Coughing Upon Awakening: Why Does It Happen?

Waking up from your sleep due to coughing is a common occurrence that can be caused by various factors. Nocturnal coughing can be a symptom of an underlying disease or condition affecting the upper airway, lower airway, gastrointestinal system, or cardiovascular system. The most common causes of coughing include upper and lower airway infections, asthma, chronic obstructive pulmonary disease (COPD), and gastroesophageal reflux disease (GERD). Environmental factors such as smoking and exposure to allergens can also contribute to coughing. In addition, certain medications, such as ACE inhibitors, can lead to a frequent, dry cough as a side effect. Understanding the underlying causes and managing the symptoms through various remedies and medical treatments can help alleviate nocturnal coughing and improve sleep quality.

Postnasal drip

• Allergies
• Colds
• Flu
• Sinus infections
• Fumes
• Smoke
• Dust
• Very cold air
• Chronic acid reflux
• Ageing

If you are experiencing postnasal drip, there are a number of treatment options, including home remedies and over-the-counter medications:

• A humidifier or steam inhalation (as during a hot shower)
• A nasal decongestant such as oxymetazoline, which constricts blood vessels in the nasal passages, leading to fewer secretions. These medications should only be taken for a day or two; longer-term use can do more harm than good.
• Antihistamines and decongestants can often help with post-nasal drip caused by sinusitis and viral infections. They can also be effective, along with steroid nasal sprays, for post-nasal drip caused by allergies.
• Antacids like calcium (Tums) or aluminum (Alka-Seltzer) can reduce the amount of acid in your stomach if chronic acid reflux is the cause of your post-nasal drip.
• Drink more water and avoid caffeine, alcohol, and diuretics to thin out secretions.
• Sleep with your head slightly elevated to help keep the mucus from pooling at the back of your throat.

Gastroesophageal reflux disease (GERD)

GERD can cause a dry cough that may or may not be accompanied by a burning feeling in the chest and middle abdomen (heartburn) or pain in the chest. People with GERD may also experience belching, wheezing, and difficulty swallowing.

GERD can be difficult to diagnose in people who have a chronic cough but no heartburn symptoms. An upper endoscopy or oesophageal pH monitoring are effective tests for diagnosing GERD in people with chronic cough.

If you are experiencing a chronic cough, it is important to speak to a healthcare professional. They can help develop a treatment plan that's right for you.

There are some measures you can take to improve your symptoms, such as:

• Raising your head when sleeping
• Using a wedge pillow
• Sleeping on your left side
• Taking over-the-counter medications
• Losing weight
• Practising diaphragmatic breathing exercises
• Avoiding eating a few hours before bedtime
• Avoiding trigger foods

Asthma

Nocturnal asthma, or nighttime asthma, is a common condition where individuals experience asthma symptoms while sleeping, disrupting their sleep and making it challenging to manage the condition. Nocturnal asthma can vary in severity, ranging from mild to severe. It is estimated that up to 60% of asthma patients may experience nocturnal asthma, with 75% of them waking up from nighttime symptoms at least once a week.

The exact mechanisms behind nocturnal asthma are not fully understood, but several factors are believed to contribute to the worsening of asthma symptoms at night. One factor is the decrease in epinephrine levels during sleep, which help keep the airways relaxed and suppress the release of substances like histamines that cause mucus secretion and bronchospasm. Lower epinephrine levels during sleep may increase the likelihood of nocturnal asthma.

Additionally, the cooling of the airways at night, exposure to allergens, and hormonal changes following a circadian pattern can also trigger nocturnal asthma. Normal hormonal changes in the evening, such as fluctuations in epinephrine, cortisol, and melatonin, may contribute to inflammation in the airways, increasing the risk of nocturnal asthma.

Other factors that can worsen nocturnal asthma include gastroesophageal reflux, obesity, and obstructive sleep apnea (OSA). OSA is particularly common in people with asthma and involves interruptions in breathing throughout the night due to partial or complete upper airway collapse. Undiagnosed or uncontrolled OSA can exacerbate nighttime asthma.

If you suspect you have nocturnal asthma, it is important to consult a healthcare professional for a proper diagnosis and effective treatment. Daily asthma medications, such as inhaled steroids, can help reduce inflammation and prevent nocturnal symptoms. Maintaining a healthy weight, avoiding smoking, and eating a balanced diet can also help manage asthma and reduce the severity of nocturnal symptoms.

Allergies

If you are waking up from your sleep coughing, it could be due to postnasal drip. When you are upright during the day, nasal secretions drain with the help of gravity. However, when you lie down, mucus can collect at the back of your throat, triggering a cough that wakes you up. Sleeping with your mouth open can also lead to dryness, making coughing more likely. Allergens such as pollen, dust mites, and pet dander can be present in your bedding, aggravating your allergies and causing coughing.

To alleviate allergy symptoms and improve your sleep, you can try the following:

• Take an antihistamine before bed.
• Use a HEPA air purifier in your bedroom to reduce allergens in the air.
• Keep your head elevated while sleeping to help with postnasal drip.
• Ensure your bedding is clean and allergen-free. Wash your bedding regularly to minimise exposure to dust mites and pollen.
• Take a shower before bed to remove accumulated allergens from your body and hair.
• Avoid heavy drapes and upholstered furniture in the bedroom, as they can collect allergens.
• Do not sleep with your pets, and bathe them regularly to reduce allergens in the home.
• If over-the-counter medications are ineffective, consult a doctor about prescription medications and allergy testing.

Medication side effects

Some medications known to cause coughing include ACE inhibitors, beta-blockers, and non-steroidal anti-inflammatory drugs (NSAIDs). ACE inhibitors, such as lisinopril (Prinivil, Zestril) or enalapril (Vasotec), are used to treat high blood pressure and heart disease and are known to cause a frequent, dry cough as a side effect. If you are taking any of these medications and are experiencing a persistent cough, consult your doctor, who may be able to prescribe an alternative.

A persistent cough can also be a symptom of an underlying condition, such as heart failure, sleep apnea, or a respiratory virus, so it is important to seek medical advice if a cough lasts more than a few weeks or is accompanied by other symptoms such as wheezing, shortness of breath, coughing up blood, high fever, body aches, or difficulty swallowing.

In the meantime, there are several strategies you can try to reduce coughing at night, including:

• Sleeping with your head elevated on a wedge pillow to help you swallow secretions better and prevent acid reflux.
• Using a room humidifier, especially in dry winter months, to break up and thin out secretions.
• Staying upright after eating and waiting a few hours before lying down to prevent acid reflux.
• Sucking on cough drops or lozenges to calm an irritated throat and block the cough reflex.
• Drinking lemon with honey before bed to soothe the throat and reduce irritation. Honey has antibacterial and antiviral properties and can help fight off the bacteria causing your illness.
• Taking a steamy shower before bed to open your airways and loosen up secretions.
• Reducing allergens in your home by cleaning and dusting regularly, investing in a HEPA filter, and washing your bedding frequently.

Frequently asked questions