Medically reviewed guide · Last updated: 1 September 2026 · Reading time: approx. 10 min

Dry Cough at Night: Asthma, Reflux, ACE Inhibitors or Postnasal Drip?

The most common causes compared

The causes in detail

This article covers a narrow pattern: a dry, tickly cough that mainly occurs at night or wakes you from sleep. Coughs with colds, coughs that bring up phlegm and the general classification by duration can be found in the article on coughs. Coughing fits that go on for weeks, to the point of retching, are described in the article on whooping cough, and a constant urge to clear your throat in the article on frequent throat clearing. For orientation: a cough lasting up to three weeks is considered acute, up to eight weeks subacute, and beyond that chronic. In deep sleep the cough reflex is dampened — so a cough that regularly wakes you deserves attention.

Asthma: the cough of the early hours

The airways follow a daily rhythm and are at their narrowest in the second half of the night. In asthma, this shows itself as coughing, chest tightness, wheezing or breathlessness, often between midnight and the early morning. Triggers are house dust mites in the mattress and bedding, pet hair, cold air, exertion, laughing, smoke and infections. In cough-variant asthma, a dry cough is actually the only sign — without wheezing and without breathlessness.

Your practice makes the diagnosis with a lung function test before and after using a bronchodilator spray, and with further tests if the result is normal. Treatment is usually based on an inhaled corticosteroid. According to current international recommendations, reliever sprays alone, without a corticosteroid, are no longer considered sufficient for adults. If you cough at night despite having known asthma, it is a sign that it is not adequately controlled: your treatment, how consistently you use it and your technique should all be reviewed — the guide Inhaling correctly can help with this.

Reflux: coughing without heartburn

When you lie down, gravity no longer protects you, and stomach contents rise more easily into the oesophagus. Even small amounts that reach the larynx or irritate nerves in the oesophagus can trigger the cough reflex. Typical is coughing shortly after lying down, after a late, fatty or large meal and after alcohol. Many people affected have no heartburn, but instead have hoarseness in the morning, a sour taste, a constant need to clear their throat or a feeling of a lump in the throat — specialists then speak of silent or laryngopharyngeal reflux. Being overweight and a hiatus hernia make this more likely.

Everyday measures help most: have your last meal two to three hours before going to sleep, raise the head end of the bed by a few centimetres rather than just using more pillows, lie on your left side, lose weight and drink little alcohol in the evening. Acid blockers help mainly when typical reflux symptoms are present. In chronic cough without signs of reflux, studies show hardly any benefit — so taking them long term on suspicion alone makes no sense. More on reflux in the article on heartburn and reflux.

ACE inhibitors: the cough from the tablet box

ACE inhibitors for high blood pressure and heart failure slow the breakdown of messenger substances such as bradykinin, which make the cough reflex more sensitive. In a considerable proportion of the people treated, the result is a dry, tickly cough that is often worse when lying down and at night. It can start a few days, but also months, after treatment begins, which is why the link is easily overlooked. You can recognise these active substances by the ending "-pril", for example ramipril, enalapril or lisinopril. Cough suppressants hardly help against it. Switching to a different ACE inhibitor achieves nothing, because it is a class effect; sartans such as candesartan trigger the cough much less often and are the usual alternative. After switching, the cough usually settles within one to four weeks, occasionally taking up to three months.

Postnasal drip: nasal mucus running down into the throat

If mucus from the nose and sinuses runs down the throat when you lie down, it irritates the larynx. Typical signs are coughing when lying down and in the morning, the feeling of mucus in the throat, constant throat clearing and a blocked nose. Common reasons are allergic rhinitis — with a house dust mite allergy, the bed is the main place — chronic sinusitis and long-term use of decongestant nasal sprays. Treatment targets the nose: saltwater rinses, a corticosteroid nasal spray such as mometasone for allergy or chronic inflammation, and antihistamines for allergy as well.

After an infection: the cough that lingers

After a cold, flu or COVID-19, the airways often remain oversensitive for weeks. The cough is then dry, worse at night, in cold air and when talking, and usually settles by itself within eight weeks. Antibiotics do not help here. If coughing fits to the point of vomiting are added, think of whooping cough, even in adults — if it is recognised early, treatment shortens the period during which you are infectious.

Heart failure: when coughing lying down means breathlessness

If the left ventricle of the heart does not pump strongly enough, fluid builds up in the lungs when you lie down. This shows itself as a dry cough and breathlessness when lying flat, the need to sleep almost sitting up on several pillows, and waking at night short of breath in a way that improves when you sit up or go to an open window. Additional clues are swollen ankles, rapid weight gain and breathlessness when climbing stairs. More in the article on heart failure.

Bedroom, smoke and less common causes

Dry, overheated air, dust, pets in the bed and smoking — including e-cigarettes and second-hand smoke — irritate the airways. Less often, diseases of the lung tissue, sarcoidosis, tuberculosis or a lung tumour are behind it; the clues are then usually warning signs such as weight loss, night sweats or coughing up blood. In children, a barking cough at night with a whistling sound on breathing in is typical of croup. If no cause is found after a thorough assessment, specialists speak of a hypersensitive cough reflex, for which specialised treatment is available.

Self-tests: first clues at home

These observations do not replace a diagnosis, but they help to narrow down the pattern — often several causes are present at the same time.

