The Medical Consumer's Advocate
A dry cough at night
Q:
Over
the last 3 months or so, I have developed a dry cough,
which occurs only after I fall asleep in the evening. The
pattern seems to be that within 2-3 hours of falling
asleep, I am awakened by my persistent dry cough. The
coughing continues for a few minutes, subsides and I fall
back asleep. Two to 3 hrs later, the sequence recurs. I
have started using a humidifier at night, since it is a
dry cough, and this has reduced the number of incidents
somewhat and perhaps even shortened their duration by a
minute or so, but I am still experiencing at least two a
night and am feeling terribly sleep-deprived. I have no
symptoms during the day, have tried various medications
including Claritin, Sudafed, Contac, Nyquil, Xanax, Tums
(thought maybe it was that reflux thing), and sleeping
sitting up. Other than the Sudafed, which worked a bit
but made it difficult for me to fall asleep, nothing
seems to help.
Over the counter cough medicine
doesn't really work any better than a glass of fruit
juice (e.g., orange juice) to quell the cough. Any
thoughts on what I might try to get rid of this thing?
A: If you've looked at any of the other
questions on my Q & A page, you'll know that I generally
cannot diagnose someone via email; but what I can do is give
you a differential diagnosis, i.e., a list of possibilities.
This is useful in a number of ways, not least of which, it
gives you a list of questions to ask your doctor (how do you
know it isn't A? how do you know it isn't B? etc.) This will
force your doctor to consider several possibilities, and
hopefully he/she will not jump to any conclusions.
Here is my differential diagnosis
for a dry cough at night:
1. Postnasal drainage. If the stuff
is thick enough, you may not be able to cough it up... hence
the DRY cough. The fact that Sudafed helped you a bit
suggests that this is a reasonable possibility, but it pushes
the question up one step: WHY are you having postnasal
drainage? The most common possibilities are chronic sinusitis
and allergic rhinitis.
2. GERD (gastroesophageal reflux
disease). The
timing of your problem (waking within 2 to 3 hours of going
to sleep) suggests that GERD is a possibility. Most people
with GERD do not have classic heartburn symptoms; the damage
is done while you sleep. The failure of Tums to relieve your
symptoms is irrelevant. GERD laughs at Tums.
3. Asthma is a very common cause of
dry cough. This may be occurring in addition to #1 and/or #2
(and may, in fact, be provoked by #1 and/or #2). Not all
asthmatics wheeze; there's such a thing as 'cough variant asthma'. Even if
you are wheezing, you may not be aware of it.
4. Chronic mouth breathing. We were
designed to breathe through our noses, not our mouths. Nasal
breathing warms, filters and humidifies the air we inhale. If
we breath through our mouths, the air is cold and dry, and
tends to be fairly irritating to the throat. Usually, mouth
breathing is a consequence of nasal airway obstruction. If
you have nasal airway obstruction, take a look at my article
on stuffy
noses.
5. Congestive heart failure... but
in this case, you would probably be primarily troubled by air
hunger -- you would wake up gasping for breath. Nevertheless,
congestive heart failure still belongs on this list.
Well, that exhausts my imagination,
and certainly gives you a few things to discuss with your
doctor. I would start with your internist/GP, because he/she
is most suited to ruling out possibilities #3 and #5. With
careful questioning, your doctor should be able to develop an educated guess
(a very educated guess) as to the source of your cough.
NOT COOL is a doctor who talks to
you for five minutes, finds out you have a dry cough, and
immediately writes you a prescription for a cough
suppressant. You need someone who will work with you to
discover the root cause of your problem.
Q: Thank you so much for your response.
I will be calling my internist to follow up; in the
meantime, you have given me much to think about and
prepared me to quickly present to him the kinds of
questions that managed care programs curtail when we have
only those 2-minute doctor visits these days.
A: If you are fed up with your managed care
situation, you should consider changing over to a medical
savings account. Check out this website for more information:
I have no connection with that
website -- I just happen to believe in medical savings
accounts. They make more sense now than ever before.