Cough is a classic accompanying symptom of acute bronchitis associated with a cold . It can get worse, especially when lying down, and can deprive those affected of sleep.
However, if there are no signs of a cold and the cough is mainly noticeable at night or when lying down, it may not be an acute infection, but another illness. Those affected should have a doctor clarify which ones – especially if the nighttime cough lasts longer and/or there are other symptoms.
Nighttime cough without a cold: Common causes
Coughing while lying down can be caused by respiratory diseases. On the other hand, there are possible causes that originate elsewhere in the body. In addition, nighttime coughing can be caused by illnesses that affect the entire body (systemic illnesses).
By far the most common causes of coughing while lying down are:
- bronchial asthma
- Reflux disease
- Increased mucus formation in the throat (Upper Airway Cough Syndrome)
Heart failure can – along with numerous other illnesses – trigger a cough when lying down. You can find out more about the common causes of nighttime coughs without a cold in the following chapters.
Coughing at night due to asthma
Most people associate asthma primarily with shortness of breath . However, some affected people, including children and adolescents in particular, suffer predominantly from coughing.
Experts then speak of “cough-variant asthma” – asthma that is primarily noticeable through a persistent (chronic), dry cough. The symptoms often get worse at night.
Since classic asthma symptoms such as shortness of breath or wheezing are usually absent in this type of asthma and lung function is normal, it often takes a long time for sufferers to receive the correct diagnosis.
Over time, the cough turns into classic asthma in every third person. However, this can be prevented in many cases with early treatment.
Nocturnal cough due to reflux
Coughing at night can be caused by reflux disease . Gastric juice keeps getting into the esophagus.
The sphincter at the junction between the esophagus and stomach normally ensures that food mixed with gastric juice does not flow back into the esophagus. The fact that this does happen occasionally – for example after a heavy meal – is usually not a cause for concern.
However, if the closing mechanism is permanently impaired, large amounts of stomach contents flow repeatedly into the esophagus. This can lead to more severe and/or persistent symptoms. Experts speak of reflux or gastroesophageal reflux disease, or GERD for short.
Those affected then particularly suffer from frequent or severe heartburn and belching. Difficulty swallowing, a feeling of fullness , a burning sensation in the throat, or an unpleasant taste in the mouth may also occur.
But coughing is also a possible symptom. It occurs when gastric juice irritates the vagus nerve, which runs along the esophagus, or when gastric juice reaches the trachea. Since the contents of the stomach can flow particularly easily into the esophagus when lying down, the cough often gets worse at night. Those affected then notice an unpleasant dry cough. Some sufferers are also hoarse or have a thick voice.
If you have a nighttime cough caused by reflux, changing your lifestyle may be helpful – for example, by giving up smoking, drinking less alcohol or losing excess weight. There are also medications that inhibit the formation of gastric juice. In some cases, surgery may make sense.
Nocturnal cough due to Upper Airway Cough Syndrome
Certain upper respiratory diseases can cause a chronic cough that gets worse when lying down. The cough is then associated with excessive mucus production.
The nose and paranasal sinuses are lined with a mucous membrane that constantly produces mucus. In this way, the respiratory tract stays moist and foreign substances such as pathogens collect in the mucus. Most of the mucus goes from the back of the nose into the throat and is swallowed almost unnoticed.
However, if excessive or very thick mucus forms due to an illness, this can lead to symptoms. Then some mucus keeps flowing into the throat and building up there. In this context, experts speak of postnasal drip syndrome (PNDS) or upper airway cough syndrome (UACS).
Since the mucus drips particularly easily into the throat when lying down, those affected usually have problems with coughing at night because the mucus then irritates the respiratory tract. In addition, many sufferers feel that there is increased mucus in the throat and often have to clear their throat. Other possible symptoms include a feeling of lumpiness in the throat, sore throat , hoarseness, a stuffy nose or repeated runny nose.
Upper Airway Cough Syndrome is not a disease, but a symptom. Common triggers include infections such as flu , allergic rhinitis , sinusitis , polyps in the nose or a deviated nasal septum. If the nighttime cough is caused by upper airway cough syndrome, the cause must be treated accordingly.
Coughing at night due to heart failure
Coughing at night can be a sign of heart failure, especially in older people. The heart’s pumping power becomes weaker – usually gradually, rarely suddenly. As a result, tissues and organs are less supplied with blood and oxygen. Fluid accumulation can also form in or near the lungs.
Signs of heart failure include rapid exhaustion, shortness of breath, feeling weak and water retention – for example in the legs or ankles. Frequent urination at night can also indicate this.
Depending on which chamber of the heart is particularly affected, experts differentiate between left and right heart failure. As part of left heart failure, those affected can develop a dry cough, which is also known as cardiac cough and occurs more frequently when lying down.
Coughing at night without a cold: Other causes
Chronic cough, which mainly occurs at night or when lying down, can have numerous other causes, for example:
- Smoking, because the harmful substances it contains can irritate the respiratory tract
- certain medications, such as antihypertensive agents such as ACE inhibitors or beta blockers
- chronic obstructive pulmonary disease (COPD)
- pathological expansion of the bronchi in the lungs (bronchiectasis)
- Cystic fibrosis, an inborn error of metabolism
- Tumors in the lungs
- Sarcoidosis, a rare inflammatory disease that can affect the entire body
- chronic enlargement of the pharyngeal tonsils
- Sleep apnea
- Throat problems
- Foreign bodies in the respiratory tract
- a narrowing of the mitral valves in the heart (mitral stenosis)
- a pulmonary infarction in which lung tissue dies
- psychologically induced cough
An infection with the coronavirus can also lead to a long-lasting cough that worsens at night.
Chronic nocturnal coughs without a cold are particularly often caused by bronchial asthma, reflux disease or excessive mucus production in the throat. There are also numerous other possible causes. If symptoms persist or worsen, it is important to see a doctor.