man covers his mouth to cough in bed

How to Sleep When You Have a Cough

Two experts offer tips on getting a good night's sleep, even when you're under the weather

February 27, 2024

Not getting any sleep when you’re sick is the worst. And there's one persistent symptom that keeps many people up at night: coughing.

“It’s hard to sleep when you have a cough because it can prevent you from falling asleep, or it can wake you up,” says Romina Wahab, MD, assistant director of the intensive care unit at NewYork-Prebysterian Allen Hospital and assistant professor of medicine at CUIMC. She treats people who have lung problems, sleep-related breathing problems, and critically ill medical conditions requiring constant attention in the hospital.

Sitting up, extra pillows, comforters rolled into backboards, a spoonful of medicine or honey: how many tricks have you tried to get some sleep when you have a cough? How many worked? If you said zero, you’re not alone.

The best way to sleep when you have a chronic cough is to control the cause when you’re awake. In the case of a cold, which is the most common cause of acute cough, that may be difficult to achieve; however, such cough is transient and usually takes a few days and up to 3 weeks,” says Sanja Jelic, MD, director of Columbia’s Center for Sleep Medicine. She treats people who have sleep problems, especially difficulties breathing while asleep.

To understand cough and help you get the rest you need to get well and stay that way, we asked these two experts to explain. Here’s what they said.

Why do people cough?  

Coughing is a natural reflex. It’s a response to mechanical (touch, particle irritation) or chemical (cold, heat, chemical irritants) stimulus.

A cough involves a quick, usually involuntary, inhalation of air followed by a forceful exhalation of air when the abdominal and rib muscles contract. The purpose of a cough is to clear anything irritating the airways inside your lungs, up to the vocal cords and throat.

Coughs protect your respiratory tract from inhaling foreign bodies and clear excessive bronchial secretion (mucus).

What causes us to cough?

Jelic: The most common causes of cough are upper and lower airway infections, post-infectious cough, asthma, COPD, chronic rhinitis, and gastroesophageal reflux disorder (GERD). Other causes could be certain medications, smoking, heart disease, and other less common conditions.

Why is it hard to sleep when you have a cough?

Jelic: Normally, sensitivity to cough reflex is much decreased during sleep. However, if a person has an acute (up to 3 weeks), subacute (3 to 8 weeks), or chronic (more than eight weeks) daytime cough, it may be difficult to fall asleep or maintain uninterrupted sleep because this natural decrease in cough sensitivity is gone. 

What’s the best way to sleep when you have a cough?

Wahab: If your cough is part of a seasonal respiratory virus, like the common cold, try elevating your head and chest with extra pillows or a wedge. Try laying on your side, not back. These tricks can work because you usually have nasal congestion when coughing. Mucus buildup can drip back into your throat (AKA post-nasal drip) and trigger the cough. Elevating your head or laying on your side may let the mucus drip out instead of back into your throat.  

Jelic: If you have post-nasal drip, using a nasal decongestant for a brief period may help. Do not make this a habit. If you have acid reflux or GERD, treatment specific to these conditions for at least six weeks may help. If you have a chronic lung condition, such as asthma or COPD, it’s best to discuss possible treatments with your healthcare provider.

What’s the most frequent question people ask about coughs?

What treatment works for coughing? 

Wahab: It depends on the cause of the cough.

Commonly, a cough is from a viral respiratory tract infection (AKA a cold). A productive cough—meaning you cough up yellow, white, or green phlegm—clears the lung airways of the mucus. So, coughing the phlegm out removes the irritant from your airways. You want that.

Over-the-counter (OTC) cough medicines can help thin out phlegm and make coughing up the phlegm easier. Other OTC cough suppressants can calm the cough reflex. Warning: They tend to cause drowsiness, so use them at night when you do not need to be alert.

If you have a lot of nose congestion, you might benefit from an OTC nasal decongestant spray.

You might find a throat lozenge or honey soothing if you have a sore or dry throat or cough. It can also calm the cough reflex.

Staying hydrated and keeping the air warm and humidified may also help reduce coughing. Cold and dry air can be a trigger for cough.

What’s the most frequent question people ask about sleep?

Why can’t I sleep?

Jelic: The most common reason someone comes to the sleep center is sleep apnea symptoms, such as snoring and daytime fatigue or sleepiness. If they do not have sleep-disordered breathing, trouble sleeping is usually because of insomnia. I refer these cases to psychologists who specialize in insomnia.

What should everyone know about coughs and sleeping?

Jelic: Acute cough almost always goes away within a few weeks. If the cough persists, or you have a known condition causing chronic cough, you should develop a clear treatment plan with a healthcare provider to minimize it.

Wahab: Besides a common cold, many things can cause coughing that interferes with sleep: medication side effects, gastric acid reflux, asthma, and more. If you have a cough that has not improved after a few weeks, please seek medical evaluation.

Wheezing, shortness of breath, coughing up blood, high fevers, body aches, chills, or difficulty swallowing or keeping own liquids/food are concerning conditions. If you develop any of these, please seek medical attention sooner.