You’ve gone through your nighttime routine, relaxed and ready for sleep. Except when you lie down, an annoying cough starts up. If this happens night after night, you may begin to ask, “Why do I cough when I lie down?”
We wish there was one simple answer. The truth is, that myriad underlying conditions could be behind your nighttime cough. To help, we compiled a list of potential causes, tips on how to discover which one is to blame, and actionable ways to get a better night’s sleep.
Understanding nighttime coughing
“Nighttime coughing is a persistent cough that occurs primarily or exclusively at night,” says Paul Daidone, MD, FASAM, an internal medicine specialist in Arkansas, “This symptom can disrupt sleep, leading to fatigue and a lower quality of life.” And symptom is the keyword here.
Nighttime coughing isn’t in and of itself a diagnosis, but a symptom of an underlying condition.
Coughs, whether at nighttime or during the day, are a reflex by the body’s immune system. Their goal: To get foreign objects out of the body. If you’re sick, for example, the immune system will do everything it can to get rid of the illness, including coughing. The same can be said about if you accidentally take a giant gulp of water when swimming. Coughing is a way to get that water out.
Coughs have many potential causes, though there are three factors that can help pinpoint the underlying condition: accompanying symptoms, if the cough occurs at night, during the day or both, and if it’s acute or chronic.
If you are confused about what constitutes a chronic cough, you’re not alone. Chronic varies, depending on the symptom or medical condition. For coughing specifically, “it is considered chronic when it lasts more than eight weeks in adults and four weeks in children,” says Dr. Daidone.
Common causes of coughing at night
The causes of a nighttime cough can be grouped into two categories: respiratory and nonrespiratory. While there’s only two overarching categories, quite a few conditions fall into each camp, making it difficult to diagnose the underlying cause. To make matters more confusing, a nighttime cough can also be caused by a trigger that doesn’t fall into one of the two groups.
While there are many possible culprits, three conditions cause 90% of cases: cough variant asthma, GERD, and upper airway cough syndrome (UACS). None of these conditions can be self-diagnosed, and all can present alongside other conditions on the lists below.
Respiratory causes
More often than not, a nighttime cough is due to a respiratory condition, especially ones that cause post nasal drip. Postnasal drip occurs when the back of the nose feels stuffed with mucus, and some drips down into the throat, leading to a cough.
Medical conditions linked either directly to a nighttime cough or to postnasal drip include:
Asthma: A chronic condition that impacts the lungs.
Upper airway cough syndrome (UACS): The medical name for postnasal drip when there are no known causes for the condition, such as asthma or allergies.
Chronic rhinitis: A group of conditions characterized by multiple nasal symptoms.
Chronic obstructive pulmonary disease (COPD): A group of lung conditions that make it hard to breathe.
Cystic fibrosis: A genetic condition that impacts multiple parts of the body, including the gland responsible for making mucus.
Interstitial lung disease (ILD): Disorders characterized by scarring in the lungs.
Primary or secondary lung tumors: Tumors in the lungs that often stem from lung cancer.
Sarcoidosis: A disease that can cause inflammation in the lungs, lymph nodes, liver, and eyes.
Tuberculosis: A bacterial disease that impacts the lungs.
Obstructive sleep apnea (OSA): A condition where there’s a partial or complete collapse of the airway during sleep.
Respiratory infections: Viruses that impact the respiratory system, including the flu, COVID-19, and respiratory syncytial virus (RSV).
Post-COVID-19 syndrome: Symptoms that linger after COVID-19. If someone still experiences post-COVID-19 respiratory symptoms, they may experience a nighttime cough. While this is a possible cause, it’s more likely someone with post-COVID-19 syndrome won’t have a cough that discriminates based on time of day—and not everyone who gets COVID-19 will experience this syndrome.
There are also a few respiratory-adjacent reasons (aka they affect the upper airways but aren’t necessarily related only to the respiratory system) that may cause a nighttime cough. These include laryngeal problems, often injuries to the laryngitis, and when foreign objects enter the upper respiratory tract.
When respiratory causes are to blame, it’s important to assess markers of systemic inflammation and any exposure to toxins. Both inflammation and environmental toxins can contribute to respiratory conditions. When a medical provider evaluates inflammation and the body’s ability to detoxify, it’s easier to understand the root cause of respiratory symptoms, including a nighttime cough.
