Coughing at Night? Here Are 7 Possible Causes—and How To Treat Them

From allergies to acid reflux—here are seven possible causes for why you are coughing at night.

Allergies? A cold? Acid reflux? No matter the cause, there's a simple reason behind all your nighttime hacking: "A cough is a protective mechanism to clear your airway," explained Jonathan Parsons, MD, a pulmonologist at the Ohio State University Wexner Medical Center.

There are several ways healthcare providers can get to the bottom of what's causing your cough at night. "First question we'd want to know is: Is [the] cough part of the daytime symptoms as well?" explained Joseph Khabbaza, MD, a pulmonologist at Cleveland Clinic.

Here's how to tell what that nighttime cough means.

Postnasal Drip

Postnasal drip, also known as upper airway cough syndrome, is one of the most common causes of chronic cough, according to a 2020 article in Physiological Research. It's caused by mucus dripping down your throat (due to allergies or a cold), which tickles nerve endings, triggering coughing, Dr. Parsons said.

Along with itchy eyes, sneezing, and congestion, postnasal drip can be a symptom of nasal allergies, according to the Asthma and Allergy Foundation of America. If you suspect allergies, try an over-the-counter antihistamine, nasal spray, or decongestant.

Asthma

People with asthma have inflamed airways, which can cause difficulty breathing as well as wheezing and coughing, according to the Centers for Disease Control and Prevention (CDC). The cough gets worse at night or early morning. Additionally, chest tightness and shortness of breath might accompany asthma.

To check for asthma, your healthcare provider will most likely order spirometry, a lung function test, Dr. Parsons said. According to the CDC, two types of medications can treat asthma: quick-relief drugs, which provide symptom relief; and drugs you take daily to keep asthma attacks under control.

Acid Reflux

Gastroesophageal reflux disease (GERD) is when acid from your stomach backs up into your esophagus, according to Johns Hopkins Medicine. If you're only coughing at night, acid reflux could possibly be to blame for your cough, Dr. Khabbaza said, since stomach acid can creep up when you lay down to sleep at night. "The classic sign is coughing that starts as soon as you lie in bed at night," said Dr. Parsons. According to Johns Hopkins Medicine, other symptoms can include:

  • Chest pain
  • Difficulty swallowing
  • Shortness of breath

Diagnostic tests may include an x-ray of your upper GI tract or an endoscopy (where a healthcare provider inserts a thin, flexible tube down your throat to examine it), according to Johns Hopkins Medicine. GERD is treated with medication, lifestyle changes, or surgery, according to Johns Hopkins Medicine. Additionally, Dr. Khabbaza said you might want to consider eating your last meal three or four hours before bed to avoid coughing throughout the night.

Chronic Obstructive Pulmonary Disorder

Chronic obstructive pulmonary disease (COPD) includes chronic bronchitis and emphysema, according to Johns Hopkins Medicine. Dr. Parsons said it sounds like a hacking cough that produces a lot of mucus, particularly in the morning. The main cause of COPD is thought to be cigarette smoking.

According to MedlinePlus, patients with COPD can also experience:

  • Shortness of breath (especially with physical activity)
  • Wheezing
  • Chest tightness
  • A whistling sound when breathing

Lung function tests, chest x-rays or CT scans, and blood tests are used to diagnose COPD, according to MedlinePlus. The disease is treated with medications such as bronchodilators and inhaled steroids. It's also imperative to stop smoking. In extreme cases, you may need oxygen therapy.

ACE Inhibitors

ACE inhibitors are medications that are commonly prescribed to treat high blood pressure, according to MedlinePlus. A common side effect of ACE inhibitors is a dry cough. A study published in 2014 in Clinical and Experimental Hypertension found that ACE inhibitors caused cough in about 20% of the people that participated.

A medication-related cough begins a few weeks after starting these meds, Dr. Parsons said. If your cough is mild, you may be okay switching to a different ACE inhibitor, Dr. Parsons said. Still, if it's severe, you'll want to switch entirely to another type of blood pressure medicine, such as an angiotensin receptor blocker or ARB, like Cozaar.

Pneumonia

Pneumonia is an infection that occurs in the lungs, according to MedlinePlus. Pneumonia can cause:

  • Phlegmy cough
  • Fever
  • Chills
  • Trouble breathing
  • Chest pain when coughing or breathing in deeply

Your healthcare provider can usually tell if you have pneumonia by listening to your chest with a stethoscope. However, they may order an x-ray and blood tests to determine if it's viral or bacterial, Dr. Parsons said. Treatment for bacteria pneumonia is antibiotics, according to MedlinePlus. If it's viral, the only remedy is rest and over-the-counter cough medicine.

Whooping Cough (Pertussis)

Whooping cough, also known as pertussis, is a bacterial infection that occurs in the respiratory system, according to MedlinePlus. Coughing is the main symptom of pertussis and can become violent.

The first symptoms resemble the common cold: stuffy, runny nose, watery eyes, fever, and cough. But after about a week, the classic coughing signs emerge, with hacking so intense you may throw up or turn red or blue, Dr. Parsons said.

Pertussis is very contagious, but luckily, there is a vaccine to prevent the spread. The CDC reports that cases of pertussis often peak every few years or so. In 2012 there were more than 48,000 cases.

Pertussis is diagnosed with blood tests or by taking a mucus sample, according to the CDC. It's treated with antibiotics.

Summary

Coughing may be interrupting your nighttime routine. There are several explanations for why you are coughing at night. Maybe you have inflamed airways, mucus dripping down your throat, or stomach acid backing into your esophagus. If you are taking ACE inhibitors, coughing may be a side effect of that medication. Nighttime coughing could also be due to COPD, pneumonia, or pertussis. Whatever the cause, it is important to consult a healthcare provider to figure out what is causing this nighttime cough.

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