Dear Alice,

What can you do to stop a persistent cough so you can sleep?

Dear Reader,

Persistent coughs can be wily buggers, and feeling like you’re about to hack up a lung doesn’t sound like a recipe for clocking in those quality zzzs. In broad strokes, a cough is the body’s response to an irritant, or an attempt to rid the body of that irritant, or to open up blocked airways. The most common causes are relatively benign, and may get better on their own over a few days or weeks (referred to as “acute” coughs), including coughs associated with the common cold or the flu, allergies, and sinusitis. However, a number of less common, but more serious, conditions can also cause coughing, that may be described as chronic (i.e., coughing that lasts longer than three weeks). Depending on the cause, treatment plans can range from DIY (do-it-yourself) to seeking the assistance of a health care provider.

First things first: there are a few things you can do on your own to try to quiet down your cough. Some of the simpler, first-step strategies can be tried out from the comfort of your own bedroom, such as:

  • Keeping the air in your bedroom humid can help with a cough that’s due to dry air irritating the airways.
  • Drinking fluids can help keep mucus thinner and easier to expel when you cough.
  • Speaking of drinking, you might also try sipping warm water with honey or using cough drops may make your throat feel soothed as you fall asleep; the effectiveness of these options has been doubted, but they’re relatively harmless.
  • Propping up your pillows not only curbs the effects of nasal drainage that might be causing a cough, but it can also stop acid from coming back up into your throat and irritating it if you have acid reflux.

If these at-home strategies don’t alleviate your ailment, it may be time to bring in the (medical) professionals. During a visit with a health care provider, s/he will likely take inventory of any other symptoms you have, consult your medical history, and potentially run a test for blood oxygen levels or perform a chest x-ray. There are a number of potential underlying causes of a cough that may warrant extra attention and once the cause has been identified, your provider may advise you to take or do the following:

  • For "productive" coughs, such as those caused by a cold, medications called “expectorants” (such as guaifenesin, potassium iodide, or syrup of ipecac) may help loosen up mucus in the airways so they can be more easily expelled, which might help your cough clear up faster. However, the effectiveness of these medications, too, is inconclusive.
  • For coughs caused by acid reflux (or GERD), medications that block stomach acid production may be useful. Other strategies, such like not eating meals right before bed, used in conjunction with these meds can help protect your throat from irritating acid, especially at night when lying down.
  • For dry coughs caused by asthma or bronchitis, the use of inhaled medications (“inhalers”) may help open airways and to let air flow through freely.
  • For coughs caused by allergies using an antihistamine may be warranted, but only if irritation from allergies is what’s keeping it going into the wee hours. Antihistamines aren’t recommended for productive coughs because they can make the mucus too thick to cough up.
  • For dry coughs not caused by allergies, there are a number of prescription cough suppressants that can used to tame an unruly cough. These medications are thought to calm down the areas of the brain that activate a cough (in the case of opioid- or dextromethorphan-based suppressants) or to numb the lungs (in the case of benzonatate suppressants). The research is inconclusive regarding whether these methods are effective. Another concern is that opioid suppressants can be addictive, and dextromethorphan can lead to dangerous side effects (including the possiblity of coma) if used in excess. Talking with a health care provider about using a suppressant is crucial in order to use it safely.
  • For coughs caused by an infection, such as pneumonia, antibiotics may be necessary; once the infection is gone, the persistent cough will likely disappear, too.

The reality of cough treatments is that there’s no magic bullet: studies have found that the effectiveness of many over-the-counter (OTC) cough medications aren’t any better than a placebo. But, it’s possible that lifestyle modifications or treatment of an underlying cause could do the trick.

While many coughs will go away on their own, a handful of other signs and symptoms (in addition to your cough) may indicate that a visit to your health care provider is warranted. These symptoms include unexpected weight loss, fever for longer than a week, shortness of breath, and certain risk factors for tuberculosis or HIV. It’s strongly recommended that you visit your health care provider if you recently inhaled food or another object or were around a toxic gas. Additionally, coughing up blood or serious breathing difficulty likely indicate that a trip to an emergency room is in order.

Whatever the cause of this nocturnal nuisance, here’s hoping that you’re able to keep that bothersome cough at bay so you can get that peaceful rest you deserve!

Alice!

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