Dry cough: what soothes the tickle at night

A dry cough is a reflex from an irritated airway, not phlegm to be cleared. The home plan is to calm the lining, remove what is tickling it at night, and know the signs that mean it is examined rather than soothed.

What is actually happening

After a fever, a cold or a stretch of polluted weather, the lining of the airways stays raw for weeks. Cold air, laughing, a deep breath or lying down triggers a cough even though the infection is long gone. This is the commonest dry cough, and it settles on its own between three and eight weeks.

• It is a tickle behind the upper throat or breastbone, not a chest full of sound.
• It comes in bouts, often two or three sharp ones and then quiet.
• It is worse at the moment of lying down and on waking.

Why nights are the worst hours

• Lying flat lets drip from the nose run to the back of the throat, and the throat coughs at it.
• Bedroom air in winter or under an air conditioner is dry, and a dry lining itches.
• Pillows and mattresses carry dust, which is the classic trigger for a night cough in someone with an allergic nose.
• Acid rising after a late, heavy meal reaches the throat and is felt as a tickle, not as heartburn.

What helps during the day

• Warm fluids in small amounts through the day: water, clear soup, tulsi or ginger water. Warmth soothes the lining; volume alone does not.
• One teaspoon of honey, straight or in warm water, before bed. This is the one home measure with real evidence behind it. Never give honey to a child under one year.
• Steam over a bowl of hot water for five minutes, face at a comfortable distance, eyes closed. Water that is too hot scalds the face and buys nothing.
• A plain salt-water gargle, half a teaspoon of salt in a glass of warm water, two or three times a day.
• Warm milk with a little turmeric at night, if milk suits you. Some people find milk thickens the feeling in the throat; if so, take it as soup instead.
• A ginger chew or a drop of ginger juice in honey for the tickle itself.
• Lozenges or plain hard candy keep the throat wet on a long, dry afternoon.

What fixes the night

• Sleep with the head of the bed raised on two pillows, or a wedge, rather than flat.
• Dust covers on pillow and mattress, and bed linen washed hot once a week.
• A humidifier, or a pot of water on the radiator, if the room air is dry all night.
• Windows shut in the dusty and traffic hours, and the room aired at another time.
• No incense, mosquito coil, aerosol deodorant or strong room freshener in a closed bedroom.
• The last meal two to three hours before lying down, and a smaller one, if the cough arrives with a sour taste or a burning chest.

What makes it worse

• Smoking, and sitting in someone else's smoke. This is the largest single cause of a cough that never leaves.
• Talking over a cough, and whispering, both of which strain the same irritated lining.
• Cold air straight into the face without a scarf or mask over the mouth.
• Cough suppressants bought for a night, when the real cause is nasal drip or acid. Suppressing the reflex while the drip continues simply moves the cough to morning.
• An antibiotic started for a viral tickle. It does nothing to it and costs the gut its bacteria.
• Air fresheners, room fresheners and dusting a dry room with a cloth.

Three causes that need their own plan

• Post-nasal drip from an allergic or inflamed nose: sneezing in the morning, an itchy nose and eyes, a blocked head, and a cough that is worst on waking. The nose is treated, not the throat.
• Acid: heartburn, sour taste, a hoarse morning voice, cough after meals and on lying flat. The reflux routine is what settles this cough.
• A medicine: some blood pressure tablets cause a dry, persistent tickle in a noticeable number of people. If the cough began after a new tablet, that is the first thing to ask about, and the answer is a different tablet, not a syrup.

How long before it is examined

• A post-viral tickle that is easing, even slowly, over three to eight weeks needs patience rather than tests.
• A cough that has not changed at all after three weeks, or has gone past eight weeks, is examined.
• Anything that keeps waking you, or that stops you working, is worth being seen for, whatever the calendar says.

Be seen without waiting if

• There is blood in the cough, even a streak.
• Fever returns after the cough began, or fever runs with night sweats and weight loss.
• Breathlessness, chest pain, or a wheeze you have not had before.
• The cough comes in uncontrollable bouts with a gasping sound after, or with vomiting.
• It is a young child or an infant, especially with fast breathing or a poor feed.
• There was contact with someone being treated for tuberculosis, or the cough has run past two weeks with fever and weight loss.
• A long-term smoker notices the cough has changed in character.
• There is swelling in one leg, or the cough began suddenly after a new medicine.

In a free video consultation an Aksa physician sorts the tickle from the causes above, asks about the nose, the acid and the medicines, and tells you plainly which one of them your night cough belongs to.

Every individual is different. This page is general education, not a prescription for you, and it cannot replace an examination.