GERD may improve their perspective by controlling illnesses and collaborating with doctors to determine the best treatment choices to alleviate symptoms.