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Night cough
Last reviewed: 07.06.2024
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A nighttime cough can be caused by a variety of reasons. It is important to note that coughing is a reflex reaction of the body to irritation of the respiratory tract, and it can be a symptom of various conditions.
Causes of the night cough
Here are some possible causes of nighttime coughing:
- Allergies: An allergic reaction to allergens in the air, such as pollens, dust, house pollen, can cause coughing, especially at night when you are indoors and breathing becomes shallower.
- Postnasal Constipation: Postnasal Constipation, caused by mucus running down the back of the throat from the nose, can irritate the throat and cause coughing.
- Acid reflux: Gastroesophageal reflux disease (GERD) or excess stomach acid production can cause acid reflux into the throat and cause coughing, especially when lying down.
- Coughing attacks: Some medical conditions, such as asthma, bronchitis, or chronic obstructive pulmonary disease (COPD), can lead to nighttime coughing attacks.
- Infections: Although fever does not always accompany respiratory tract infections, they can cause coughing, especially in the initial stages.
- Medicines: Some medicines, such as ACE (angiotensin-converting enzyme) inhibitors, can cause coughing in some people.
- Other factors: Other causes such as stressful situations, smoking, polluted air or obstructive sleep apnea syndrome (OSAS) are also possible, especially if heavy snoring is an accompanying symptom.
Nighttime dry cough can be caused by a variety of factors. Here are some of the most common causes of nighttime dry cough:
- Allergies: Reactions to allergens in the air, such as pollen, dust, or pet pollen, can cause irritation of the airways and a dry cough, especially at night.
- Postnasal junction: The release of mucus from the nose that runs down the back of the throat can cause coughing, especially in a horizontal position while sleeping.
- Acid Reflux: Gastroesophageal reflux disease (GERD) is a condition in which stomach acid rises into the esophagus and even into the throat. This can cause irritation and a dry cough, especially when lying down.
- Chronic bronchitis: Chronic inflammation of the bronchi can cause a dry cough that worsens at night.
- Asthma: Some people have asthma with a dry cough, especially at night or early in the morning.
- Respiratory tract infections: Even without a fever, respiratory tract infections can cause a cough. A dry cough may be the initial symptom, which may later be accompanied by other symptoms.
- Medications: Some medications, such as ACE (angiotensin-converting enzyme) inhibitors, can cause dry cough in some patients.
A nighttime cough with fever (fever) can be a sign of a variety of conditions. Some of the possible causes of this cough include:
- Infectious diseases of the upper and lower resp iratorytract: For example, acute respiratory viral infections (ARVI), influenza, bronchitis or pneumonia may be accompanied by cough and fever. These infections may worsen at night due to increased inflammation and coughing fits when lying down.
- Allergies: Allergic cough caused by allergens in the sleeping environment, such as pollen, house pollen mites or mold, can lead to airway inflammation and coughing, as well as fever.
- Asthma: Ast hma attacks may be worse at night and may be accompanied by cough and fever.
- Gastroesophageal reflux disease (GERD): In GERD, acid and food mass from the stomach can rise into the esophagus and airways, causing coughing and irritation. This cough may also occur at night.
- Bronchial asthma: In some people, asthma may get worse at night, which can cause coughing and fever.
- Heart failure: In some cases, heart failure may be manifested by coughing, especially at night, due to fluid buildup in the lungs.
- Other causes: A nighttime cough with fever may also be related to other medical problems or medication side effects.
Symptoms
Here are some of the possible symptoms that may accompany a nighttime cough:
- Shortness of breath: Coughing may be accompanied by a feeling of shortness of breath and difficulty breathing.
- Mucus: Sometimes a cough may be accompanied by excessive mucus production from the nose or throat.
- Pain or discomfort in the throat: The throat may feel irritated or sore due to coughing.
- Wheezing: There may be wheezing sounds during breathing or coughing.
- Sleep problems: A nighttime cough can interfere with normal sleep and lead to insomnia.
- Reflux: If the cough is caused by acid reflux from the stomach, it may be accompanied by a burning sensation in the throat (pyropathy).
- Chest pain: Sometimes coughing can cause pain or pressure in the chest area.
- Symptoms of an underlying condition: If the nighttime cough is associated with an underlying condition such as asthma, bronchitis, or allergies, symptoms characteristic of that condition may also be present.