Nonrespiratory causes
A nighttime cough may also stem from nonrespiratory conditions, most of which impact the digestive tract or heart. The most common in this group are:
Gastroesophageal reflux disease (GERD): If experiencing a dry cough at night, GERD may be to blame. GERD is a condition where the muscle between the esophagus and the stomach doesn’t work properly, and food and stomach acid travel up the digestive tract. It’s marked by chronic acid reflux, which causes heartburn and may lead to a cough when someone lies down.
Chronic tonsillar enlargement: This condition enlarges the tonsils and can make the airway tighter, leading to a chronic cough.
Recurrent aspiration: A condition where food materials can descend into the lungs.
Heart conditions: Various heart diseases could cause a nighttime cough, including left ventricular failure (heart failure characterized by a dysfunction in the left ventricle) and mitral stenosis (a type of valvular heart disease).
Pulmonary infarction: A lung infarction that can be caused by multiple conditions, though it’s often due to a pulmonary embolism, a condition that impacts blood vessels in the lungs.
Psychogenic cough: A cough without an obvious physical cause that is believed to be linked to psychological health.
In very rare conditions, other health conditions may be at play, including a collapsed lung, vitamin B-12 deficiency, cardiac arrhythmias, and aortic aneurysms. Gut health can also contribute to many of the above conditions. A functional medical provider will test for any nutrient deficiencies or imbalances in the gut and determine if they are causing any non respiratory or respiratory conditions listed above.
Other potential causes
While an underlying medical condition is usually to blame (especially if the cough appears night after night), external triggers, like allergens, smoking, and medications, could be to blame.
Triggers range wildly and include anything that could irritate your throat or immune system. “Dust, pet dander, mold, and dry air can trigger coughing at night,” explains Andrew Youssouf, MD, an emergency medicine specialist in New Jersey. He explains that these triggers can cause the immune system to trigger coughing, and that lying down often makes this coughing worse.
Smoking is the most common environmental cause, after allergens. Being around secondhand smoke at night may also be a culprit. Like other environmental triggers, smoking irritates the lungs, potentially triggering a cough.
There’s also multiple medication classes that may be responsible. These include angiotensin-converting enzyme inhibitors (ACEIs), beta-blockers, non-steroidal anti-inflammatory drugs, and any drug that causes pulmonary fibrosis, a condition that scars the lungs.
Managing chronic coughing
If the list above didn’t give it away, there’s quite a few potential causes for a chronic cough. “If your cough is chronic, you should see a doctor to find out what's causing it and how to treat it,” Dr. Daidone recommends. As a reminder, a chronic cough is defined as one that lasts four weeks or more for children and eight weeks or more for adults.
You may want to see a medical professional sooner, rather than later, if the cough is accompanied by other symptoms, such as fatigue, a fever, or night sweats. If you cough during the night for a limited time without other symptoms, medical attention may not be needed.
When this is the case, a functional medical provider can best identify the root cause and create a personalized treatment plan to treat the cause, as well as the chronic cough. This treatment plan will most likely include dietary changes, taking specific supplements, and lifestyle modifications.
If dietary changes, supplements, and lifestyle modifications sound vague, it’s because they are. There isn’t a one-size-fits-all approach to managing a chronic cough. Instead, your treatment plan will be based on a personalized, comprehensive assessment that considers the many factors contributing to your health.
Solutions for a peaceful night’s sleep
A peaceful night’s sleep seldom started with an uncontrollable cough. Fortunately, there are multiple ways to ease this symptom and have a restful night.
The first tip is to design a peaceful sleeping environment. Dr. Daidone recommends using a humidifier to reduce dryness in the air and avoid irritating symptoms of respiratory conditions. It may also help to keep your bedroom allergen-free, which will go into more detail in the next section.
A peaceful night’s sleep also comes from how you position yourself. Propping your head up while sleeping can help with a post nasal drip and/or acid reflux, explains Dr. Youssouf. He adds, “Staying hydrated and clearing your nasal passages before bed can also make a big difference.”
There are multiple effective methods to clean the nasal passages, including using a neti pot (though there are strict safety guidelines to follow), over-the-counter nasal sprays, and inhaling steam. If curious about which one is right for you, ask a clinician.
