How to sleep when you have a cough

Experts reveal the most common types of cough and the remedies to fix them so you can get a restful night’s sleep

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Night-time coughing can wreck your sleep pattern and lead to lethargy and fatigue the next morning. Millions of us self-medicate for coughs, with the market for cough, cold and sore throat remedies worth £583 million in 2023.
Yet while coughs are great sleep disruptors, they also provide a protective reflex.
“Coughing is essentially a reflex designed to protect our airways and prevent the aspiration of foreign bodies into the lungs,” says Dr Adrian Draper, a consultant chest physician at HCA’s London Bridge Hospital.
“Coughing also helps you clear secretions, we each make about a litre to a litre and a half of these every day in the body and we swallow these subconsciously.
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Sometimes called productive coughs – these are the type where you bring up phlegm that is blocking or irritating your airways. Phlegm can build up at the back of your throat when you lie down in bed and trigger coughing at night.
“The most common cause of this is an upper respiratory tract infection such as colds or flu,” says Dr Draper. “This is a sign of inflammation in your airways, and your body is trying to shift the mucus by coughing.
“Most of these types of coughs will go away within three weeks, but if your cough persists and you are bringing up green phlegm you may need to see a health professional and may need antibiotics prescribed to treat the underlying infections.”
Dr Aimee Brame, a consultant physician at the private HCA London Bridge Hospital and the NHS Royal Brompton Hospital, says wet coughs can also be caused by chronic lung conditions such as chronic bronchitis (prolonged inflammation of the airways) or cystic fibrosis, a hereditary condition that causes the build-up of additional mucus.
“A solid evidence base on how best to treat a wet cough is sadly lacking,” says Dr Draper. But anecdotally some people do find some of the following tips helpful.
A review of 14 studies by the University of Oxford, published in The BMJ, concluded honey to be superior to usual care for upper respiratory tract infections. Honey may also be useful for preventing antimicrobial resistance. Lemons contain vitamin C, important for the immune system.
“Again there isn’t research evidence to say inhaling steam helps a cough, but some patients do swear by it. You can get the same effects as a humidifier from taking a hot bath or shower and letting the steam fill the room,” says Dr Draper.
The NHS recommends people try pelargonium as a remedy, saying it may help with coughs, although the research evidence on this is limited. Not suitable for children under 12.
“Menthol opens the airways and may reduce coughs,” says Dr Draper.
“There’s not much evidence that over-the-counter cough medicines help with coughs, but the placebo effect may make a difference,” says Dr Draper. Look for medicines that contain the expectorant guaifenesin, which thins mucus so you more easily cough it up during the day, although evidence is mixed on this.
“Any cough that persists longer than three weeks may benefit from a prescription medicine such as antibiotics or steroids, or need further investigations to find out the underlying cause,” says Dr Draper.
Also known as an unproductive cough as it doesn’t produce mucus, dry coughs can have a number of causes including hypersensitivity of nerves in the airway after an infection (known as post-infection cough), asthma, allergies, acid reflux (where stomach acid comes up and irritates the throat), smoking and whooping cough.
“The most common type of dry cough at the moment is the post-viral or post-infection cough,” says Dr Brame.
A number of prescribed drugs, such as ACE inhibitors used to treat blood pressure, can also produce a dry cough starting at some point in the year after beginning a course, see your doctor if this happens when you change to a different blood pressure drug.
“If you can identify what triggers your coughing – be it foods, chemicals or perfumes, smoking, or allergens such as dust mites or pets – avoid them where possible,” says Dr Draper.
“This may help with a cough caused by acid reflux by stopping stomach acid rising up to the throat,”says Dr Brame.
…if your cough is caused by a worsening of your asthma. “You may need to see your doctor to get your asthma medicine reviewed if you have asthma and your symptoms have worsened,” says Dr Brame.
This works by forming a protective layer on top of the food in your stomach and neutralising stomach acid.
It’s a weak opiate that lessens the cough reflex. It might not stop your cough but you should cough less often.
“In medical terms, there’s technically no such thing as a tickly cough, but that’s how many patients describe the sensation of a type of cough, which causes a feeling of irritation at the upper part of the throat,” says Dr Draper.
“One cause may be a condition called postnasal drip where mucus drips down into the back of the throat from the nose, causing irritation in the throat.”
Dr Brame adds that “tickly coughs can be either wet or dry. There’s quite a lot of overlap, but tickly coughs affect the upper airways and can be caused by clearing your throat of phlegm, acid reflux and irritation from breathing in chemicals or allergens.”
Tickly coughs can be both wet and dry coughs, so use some of the measures above. Other tips you might want to try:
…plus hay fever medications, for allergies. “These can help keep the nasal mucosa clear and stop postnasal drip,” says Dr Brame.
And change your bedding regularly. “This may help if your cough is caused by house dust mite allergy, which can irritate your throat,” says Dr Draper.
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