It’s a familiar scene: the house is quiet, the lights are dimmed, and you’re finally settling into bed after a long day. As your head hits the pillow, something unexpected happens—a persistent, irritating cough begins to surface. It’s as if the body is choosing the quiet of night to remind you that something’s not quite right. This condition, known as bedtime cough, can feel like a nuisance, disrupting sleep and making you wonder why it’s always worse when the day winds down.
But what causes this frustrating cough to flare up in the evening? Is it just a seasonal irritation or is there something more to it?
The science behind bedtime cough1
To understand why coughing intensifies at night, we first need to look at the body’s natural rhythms. During the day, we’re usually active, and the upright position of the body helps prevent excess mucus from pooling in the lungs and airways. But as you lie down to sleep, gravity no longer works in your favour. Mucus can accumulate in the throat and chest, irritating the airways and triggering a cough reflex. This is especially common for those with respiratory conditions like asthma, chronic bronchitis, or postnasal drip.
The body’s circadian rhythm also plays a role. This internal clock regulates various bodily functions, including the immune system and the production of certain hormones. Studies show that the immune system can be less effective during the night, which might make inflammation in the airways more pronounced while you're sleeping. For people with asthma, the evening hours are particularly problematic, as lung function tends to decrease, making breathing harder and increasing coughing episodes.
Underlying causes of bedtime cough2
While coughing at night can happen for a variety of reasons, some conditions are more likely to trigger the symptoms.
|
Asthma
For those with asthma, the night can be a time when symptoms worsen. Asthma is a condition where the airways become inflamed and narrow, leading to wheezing, shortness of breath, and coughing. At night, the body's lower levels of cortisol (a hormone that helps to reduce inflammation) may cause the airways to become more sensitive, setting off a coughing fit. It’s also common for asthma sufferers to have increased airway inflammation due to cooler air or allergens like dust mites that are more concentrated in bedrooms.
|
|
Postnasal drip
Another common culprit is postnasal drip, where excess mucus from the sinuses drips down the back of the throat, especially when lying flat. The sensation of mucus trickling down irritates the throat, often triggering a cough. This can happen during a cold, allergy flare-ups, or even due to acid reflux.
|
|
Acid reflux
Gastroesophageal reflux disease (GERD) is another condition that can provoke coughing at night. When stomach acid flows back into the oesophagus while lying down, it can irritate the throat and airways, leading to a dry, persistent cough. This is often worse after eating or drinking, particularly if the meal was rich or acidic.
|
|
Chronic obstructive pulmonary disease (COPD)
For individuals with COPD, a lung disease that causes chronic shortness of breath and cough, night-time coughing can become more frequent. The body’s reduced ability to clear mucus from the lungs means it can collect overnight, leading to coughing and discomfort when trying to sleep.
|
|
Allergies and dust
Bedrooms are full of dust mites, pet fur, and pollen—all common allergens that can cause coughing, particularly when a person is lying down. These particles can trigger an allergic reaction, leading to inflammation in the airways and the need to clear the throat through coughing.
|
The human experience
Meet Anong (not her real name). A 42-year-old mother of two from Bangkok, Anong had been dealing with a persistent nighttime cough for months. It wasn’t just an occasional nuisance—it was an all-too-familiar companion that would disrupt her sleep every evening.
"I could set my watch by it," she said, describing how her coughing would begin right as she lay down in bed. At first, she thought it was just a seasonal cold or allergy, but as the months went by, the cough became more severe, leaving her feeling exhausted and frustrated.
After consulting with her doctor, Anong discovered she had postnasal drip, a condition where mucus from her sinuses would trickle down her throat as she lay down, triggering the cough. "It feels like my throat is being constantly irritated," she shared. With a plan in place that included using a humidifier and nasal decongestants, Anong was finally able to reduce her symptoms.
Now, she sleeps more soundly and wakes up feeling rested, without the nagging cough that once plagued her nights. “I never realised how much of a toll it was taking on me until it was gone,” Anong reflected, grateful for the relief she found after addressing the root cause of her bedtime cough.
Managing bedtime cough3,4
The good news is that bedtime cough can often be managed with some simple lifestyle adjustments and medical interventions.
|
Elevate the head
Propping up your head with extra pillows can help prevent mucus from pooling in the throat and airways, reducing coughing episodes.
|
|
Humidify the air
A dry environment can aggravate coughing, so using a humidifier in your bedroom can add moisture to the air, easing irritation in the throat and lungs.
|
|
Allergy-proof your bedroom
If allergens are to blame, regularly washing your bedding, vacuuming carpets, and keeping windows closed can reduce your exposure to dust mites and pollen.
|
|
Avoid eating before bed
For those with acid reflux, it’s wise to avoid large meals, especially acidic (e.g., oranges, grapefruits, vinegar) or fatty foods (e.g., fried chicken, French fries, pizza), in the 3–4 hours leading up to bedtime. Eating too close to sleep can trigger GERD and increase coughing.
|
|
Medication
In some cases, a doctor may recommend antihistamines, decongestants, or inhalers for those with asthma or postnasal drip. If acid reflux is the issue, medication to reduce stomach acid may be prescribed.
|
When to seek medical advice
While occasional coughing at night is usually harmless, persistent or severe coughing may indicate an underlying health issue. If the coughing disrupts your sleep frequently, or if it’s accompanied by other symptoms like wheezing, shortness of breath, or chest pain, it’s important to seek medical advice. A doctor may perform tests, such as a chest X-ray or spirometry, to pinpoint the cause and recommend appropriate treatment.
DID YOU KNOW?
Coughing is a natural reflex that helps clear the airways of irritants, but while most coughs are short-lived, a persistent cough lasting more than three weeks is considered chronic and may require medical attention.
More than just a nuisance
Though often considered a mere nuisance, bedtime cough can be a signal that something more serious is at play. It’s a reminder that our bodies are finely tuned instruments, responding to external and internal cues, with the night being a vulnerable time for many of us. While it’s easy to dismiss a cough as nothing more than a passing irritation, understanding the cause of a bedtime cough can be key to addressing it effectively and getting the restful sleep we all need.
DID YOU KNOW?
Studies show that our bodies produce more mucus at night, which may explain why coughs seem to get worse when we lie down to sleep.
Reclaim your rest
Whether it’s asthma, allergies, postnasal drip, or acid reflux, a nighttime cough can be disruptive, but it doesn’t have to be the final word in your quest for a peaceful night’s sleep. By understanding the root cause and taking simple steps to manage it, you can reclaim those much-needed hours of rest. So next time you find yourself reaching for a glass of water in the middle of the night, know that your body is simply trying to clear away what’s in its way—and that there are ways to make the process a lot smoother.
References
- Singh DP, Jamil RT, Mahajan K. Nocturnal Cough. StatPearls. Available at: https://www.ncbi.nlm.nih.gov/books/NBK532273/.
- Why are you coughing at night? Harvard Health Publishing. Available at: https://www.health.harvard.edu/diseases-and-conditions/why-are-you-coughing-at-night.
- How to Sleep When You Have a Cough. Columbia University Irving Medical Center. Available at: https://www.columbiadoctors.org/news/how-sleep-when-you-have-cough.
- How to Sleep With a Cough or a Cold. Sleep Foundation. Available at: https://www.sleepfoundation.org/sleep-faqs/how-to-sleep-with-a-cough.
Copied
9 mins read 