Diagnostics of the night cough
Diagnosing a nighttime cough involves a series of steps to determine its cause and choose the most effective treatment. Here's how the diagnostic process usually works:
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Collection of medical and medical history:
- Your doctor will start by talking to you about the nature of your cough, its frequency, the symptoms that accompany it, and the duration of your symptoms. It is also important to talk about any co-morbidities and risk factors.
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Physical Examination:
- The doctor will perform a physical exam, including listening to your lungs and heart, to assess for signs of inflammation, obstruction, or other abnormalities.
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Laboratory studies:
- Based on the symptoms and the result of the physical exam, the doctor can decide whether laboratory tests, such as blood tests, are needed to detect inflammation or infection.
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Instrumental studies:
- Depending on the clinical picture, the doctor may prescribe various instrumental tests such as chest X-ray, computed tomography (CT) scan, bronchoscopy or spirometry (measuring the volume and rate of breathing).
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A study of allergic factors:
- If it is suspected that the cough may be related to allergies, your doctor may recommend allergy tests to identify allergens that may be causing the reaction.
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Monitoring:
- Your doctor may suggest keeping a cough diary in which you record the dates and times of the cough, its pattern and associated events. This can help in identifying patterns and causes.
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Counseling and additional research:
- If necessary, your doctor may refer you to a specialist such as an allergist, pulmonologist, or gastroenterologist for a more detailed evaluation and additional tests.
Treatment of the night cough
Treatment of nighttime cough depends on the cause of the cough. Before starting treatment, it is important to determine what is causing the cough, as different causes require different treatment approaches. Below are some general guidelines for treating a nighttime cough:
Air humidity
The level of humidity in the air can affect nighttime coughing and overall respiratory health. Here's how air humidity can affect nighttime coughing:
- Low humidity: Dry air, especially during winter months or in climates with low humidity, can worsen irritation of the respiratory tract. Low humidity can dry out the mucous membranes of the throat and bronchi, which can cause a dry cough. This is especially noticeable at night when breathing is more shallow.
- High humidity: On the other hand, too much humidity can promote mold growth and compromise air quality, which can also cause coughing, especially in people with allergies or asthma.
- Using a humidifier: If your nighttime cough is caused by low humidity, using a humidifier in your bedroom can help improve your symptoms. A humidifier will help maintain optimal humidity levels and soften the mucous membranes of the airways.
- Soak the air: Ventilating the room regularly and allowing fresh air to circulate can also help improve air quality and reduce respiratory irritation.
- Allergens: Air humidity can affect the spread of allergens such as pollen and house pollen. If your nighttime cough is allergy-related, humidity levels may affect its severity.
Avoid allergens
Avoiding allergens can be an important step in preventing nighttime coughing, especially if your cough is allergy-related. Here are some allergen avoidance tips that may help reduce nighttime coughing:
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Pollen allergens:
- Keep an eye on the pollen allergen forecast and try to stay indoors on days when pollen levels are high.
- Use air conditioners with HEPA filters to clean pollen from the air.
- After walking outside, wash your face and hands to remove pollen and change your clothes.
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House pollen:
- Clean and vacuum your home regularly, including carpets, upholstered furniture and curtains.
- Use a vacuum cleaner with a HEPA filter to catch the smallest dust particles.
- Bedding and mattresses can be wrapped in special allergen-protective covers.
- Avoid soft toys on the bed as they can collect dust.
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Dust mites:
- Wash bedding and pillows in hot water every week.
- If possible, use mattresses and pillows with anti-allergenic coverings.
- Ventilate your mattress and pillows to reduce moisture.
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Pets:
- If you have pets, brush and comb them outside regularly.
- Limit pets' access to your bedroom and places where you sleep.
- Wash animal toys and bedding in hot water.
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Tobacco smoke:
- Avoid smokers and places where people smoke.
- If you have smoking neighbors, make sure your windows are closed at night to prevent smoke from entering your bedroom.
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Fungus and mold:
- Eliminate sources of fungus and mold in your home.
- Keep an eye on the humidity in the room and use moisture deodorizers if necessary.
