Why does a cough get worse at night?
Several things change when you lie down. Mucus from the nose and sinuses drains down the back of the throat, triggering the cough reflex. Stomach acid can reflux more easily when flat, irritating the throat and airways. Airways in asthma are more reactive at night because of natural hormone rhythms. Bedroom air is often drier, and allergens such as dust mites live in bedding. Fewer distractions also make a cough more noticeable. See postnasal drip and sore throat and cough.
Common causes
- Postnasal drip from colds, allergies, rhinitis or sinusitis. See sore throat from allergies.
- Acid reflux (GORD) and LPR, which can cause cough without heartburn. See laryngopharyngeal reflux.
- Asthma, including cough-variant asthma, with night-time or early-morning cough, wheeze or chest tightness.
- Post-viral cough lingering for up to 3–8 weeks after a cold or flu.
- Dry air and heating.
- Irritants and allergens: smoke, vaping, dust mites, pets, mould.
- Medicines: ACE inhibitors (such as ramipril, lisinopril) cause a dry persistent cough.
- Heart failure, where lying flat causes fluid to build up in the lungs.
- Whooping cough, COVID-19 and other infections.
- Chronic lung disease, smoking and, rarely, tumours.
Home remedies and sleep tips
- Raise your head with extra pillows or a wedge so that mucus and acid drain less.
- Use a humidifier or place a bowl of water near the heater; keep it clean.
- Honey (a spoonful or in warm water or tea) before bed can ease cough; not for babies under 1 year.
- Drink fluids, and keep a glass of water by the bed.
- Avoid eating or drinking alcohol 3 hours before bed; see home remedies for heartburn.
- Rinse your nose with saline before bed if congested.
- Wash bedding weekly in hot water and use dust-mite covers if allergic.
- Avoid smoke, strong scents and pets in the bedroom.
- Lozenges or hard sweets to soothe; avoid giving to young children.
- Sleep on your side or propped up.
Medical treatment depends on the cause
- Postnasal drip: nasal steroid spray, antihistamines and saline irrigation.
- Reflux: lifestyle changes, antacids or proton pump inhibitors under medical advice.
- Asthma: inhalers (preventer and reliever) after spirometry or peak flow testing.
- ACE inhibitor cough: ask your doctor about switching to another medicine; do not stop it yourself.
- Infection: treated as needed; antibiotics only for bacterial infection.
- Chronic cough work-up: chest X-ray, spirometry, allergy tests and an ENT or respiratory referral.
- Cough suppressants are not recommended for children and have limited evidence in adults.
How long does it last?
A cough after a cold usually settles within 3 weeks. A cough lasting more than 3 weeks is considered subacute, and beyond 8 weeks chronic; both warrant a medical review. The commonest causes of chronic cough in non-smokers with a normal chest X-ray are upper airway cough syndrome (postnasal drip), asthma and reflux. Smoking and ACE inhibitors are other common causes.
Children with a night cough
- Colds, allergies and asthma are the main causes.
- A barking cough with noisy breathing suggests croup and needs prompt assessment.
- Whooping, vomiting after coughing or a long-lasting cough should be checked. See sore throat and cough.
- Avoid cough and cold medicines in young children.
- Raise the head of the mattress slightly for older children, not pillows for babies.
- See a paediatrician for cough with fast breathing, wheeze or lasting more than 2–3 weeks.
Red flags
- Coughing up blood or rust-coloured phlegm.
- Shortness of breath, wheeze or chest pain.
- Swelling of the ankles and breathlessness lying flat.
- Fever, night sweats or unexplained weight loss.
- A cough lasting more than 3 weeks, or changing in character.
- Hoarseness or difficulty swallowing with cough.
- Cough after starting a new medicine.
- Smoker with a new or changing cough.
When to see a doctor
- Any red flag above.
- A dry cough that wakes you most nights for more than 2 weeks.
- Cough with wheeze or breathing difficulty.
- Cough that does not improve with home care and treating congestion or reflux.
- People with heart or lung disease, immune problems or on ACE inhibitors.
- Children with persistent night cough or breathing difficulty.
- Older adults with new cough and fatigue.
Three common situations
A dry cough every night during pollen season with sneezing: likely allergy and postnasal drip; treat nasal symptoms.
A tickly night cough with heartburn and a sour taste: consider reflux; avoid late meals and raise the bed.
A dry night cough that started two weeks after beginning a new blood pressure pill: ask your doctor about an ACE inhibitor cough.
Key points to remember
A dry cough at night usually comes from postnasal drip, reflux, asthma, dry air or medicines. Raise your head, humidify, avoid late meals and treat allergies; see a doctor for cough over 3 weeks or any warning sign. Our ENT team can look for nasal and throat causes.
This guide is for general information and does not replace an examination by your own doctor or ENT specialist.
Questions about a dry cough at night
These answers are general information and do not replace an examination or individual medical advice.
Why is my dry cough worse at night?
Lying flat lets mucus drip down the throat and acid rise, and the air is often drier.
What helps a dry cough at night?
Raising your head, a humidifier, honey in warm water, avoiding late meals and treating allergies.
Can reflux cause a night cough?
Yes, even without heartburn.
Can blood pressure tablets cause a cough?
ACE inhibitors can cause a persistent dry cough; ask your doctor about alternatives.
How long should I wait before seeing a doctor?
If it lasts more than 3 weeks, sooner with warning signs.
Is a night cough a sign of asthma?
It can be, especially with wheeze or chest tightness.
Sources
This guide is for general information and does not replace medical advice. How a problem is diagnosed and treated depends on your examination and medical history. If you think you have an emergency, contact your local emergency services.