Alongside these hacks for a better night’s rest, you also want to see a healthcare professional who can diagnose the underlying condition. Knowing what’s causing a chronic nighttime cough unlocks more potential treatments, such as over-the-counter or prescription antihistamines or treatments for the cough’s cause.
Preventing nighttime coughing
No matter what’s causing your nighttime cough, your goal is most likely to get rid of it. The three tips below can help with that, and they may also ease related symptoms, such as postnasal drip or difficulty breathing.
Keep your bedroom allergen-free
As we’ve discussed, allergens in the bedroom can irritate the throat and immune system, causing symptoms such as coughing. To prevent these environmental triggers, ensure your bedroom is allergen-free.
For a better idea of what an allergen-free sleeping environment looks like, let’s walk through some bedroom basics:
Mattress: Dr. Daidone recommends flipping your mattress regularly so dust, mold, and pet dander don’t accumulate. All three may trigger a nighttime cough.
Mattress and pillow covers: On top of the mattress, place a mattress cover that’s hypoallergenic. Pillow covers can also help.
Sheets and pillows: To eliminate dust mites and other allergens, wash sheets and pillowcases at least once a week.
Air: The air in the room matters too. Use a humidifier or air purifier to ensure air quality and decrease the changes of a nighttime cough.
Minimize clutter: The more clutter in your bedroom, the more places allergens and dust have to hide. Declutter for an allergen-free sleep.
Flooring: Hardwood floors are often better for those who are irritated by dust or allergies because they store fewer triggers than carpet.
Practicing good sleep hygiene
A good night’s sleep starts with the right sleep routine. This includes going to bed at the same time every night, waking up around the same time each morning, and having a relaxing nighttime routine that signals to the body that it’s time to sleep.
Other steps to improve sleep hygiene include:
Avoid caffeine in the afternoons or at nighttime
Sleep in a dark environment
Don’t use electronic devices before bed
Keep your bedroom quiet and cool
Don’t eat a large meal right before bed
Treat any underlying conditions
We may sound like a broken record, but if there’s one tip you get from this article, we hope it’s this: See a medical provider to treat any underlying conditions. A functional medical provider can provide invaluable insight into why you cough at night and the root cause.
Often, they will assess symptoms, markers of inflammation, gut health, your medical history, and environmental factors that can contribute to your cough, such as toxins. From there, they’ll create a personalized treatment plan that encompasses diet, movement, stress management, and your environment, alongside any necessary medications.
Frequently asked questions (FAQs)
How can I stop coughing when I lay down?
There are many reasons why you can’t stop coughing when you lie down. Your throat and immune system could be irritated by an environmental trigger, smoking, or a medication. It could also be due to an underlying condition, like asthma, GERD, or UACS.
Why does lying in bed make me cough?
Lying down increases acid reflux and post nasal drip, two of the most common reasons for a nighttime cough. If coughing at night doesn’t disappear on its own within four to eight weeks, see a healthcare provider who can help you determine the cause.
Why do I cough when lying down but not standing up?
If you cough when lying down but not when standing up, it’s probably because the lying down position increases the risk of post nasal drip and acid reflux. Both are common reasons we cough.
What triggers coughing at night?
Coughing at night can be triggered by underlying medications, environmental triggers, and medical conditions. The most common causes are cough variant asthma, GERD, and UACS.
What is a GERD cough?
A GERD cough is what it sounds like: A cough that is a symptom of GERD. GERD is a condition where someone experiences chronic bouts of acid reflux because the muscle at the end of their esophagus doesn’t close properly. Acid reflux causes a pain in the chest and regurgitation of the stomach’s contents, including stomach acid, which can irritate the throat and cause coughing.
Why do I cough and choke when lying down?
There are many reasons you may cough or choke when lying down. It could be due to an environmental trigger, such as an allergen in the room or secondhand smoke. 90% of chronic cases, however, are due to cough variant asthma, GERD, or UACS.
Final thoughts
A nighttime cough isn’t fun and can be tricky to treat, thanks to the laundry list of potential causes. There are some actions you can take to treat a cough when lying down, such as creating an allergen-free sleep environment or using a humidifier. But these actions probably won’t resolve a chronic cough alone. If the cough is persistent or accompanied by other symptoms, seek support from a clinician.
Parsley Health helps patients get to the root of their nighttime cough and create an effective treatment plan. To learn more about how we can help, schedule a free call.