Permanent access to water
Continuous moisturizing of the mucous membranes of the throat and airways can help soothe nighttime coughs, especially if they are caused by dryness. You can take the following steps to do this:
- Drink enough water: Drink enough water throughout the day to keep your mucous membranes hydrated. But try to limit fluid intake before bedtime to avoid nighttime visits to the toilet.
- Humidify the air in your bedroom: Use a humidifier in your bedroom, especially during low humidity seasons. This will help prevent dry mucous membranes and reduce coughing.
- Towel and hot steam: Before going to bed, you can hold a hot towel by the bathtub with hot water running. Then take the towel out, leaving it damp, and hang it in the bedroom. The steam will moisturize the air.
- Use cough remedies: You can use cough syrups or caramels to help soothe the mucous membranes of the throat and reduce irritation.
- Air purifiers: If your bedroom has allergens or other irritants, install an air purifier to clean the air of particles and allergens.
- Avoid tobacco smoke: If someone in the household smokes, try to avoid exposure to tobacco smoke in the bedroom.
Avoid irritants
Avoiding irritants can help reduce nighttime coughing and relieve symptoms. Here are some irritants that can trigger a cough and how to avoid them:
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Smoke and tobacco smoke:
- Avoid active and passive smoking.
- Make sure your home and bedroom are free of cigarette smoke.
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Polluted air:
- If possible, avoid being in areas with high levels of air pollution, such as industrial areas.
- Use air purifiers with HEPA filters in your bedroom.
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Gases and vapors:
- Avoid exposure to chemical irritants such as hairsprays, perfumes, aerosols and other chemical products.
- Ventilate the room after using chemical products.
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Sawdust and allergens:
- Avoid contact with allergens such as pollen, dust, pet pollen and pollen mites.
- Clean and vacuum your home regularly, using a vacuum cleaner with a HEPA filter.
- Use special allergen-protective covers for bedding and mattresses.
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Postnasal articulation:
- If you have postnasal articulation (mucus runs down the back of your throat), rinse your nose regularly with saline or use nasal sprays in consultation with your doctor.
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Acid reflux:
- If you have gastroesophageal reflux disease (GERD), follow your doctor's diet recommendations and take medication to reduce acid reflux.
- Avoid dinners before bedtime.
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Drug overdose:
- Take medications only as prescribed by your doctor and as directed on the package.
Postnasal syndrome
Postnasal syndrome (PNS) may be one of the causes of nighttime coughing. Postnasal syndrome is characterized by an excessive accumulation of mucus in the back of the nasal cavity and throat, which flows down the back of the throat, causing irritation and coughing. This syndrome may be worse at night when the person is lying horizontally and mucus flows more freely down the back of the throat.
Here are some symptoms of postnasal syndrome that may be associated with nighttime coughing:
- The feeling of a constant accumulation of mucus in the throat.
- Frequent feeling the need to cough up or swallow mucus.
- Irritation in the throat, which can cause coughing.
- May also be accompanied by runny nose, sneezing and occasional feelings of nasal congestion.
The following steps can be taken to manage nighttime cough caused by postnasal syndrome:
- Regular nasal rinsing with saline (isotonic solution) to clear mucus from the nasal passages.
- Using nasal sprays recommended by your doctor to relieve nasal congestion and reduce mucus.
- Ventilate the bedroom and maintain optimal humidity levels to prevent dehydration of the mucous membranes.
- Avoiding irritants and allergens that can exacerbate postnasal syndrome.
- Taking medication prescribed by a doctor if the cough persists and interferes with normal sleep.
Asthma
A nighttime cough can be a symptom of asthma. Asthma is a chronic airway disease characterized by inflammation and obstruction of the bronchi. In some people with asthma, coughing may get worse at night or be a major symptom that interferes with normal sleep.
Why asthma can cause nighttime coughing:
- Temperature fluctuations: During the night, a person is often in warm, cozy surroundings, which can cause the bronchi to dilate and increase inflammation.
- Body position: When a person goes to sleep, the position of the body can contribute to mucus accumulation in the airways and increase obstruction.
- Circadian rhythm: In some cases, asthma has a circadian rhythm in which symptoms worsen at night due to the body's biological rhythms.
- Allergens and irritants: At night, the air may be more polluted and contain more allergens (such as house pollen mites), which can make asthma worse.
