Have you ever experienced the frustrating phenomenon of coughing more frequently the moment you lay your head down on the pillow, especially at night? It's as if the quiet of the night amplifies the tickle in the back of your throat, setting off a symphony of coughing fits just when you're ready to drift off to sleep, and you start to wonder why coughs get worse at night. This nocturnal coughing is actually a common occurrence that affects many individuals worldwide.

From the influence of circadian rhythms to factors such as postnasal drip, asthma, GERD, environmental triggers, and medication side effects, we'll explore the multifaceted reasons behind nighttime coughing, plus ways to better manage and alleviate nighttime coughing episodes, so you can have a more restful and rejuvenating sleep experience.

There are two types of cough

Coughing can manifest in two primary forms: productive and non-productive coughs.

A productive cough, also known as a "wet" or "chesty" cough, typically results in the expulsion of mucus or phlegm from the lungs or airways. This type of cough often accompanies respiratory infections, such as bronchitis or pneumonia, and serves the essential function of clearing excess secretions.

On the other hand, a non-productive cough, often referred to as a "dry" or "tickly" cough, is characterised by the absence of mucus or phlegm. Non-productive or dry coughs are often more common during nighttime. While this type of cough may not result in the expulsion of secretions, it still plays a crucial role in clearing the airways of irritants and maintaining respiratory health.

So, why do we cough more at night?

There are several reasons why cough happens but in the case of dry coughs at night, it can be caused by:

1. Postnasal drip

Postnasal drip is a common condition characterised by the excessive production of mucus in the nasal passages that drips down the back of the throat. This excess mucus can irritate the throat, triggering coughing reflexes, particularly at night when lying down.

When you lie down during sleep, gravity no longer assists in draining mucus from the nasal passages, allowing it to accumulate and pool in the throat. This pooling of mucus can lead to irritation and inflammation of the throat tissues, provoking coughing spells as the body attempts to clear the airways of the irritating mucus.

Managing postnasal drip to alleviate nighttime coughing involves addressing both the underlying cause of excessive mucus production and implementing strategies to alleviate symptoms:

• Stay hydrated - Drinking plenty of fluids helps thin out mucus, making it easier to expel and reducing the likelihood of postnasal drip.

• Humidify the air - Adding moisture to the air in your bedroom with a humidifier can help prevent the nasal passages from becoming dry and irritated, reducing mucus production and postnasal drip.

• Elevate your head - Sleeping with your head slightly elevated can help prevent mucus from pooling in the throat, reducing the likelihood of nighttime coughing due to postnasal drip.

• Avoid irritants - Identify and avoid environmental triggers that may exacerbate postnasal drip, such as cigarette smoke, strong odours, and allergens like dust and pet dander.

• Allergy management - If allergies contribute to postnasal drip, taking allergy medications or undergoing allergy testing and treatment can help reduce symptoms and nighttime coughing.

• Address underlying conditions - If postnasal drip is chronic or severe, it may be a symptom of an underlying medical condition, such as sinusitis or nasal polyps. Consulting with a healthcare professional can help identify and treat the underlying cause.

2. Asthma

Asthma is a chronic inflammatory condition of the airways, and it is closely linked to nocturnal coughing. Many individuals with asthma experience exacerbation of symptoms, including coughing, during the nighttime hours.

The relationship between asthma and nocturnal coughing stems from several factors:

• Airway sensitivity - During sleep, the body undergoes changes in respiratory function, including decreased lung function and airway reactivity. Individuals with asthma have hyper-responsive airways that are more sensitive to triggers such as allergens, cold air, or respiratory infections. These factors can lead to nighttime coughing as the airways become more reactive and prone to inflammation.

• Circadian rhythms - The body's internal clock, or circadian rhythms, play a role in regulating various physiological processes, including respiratory function. Studies have shown that asthma symptoms often peak during the early morning hours, between 2 a.m. and 4 a.m., coinciding with natural fluctuations in lung function and airway inflammation.

• Supine position - Sleeping in a supine (lying flat on the back) position can worsen asthma symptoms and nocturnal coughing. In this position, gravity may cause the diaphragm to press against the lungs, reducing lung capacity and increasing airway resistance. Additionally, the supine position may promote the pooling of mucus in the airways, further exacerbating coughing and respiratory discomfort.

To reduce nighttime coughing episodes associated with asthma, it's essential to effectively manage and control asthma symptoms. Here are some strategies to consider:

• Follow your prescribed asthma treatment plan, including daily controller medications (such as inhaled corticosteroids) and rescue medications (such as short-acting bronchodilators) as needed.

• Identify and minimise exposure to asthma triggers, such as allergens, pollutants, tobacco smoke, and respiratory infections.

• Create a conducive sleep environment by ensuring proper ventilation, controlling humidity levels, and minimising exposure to allergens in the bedroom. Using hypoallergenic bedding and regularly cleaning bedding and surfaces can help reduce allergen exposure and improve sleep quality.

