From the Guidelines
For a cough that worsens when lying down, I strongly recommend elevating your head and upper body with extra pillows or a wedge pillow when sleeping, as this position helps prevent postnasal drip and acid reflux, which are common causes of nighttime coughing. This approach is supported by the most recent and highest quality study available, which emphasizes the importance of managing symptoms in patients with cough, including those with COVID-19 1.
Key Recommendations
- Try taking an over-the-counter cough suppressant containing dextromethorphan (such as Robitussin DM) about 30 minutes before bedtime, following the package dosing instructions, as suggested by expert opinion in the management of cough 1.
- For mucus-producing coughs, guaifenesin (Mucinex) can help thin secretions, although the evidence for its effectiveness is based on expert opinion and low-level evidence 1.
- A teaspoon of honey in warm tea or water may also soothe throat irritation and suppress coughing, as suggested by general medical knowledge and expert opinion.
- Running a humidifier in your bedroom adds moisture to the air, which can reduce coughing triggered by dry airways, a common issue in patients with cough 1.
- Avoid eating large meals or drinking alcohol within 2-3 hours of bedtime to prevent acid reflux, which can exacerbate coughing, especially in patients with GERD or other gastrointestinal conditions 1.
When to Seek Medical Attention
If your cough persists beyond 2-3 weeks, worsens significantly, or is accompanied by fever, chest pain, or difficulty breathing, you should see a doctor as it may indicate a condition requiring medical treatment such as asthma, GERD, or a respiratory infection 1. In such cases, a thorough medical history and physical examination are crucial to determine the underlying cause of the cough and guide further management, as emphasized in the ACCP evidence-based clinical practice guidelines 1.
From the Research
Cough Worsening When Lying Down (Orthopnea)
- A cough that worsens when lying down can be related to gastroesophageal reflux disease (GERD) or laryngopharyngeal reflux disease (LPRD) 2, 3
- Elevating the head of the bed by 6 inches can help reduce symptoms of GERD and LPRD, which may contribute to a cough that worsens when lying down 3
- Sleeping on the left side with the head and torso elevated can also help reduce recumbent esophageal acid exposure, which may alleviate cough symptoms 2
- In some cases, a cough that worsens when lying down may be related to other conditions such as upper airway cough syndrome, asthma, or nonasthmatic eosinophilic bronchitis 4, 5
- Evaluation and treatment of the underlying cause of the cough is essential to manage symptoms effectively 4, 6, 5
Management of Cough
- The history and physical examination are the basis of diagnostic evaluation for cough 6
- Empiric treatment should be initiated based on the suspected underlying cause of the cough 4, 5
- In some cases, treatment with antitussive or expectorant drugs, phytotherapeutic agents, or antibiotics may be considered, although the evidence for their efficacy is limited 6
- Alternative treatments such as gabapentin, pregabalin, or low-dose morphine may be effective in reducing cough symptoms in some patients 5