Managing nighttime coughing due to asthma includes:
- Following your doctor's recommendations to take medications, including inhalers and controller medications, to control your asthma.
- Avoiding triggers and allergens that can worsen asthma, such as smoking, waterlogged air and house pollen mites.
- Using bedroom humidifiers to maintain optimal humidity levels.
- Treatment of allergies if they are a contributing factor.
- Discussing with your doctor the possibility of using medications to help improve asthma control at night.
GERD
Gastroesophageal reflux disease (GERD) can cause nighttime coughing in some people. This is due to the rise of stomach contents (acid and food particles) into the esophagus, which can irritate the mucous membrane of the throat and cause coughing, especially when you lie in a horizontal position while you sleep.
If you suspect that GERD may be the cause of your nighttime cough, it is recommended that you consult a physician or gastroenterologist for evaluation and diagnosis. Treatment for GERD may include the following steps:
- Treatment with medications: Your doctor may prescribe antacids, proton pump inhibitors (such as omeprazole or esomeprazole), or H2-blockers (such as ramitidine) to decrease acidity in the stomach and reduce reflux.
- Lifestyle modification: It is important to follow lifestyle modification recommendations such as avoiding large meals before bedtime, raising the top of the bed to elevate the head and torso, and avoiding known triggers such as spicy or acidic foods.
- Diet: Certain foods and drinks can increase reflux. It is recommended to reduce consumption of caffeine, chocolate, citrus fruits, fatty and spicy foods.
- Avoiding smoking and alcohol: Smoking and drinking alcohol can worsen GERD and cause coughing.
- Follow yourdoctor's recommendations: Your doctor may suggest additional recommendations and a treatment regimen that will be most appropriate in your case.
Cough medicine
Treatment of a nighttime cough depends on the cause of the cough. It is important to determine exactly what is causing the cough before starting treatment. Listed below are some of the common medicines that can be used to treat a nighttime cough:
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Anti-cough medications:
- Cough medicines can help reduce the frequency and intensity of coughing. They are of two types: those that suppress a dry cough (such as dextromethorphan) and those that improve the expectoration of mucus (such as guaifenesin). The choice of medicine depends on the type of cough.
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Bronchodilators:
- If the cough is caused by bronchial contractions (such as in asthma or bronchitis), your doctor may prescribe bronchodilators to widen the airways and relieve obstruction. These medicines may help improve breathing and reduce nighttime coughing.
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Inhalers:
- If asthma is the cause of your nighttime cough, your doctor may prescribe an inhaler with glucocorticosteroids or other controller medications to reduce bronchial inflammation and prevent asthma symptoms.
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Antihistamines:
- If the cough is caused by allergies, antihistamines can help reduce symptoms and coughing. They may also help with postnasal syndrome.
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Humidifiers:
- Using humidifiers in the bedroom can help reduce airway irritation and soothe dry coughs, especially when humidity is low.
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Treatment of the underlying disease:
- If your nighttime cough is related to an underlying condition such as asthma, bronchitis, or acid reflux, treating that condition may help reduce the cough.
Nighttime cough syrups
There are many nighttime cough syrups that can help reduce coughing and relieve symptoms. However, it is important to remember that the choice of syrup depends on the cause of the cough and the symptoms you are experiencing. Below is a list of common types of nighttime cough syrups and what they do:
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Cough syrups (for dry coughs):
- Dextromethorphan: Reduces irritation of cough center receptors in the brain and reduces dry cough.
- Codeine: May be prescribed by a physician for severe and external coughs. Requires a prescription.
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Cough syrups with expectorant action (for wet coughs):
- Guaifenesin: Helps to thin and improve expectoration of mucus.
- Bromhexine: It has mucolytic and expectorant action.
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Combination syrups: Some syrups combine both cough suppressants and expectorants to treat different types of coughs.
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Syrups with added antihistamines (for allergic coughs):
- Syrups containing antihistamines (such as cetirizine or loratadine) may help with coughs caused by allergies.
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Soothing throat syrups: Some syrups contain ingredients that help reduce throat irritation and relieve itching, which can relieve coughing.
Consultation with a doctor
If your nighttime cough continues for more than two weeks, worsens, or is accompanied by other symptoms, be sure to see your doctor for a more detailed diagnosis and the best treatment.