• Practice airway clearance techniques, such as deep breathing exercises, chest physiotherapy, and using OPEP devices (such as AirPhysio) to help clear mucus from the airways and alleviate nighttime coughing. (Read more: Understand How AirPhysio Helps Your Respiratory Conditions)

3. GORD

GORD, or Gastro-oesophageal Reflux Disease, is a chronic digestive disorder characterised by the reflux of stomach acid into the oesophagus. This backflow of acid occurs when the lower oesophageal sphincter (LES), a muscular ring that normally prevents stomach contents from flowing backward, becomes weakened or relaxes inappropriately.

GORD-related coughing, especially at night, is a common symptom that occurs due to several mechanisms:

• Oesophageal irritation - The reflux of stomach acid into the oesophagus can irritate the lining of the oesophagus, triggering coughing reflexes as the body attempts to clear the throat of the irritating acid.

• Aspiration of acid - During sleep, individuals with GORD may experience episodes of acid aspiration, where stomach acid enters the airways and lungs. This can lead to coughing, wheezing, and respiratory discomfort, particularly when lying down.

• Supine position - Lying down flat allows stomach acid to flow more easily into the oesophagus, increasing the risk of GORD symptoms and nighttime coughing.

To manage GERD and alleviate nighttime coughing, lifestyle modifications and treatments are often recommended:

• Avoid trigger foods and beverages that can exacerbate GORD symptoms, such as spicy foods, citrus fruits, caffeine, alcohol, and fatty or fried foods.

• Maintain a healthy weight through regular exercise and a balanced diet. Excess weight can increase abdominal pressure, leading to the reflux of stomach contents into the oesophagus.

• Elevate head of bed. Use bed risers or a wedge pillow to elevate the upper body while sleeping.

• Over-the-counter and prescription medications, such as antacids, H2 blockers (e.g., ranitidine), and proton pump inhibitors (e.g., omeprazole), can help reduce stomach acid production and alleviate GORD symptoms. Consult with a healthcare provider to determine the most appropriate medication regimen.

• Refrain from eating large meals or snacks close to bedtime.

• Smoking can exacerbate GORD symptoms and increase the risk of complications. Quitting smoking can help improve GORD symptoms and overall respiratory health.

• Practice stress-reduction techniques, such as relaxation exercises, meditation, or yoga, to help reduce GORD symptoms and promote better sleep quality.

4. Environmental factors

Nighttime coughing can be influenced by various environmental factors present in the bedroom environment, such as:

• Dry air - Dry air can irritate the respiratory tract and exacerbate coughing, especially during the winter months or in arid climates. Heating systems, air conditioning, and indoor heating can further contribute to dry air in the bedroom.

• Allergens - Allergens such as dust mites, pet dander, pollen, and mould can trigger allergic reactions and coughing in susceptible individuals. These allergens may accumulate in bedding, carpets, curtains, and upholstered furniture, particularly in poorly ventilated or humid environments.

• Pollutants - Indoor air pollutants, including volatile organic compounds (VOCs), tobacco smoke, household chemicals, and combustion byproducts, can irritate the respiratory tract and worsen coughing symptoms.

Optimising bedroom conditions to reduce nighttime coughing involves several strategies:

• Use a humidifier to add moisture to the air and maintain indoor humidity levels between 30% and 50%. This can help alleviate dry air-related coughing and soothe irritated airways. Be sure to clean and disinfect the humidifier regularly to prevent mould and bacteria growth.

• Implement measures to reduce allergen exposure in the bedroom, such as using allergen-proof mattress and pillow covers, washing bedding in hot water weekly, vacuuming carpets and upholstery frequently, keeping pets out of the bedroom, including keeping your bedroom clean and clutter-free to minimise dust accumulation. 

• Ventilate the bedroom regularly by opening windows and using exhaust fans to remove indoor air pollutants. Avoid smoking indoors and minimise the use of chemical-based cleaning products and air fresheners. Consider using air purifiers with HEPA filters to capture airborne allergens and pollutants.

• Keep the bedroom clean and clutter-free to minimise dust accumulation. Dust surfaces regularly with a damp cloth, and vacuum floors, carpets, and upholstery using a vacuum cleaner equipped with a HEPA filter.

5. Medications

While medications are often prescribed to alleviate symptoms and manage various health conditions, there are certain medications that can contribute to or exacerbate nighttime coughing as a side effect.

Several classes of medications are known to affect cough reflex sensitivity and may contribute to nighttime coughing, and they are:

• ACE inhibitors
• Beta-blockers
• Non-Steroidal Anti-Inflammatory Drugs (NSAIDs, including ibuprofen, naproxen, and aspirin

Statins (Have been associated with coughing as a potential side effect. While less common than with other medication classes, statin-induced coughing may occur in some individuals.)

Key takeaways

We've explored how physiological mechanisms, such as postnasal drip and asthma, environmental factors like dry air and allergens, and medication side effects can all play a role in exacerbating nighttime coughing episodes. Simple changes to your lifestyle and your surroundings can make a big difference to alleviate nighttime coughing and improve sleep quality.

But always keep in mind that a persistent cough can be a sign of a more serious underlying condition. If your cough doesn't improve within a few weeks, or if you experience additional symptoms like fever, shortness of breath, or blood in your phlegm, always consult a healthcare professional for proper diagnosis and treatment.

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Health & Wellbeing Respiratory Health Sleep Tips