• The time note: if you cough straight after lying down, that fits better with reflux or postnasal drip. If the cough wakes you in the second half of the night, it fits better with asthma. If you have to sit up to breathe, think of the heart or lungs.
• The medication check: look through your medication plan for active substances ending in "-pril", and compare when you started taking them with when the cough began. Check beta blockers, eye drops and painkillers too.
• The eating test: for two weeks, eat nothing in the three hours before going to sleep, drink no alcohol in the evening and raise the head end of your bed. If it gets much better, reflux is probably involved.
• The nose test: is your nose blocked at night and your throat full of mucus in the morning? If saltwater rinses improve the cough over a week, that points to nasal mucus as the trigger.
• Peak flow measurement: if you have a peak flow meter, blow into it three times each morning and each evening and note down the best value. Marked differences between morning and evening are a sign of asthma.
• The cough diary: for two weeks, note down the nights you cough, triggers, phlegm, fever, medicines and mealtimes. This is the best basis for the conversation at your practice.

Warning signs: when not to wait

• Breathlessness at rest, bluish lips, only being able to speak in short sentences
• Waking at night short of breath in a way that improves when you sit up, together with swollen legs
• Swelling of the lips, tongue or throat, especially while taking ACE inhibitors
• Blood when coughing, a high fever or pain when breathing
• A cough lasting more than eight weeks, unintended weight loss, night sweats, or a new or changed cough in people who smoke
• In children: a barking cough with a whistling sound when breathing in at rest, or visible breathlessness
• A sudden coughing fit after choking on something, especially in young children

The treatment pathway: step by step

1. Sleeping environment and evenings. Air the room, do not overheat it, sleep smoke-free, raise the head end of the bed and avoid late meals. A teaspoon of honey before going to sleep can ease the urge to cough — but not for babies under one year old.
2. Have your medication list reviewed. If an ACE inhibitor cough is suspected, your practice can switch you to a sartan. Do not stop the blood pressure medicine on your own initiative.
3. Assessment at the GP practice. A conversation, listening to the chest, a look into the nose and throat; for a cough lasting more than eight weeks, a chest X-ray and lung function test.
4. Targeted trial treatment. Depending on what is suspected, an inhaled corticosteroid, a nasal spray or, with typical reflux symptoms, an acid blocker for a limited time. If the cough responds, that often confirms the cause.
5. Specialist care. A lung specialist for further lung tests, an ENT practice for the nose and larynx, gastroenterology for a gastroscopy or acid measurement, cardiology if heart failure is suspected. The decision about treatment always lies with the practice treating you.

The medication angle: when the tablet causes the cough

ACE inhibitors: common, harmless but annoying

The ACE inhibitor cough is not dangerous, but it robs many people of sleep and is often treated for months with cough syrups. If you take an active substance ending in "-pril" and have a dry cough at night, raise it with your practice. After switching, the cough needs a few weeks to settle — only then can you judge whether the ACE inhibitor was the cause. Any swelling of the face or throat, on the other hand, is urgent.

Beta blockers, including as eye drops

Non-selective beta blockers such as propranolol can narrow the airways in asthma. This also applies to eye drops containing beta blockers, such as timolol for glaucoma, which reach the bloodstream through the mucous membranes. Cardioselective beta blockers such as bisoprolol or metoprolol are usually better tolerated, but in asthma they should also be used with care.

Painkillers and asthma

In some people with asthma — often together with nasal polyps — acetylsalicylic acid (aspirin) and other anti-inflammatory painkillers such as ibuprofen or diclofenac trigger breathlessness and coughing. If you notice this in yourself, avoid these medicines and have it entered on your medication plan; paracetamol is usually tolerated. Without medical advice, the package leaflet usually says not to take over-the-counter painkillers for longer than three to four days in a row.

Inhalers and rare lung reactions

Inhalers themselves can also briefly trigger coughing, especially dry powder inhalers used with the wrong technique. Corticosteroid sprays such as fluticasone can cause hoarseness and oral thrush — rinse your mouth after using them. Rarely, amiodarone, methotrexate or long-term treatment with nitrofurantoin lead to inflammation of the lung tissue with a dry cough and breathlessness; this should be assessed by a doctor promptly.

Cough suppressants: short-term and targeted

Over-the-counter cough suppressants such as dextromethorphan or pentoxyverine can temporarily dampen a tormenting dry cough at night. They are not intended for asthma or chesty coughs and must not be combined with expectorants such as acetylcysteine, because mucus would otherwise build up. Together with certain antidepressants, dextromethorphan can trigger a dangerous serotonin syndrome. Medicines containing codeine make you drowsy, are not approved for children under twelve and are unsuitable while breastfeeding. According to the package leaflet, cough suppressants are only intended for short-term use; if the cough persists, it should be assessed by a doctor.

How to prevent a dry cough at night

• Eat light and early in the evening — your last meal two to three hours before going to sleep, little alcohol, raise the head end of the bed.
• Take the strain off the bedroom — air it, do not overheat it, keep pets out of the bed and, if you have a dust mite allergy, use mite-proof covers as part of an overall approach.
• Smoke-free — e-cigarettes and second-hand smoke also irritate the airways.
• Stick with asthma treatment — use the corticosteroid spray as planned even on good days, and have your inhaler technique checked regularly.
• Check your vaccinations — STIKO (Germany's Standing Committee on Vaccination) recommends that adults have a whooping cough booster together with their next tetanus-diphtheria vaccination; details in the guide Vaccinations for adults.

Coughing nights and medicines in context — with brite

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