How to stop a night cough with OTC medications and home remedies

If you’ve ever had a respiratory illness, you know this feeling: You lie down in bed, eager to catch some much-needed zzz’s, when suddenly you’re hacking away, tossing and turning, and watching your chance of getting a good night’s sleep fly out the window.

What’s worse, viral infections aren’t even the only reason for nighttime coughs. Everything from upper airway irritations and postnasal drip to acid reflux and other common health conditions can leave you coughing at night instead of snoozing.

Thankfully, there are many easy ways to fight back against nighttime coughing. With an arsenal of over-the-counter medications, environmental changes, and simple at-home cough remedies, you can turn your restless nights into restful (and cough-free!) ones. 

Why am I coughing at night? 

The first step to stopping a nighttime cough is figuring out why you have it, says Apurvi Thekdi, MD, an ear, nose, and throat specialist at Houston Methodist. Since treatments vary for different types of coughs, you need to know the root cause.

Dr. Thekdi says it’s also important to pay attention to the kind of cough you have (wet or dry, sporadic or spastic), any related symptoms (like voice changes or trouble swallowing), and any possible triggers, such as changes to your diet or environment.

If you’re ready to play detective, here are some of the common causes of coughing at night.

Common cold

You’ve got a cold. You’re sneezing and have a runny nose, but thankfully you’re not coughing…until you lie down to sleep. Why do coughs get worse at night when you’re sick? Because lying flat on your back or side to sleep allows the excess mucus from your illness to pool in the back of the throat and in the chest.

Asthma

Dr. Thekdi says certain types of asthma can lead to a chronic cough, which may become worse at night. There is also a kind of asthma called cough-variant asthma, where the only symptom is a cough (i.e., there’s no wheezing, difficulty breathing, or shortness of breath). Over-the-counter cough medicine does not work for this type of asthma. An inhaler is often required.

Postnasal drip

Whether it’s because of seasonal allergies, sinusitis, nasal polyps, or some other viral illness, postnasal drip is one of the biggest culprits of a nighttime cough. All that phlegm has to go somewhere, right? News flash: It’s going down the back of your throat.

Your environment 

Common allergens and irritants—such as dust mites, cigarette smoke, mold spores, pet dander, cockroaches, and pollen—can be enough to trigger a persistent cough every time you snuggle up for sleep. This is one of the primary reasons why you might only experience coughing at night (and not during the day).

GI-related illness 

What does your gastrointestinal system have to do with coughing? A lot, if you suffer from gastroesophageal reflux disease (GERD), also known as acid reflux. When you lie down after eating, the same stomach contents that usually cause heartburn and nausea during the day can reach as far as the back of your throat, setting off a cough reflex (and, sometimes, a sore throat).

Certain medications 

When you’re sick and clogged with mucus, you might take an expectorant to loosen things up. But if you take one too close to bedtime, you could spend half your night coughing up all that thinned-out phlegm. Meanwhile, other medications like beta blockers and ACE inhibitors, list coughing as a potential side effect.

Some serious conditions 

If you’re coughing at night, one of the above reasons is likely to be the cause. That said, there are some serious conditions that could be the source of your cough.

• Influenza. In addition to fever, body aches, and fatigue, the flu can also cause severe respiratory symptoms similar to the common cold. 
• Pertussis, aka whooping cough. This highly contagious bacterial illness is sometimes called the “100-day cough” because of how unrelenting it is. 
• Lung cancer or tumors. A new cough that doesn’t go away is one of the most common symptoms of lung disease like cancers and tumors.
• Bronchitis. An inflammation in the lining of the bronchial tubes is called bronchitis. Acute bronchitis is usually the result of a viral infection; chronic bronchitis may occur in heavy smokers or people with chronic obstructive pulmonary disease (COPD). 
• Pneumonia. When an infection occurs in the air sacs of your lungs, they might fill with fluid that causes a severe cough, chest pain, and trouble breathing. Mostly, pneumonia produces sputum with a cough. 
• Nerve problems. “One less obvious reason for nighttime cough is what we call a “neurogenic cough,” says Dr. Thekdi, “which is one caused by an irritation of the nerves that supply sensation to the larynx.”
• Heart disease. Coughing can be a sign of heart failure, a condition where the pumping function of the heart weakens. 

How to stop coughing at night 

Once you have an idea of where your cough is coming from, it’s time to test out some strategies for soothing it, especially if it’s keeping you awake at night.

Make lifestyle changes

1. Sleep in an elevated position, with your head and neck inclined, so mucus doesn’t pool as easily in your throat or chest. 
2. If dry air is the cause, run a humidifier at night or take a steam bath before bed to moisten your airways. Cold air can also lead to more frequent coughing in people with certain conditions, so keep your bedroom thermostat set around 65 degrees.
3. Adjust your diet. Caffeinated products are dehydrating and may make coughing worse. Caffeine may also worsen a cough related to GERD, as does eating too close to bedtime or eating foods commonly known to contribute to acid reflux (like chocolate or spicy foods). 

Take OTC medications

You have two options for cough medicine here: dextromethorphan (a suppressant) or guaifenesin (an expectorant). 

Expectorants are better for breaking up wet, productive coughs, but don’t take them near bedtime. If a wet cough is plaguing you, take a suppressant that includes a decongestant, which can provide relief without exacerbating your cough. To stop an unproductive or dry cough, stick to cough syrups with dextromethorphan or suck on a menthol cough drop before you fall asleep.

Drug name	dextromethorphan	guaifenesin
Drug class	antitussive	expectorant
Administration route	tablet, spray, lozenge, syrup	liquid or tablet
Dosage	maximum 120 ml in 24 hours (adults and children 12 and older)	maximum 400 mg every 4 hours (adults and children 12 and older)
Common side effects	dizziness, drowsiness, nausea, restlessness, nervousness	diarrhea, dizziness, headache, nausea or vomiting, rash, or hives

Try home remedies for a cough

1. Using a saline nasal spray can relieve postnasal drip and thin out cough-inducing mucus.
2. Staying hydrated also keeps mucus thin and flowing, so drink plenty of water.
3. Drinking a cup of hot herbal tea can hydrate you and loosen some phlegm at the same time. Try peppermint leaves, marshmallow root, or crushed thyme leaves infused in hot water for maximum cough relief.
4. Swallow a spoonful of honey, a cheap and effective natural cough suppressant that can even be used in young children (except babies under two years of age). 

Prescription options

If your nighttime cough isn’t relieved by any of these treatments, it might be time to call your doctor. 

“Generally, after more than three weeks [of a cough], it’s time to investigate it,” says Dr. Thekdi. 

If your cough is caused by GERD, getting your reflux under control could be the key to stopping it. But even if you’re struggling with a cough caused by a persistent viral illness, your doctor may be able to prescribe a medication that relieves your symptoms long enough for you to fully recover. 

Drug name	benzonatate	promethazine/codeine	hydrocodone/homatropine
Drug class	antitussive	antihistamine/analgesic	narcotic antitussive
Administration route	oral tablet	syrup	syrup or tablet
Dosage	maximum 200 mg taken 3 times per day (adults only)	maximum 5 mL every 4-6 hours (adults and children 12 and older)	5 mL or 1 tablet every 4-6 hours (adults only)
Common side effects	dizziness, drowsiness, headache, upset stomach, constipation	dizziness, headache, drowsiness, restlessness	dizziness, drowsiness, lightheadedness, fainting

FYI: Since coughs can be bacterial or viral, an antibiotic may not help you. Your doctor can determine if your cough is caused by a viral illness or an infection requiring antibiotics (for respiratory infections, amoxicillin and augmentin are typically prescribed, among others).