Why does a dry cough get worse at night?

Overview

A dry cough is a cough that does not produce mucus and can cause irritation in the throat and airways. Many individuals find that a dry cough worsens significantly during the night. Factors such as sleeping position, environmental conditions, and underlying health issues can significantly increase the prevalence and discomfort of nighttime coughing.

How your body changes at night

• Lying flat can lead to increased throat irritation and postnasal drip.
• Cooler temperatures in the bedroom may irritate sensitive airways.
• Dry air indoors can cause dehydration of the throat.
• With fewer distractions present, the urge to cough may feel more intense.

Causes for dry nighttime cough

Postnasal drip (most frequent cause)

When lying down, mucus drains into the throat, causing a tickling sensation or ongoing irritation.

Asthma

A nighttime cough is a typical symptom of asthma. While sleeping, the airways tend to narrow.

Allergies (dust mites, pets, mould)

• Allergens in the bedroom can irritate the throat.
• Bedding can accumulate dust particles over time.

Acid reflux (GORD)

Lying flat enables stomach acid to rise and irritate the throat. This is more common after late meals.

Viral infections (cold, flu, COVID)

• Inflammation occurs in the airways.
• The cough reflex becomes more sensitive.

Dry air in the bedroom or from air conditioning

This can lead to nasal passages and throat dehydration.

Certain medications

ACE inhibitors (used for high blood pressure) may lead to a persistent dry cough.

Smoking or vaping can cause irritation

This causes inflammation of the airways.

Dry cough - day vs at night

Dry cough patterns can vary depending on the time of day. The table below highlights common differences between daytime and nighttime dry coughs, along with possible causes.

Nighttime Dry Cough: Home Relief Tips

Simple lifestyle changes and home remedies can significantly reduce nighttime dry cough and improve sleep quality.

Lifestyle and home remedies:

1. Prop your head up with an extra pillow.
2. Utilise a humidifier or place a bowl of water in the room.
3. Drink warm water or herbal tea.
4. Refrain from having heavy meals 2–3 hours before bedtime.
5. Keep the bedroom clean and free of dust.
6. Avoid smoking and vaping.
7. Keep a window slightly open for better airflow.

Over-the-counter options (Australia):

Some over-the-counter treatments may provide temporary symptom relief, depending on the underlying cause.

1. Throat lozenges.
2. Antihistamines (for allergies).
3. Nasal saline sprays.
4. Cough suppressants for temporary relief.

When to see a GP

Seek medical attention if you experience any of the following symptoms:

1. A dry cough that persists for more than 3 weeks.
2. Wheezing, chest tightness, or difficulty breathing.
3. Fever, fatigue, or body aches.
4. A cough that disrupts your sleep regularly.
5. A history of asthma, allergies, or reflux.
6. Coughing after beginning a new medication.

Urgent care (ED or 000) should be sought if you experience:

• Difficulty in breathing.
• Chest pain.
• Coughing up blood.

How doctors diagnose

A GP will evaluate your symptoms and identify underlying factors that may worsen your cough at night. Diagnostic steps may include:

1. Physical examination.
2. Lung function tests (spirometry for asthma).
3. Allergy assessments.
4. Chest X-ray or CT scan.
5. Reflux evaluation.
6. Medication review.

Treatment options

Treatment depends on the underlying cause of your dry cough and may include the following:

For allergies:

• Antihistamines.
• Dust-mite-proof bedding options.
• Avoidance of allergens in the bedroom.

For asthma:

• Inhalers.
• Review of preventer medication.

For postnasal drip:

• Nasal sprays.
• Steam inhalation techniques.

For reflux:

• Acid-reducing medications.
• Avoiding late meals.

For dry air:

• Using a humidifier.
• Ensuring better hydration.

How Hola Health can help

Hola Health offers quick and convenient telehealth services for individuals experiencing persistent dry coughs, particularly at night. You can:

• Connect with an online GP in just a few minutes.
• Obtain prescriptions for asthma, allergy, or reflux treatments.
• Receive medical certificates.
• Access referrals for lung and allergy testing or imaging.
• Review any medications that might be causing your cough.

Conclusion

Night-time dry cough can be frustrating, but it usually improves with simple home measures, trigger control, and the right treatment. If your cough persists, worsens, or disrupts sleep regularly, consulting a doctor ensures proper diagnosis and relief.

FAQs

What causes me to cough only at night?

Factors such as posture, dry air, and underlying issues like reflux or allergies can exacerbate coughing when you're lying down.

Is every nighttime cough a sign of asthma?

No. While asthma is one possible cause, postnasal drip, reflux, and allergies are more frequently responsible.

Can a persistent dry cough indicate COVID?

Yes, a dry cough can be a symptom of COVID, particularly in the early stages.

Does my sleeping position influence my coughing?

Yes. Lying flat can worsen throat irritation and reflux, leading to more coughing.

Should I be concerned if I keep waking up due to my cough?

Yes. Frequent nighttime coughing should be assessed by a GP to rule out asthma, reflux, or other conditions.