Coughing in the Morning

Coughing is a protective reflex that helps prevent the accidental aspiration of fluids or solids into the lungs or the inhalation of various irritants, from pollen particles to dust to finely ground spices like pepper or paprika, perfume, room fresheners or something else. But what does it mean when you are coughing in the morning only? There are actually quite a few reasons for a morning cough, with or without phlegm. But whatever the cause, if you have been coughing every single morning for some time now, whether it’s one month or 10 years, then it’s best to make an appointment with your doctor.

  • Associated symptoms

If you are coughing in the morning and can’t really put your finger on it, then it helps to be on the lookout for any other symptoms that may accompany your morning cough as they could easily indicate the cause of the cough. A good tip is to write down all of the symptoms you’ve noticed and have your doctor take a look at the list. It can be of great help. Here is what to look for:

Cough in the morning

  1. Are you coughing in the morning only, or also in the evening, at night or in the middle of the night, or during the day as well?
  2. Is your cough dry or productive? Are you expelling mucus or phlegm?
  3. If you are coughing up phlegm, then what color is it? Transparent, thick white, white with gray streaks, yellow, brown, green, pink, red, black?
  4. Is your cough year-round or seasonal? For example, have you been coughing for the past 3 years or just in spring or in the fall?
  5. Do you also experience nasal congestion and mucus or phlegm along with the cough?
  6. Have you noticed any changes to your voice or breathing such as hoarseness or wheezing?
  7. Other symptoms to look out for: sneezing, itchy eyes, itchy ears, throat soreness, tongue soreness, heartburn, bad taste in the mouth, bad breath, pain around the heart, blue fingertips, weight loss?
  • What are the causes?

There can be many causes behind a morning cough, from acid reflux disease to a chronic respiratory system condition. Sometimes it can be nothing, that is, the cough is just helping eliminate mucus that has built up during the night, clearing the airways. In any case, here are some of the most common causes of a morning cough and the symptoms that help you identify what is causing it:

  • Acid reflux disease

If you find yourself coughing in the morning when you wake up, think about what you ate the day before, especially at dinner time. Acid reflux disease or gastroesophageal reflux disease (GERD) is a digestive condition that causes stomach acid to escape the stomach and rise up into the esophagus, causing irritation to the esophagus lining. It occurs when you eat large, heavy meals and lie down or go to sleep before digestion is over. The larger and heavier the meal, the longer the digestion and the more stomach acid is produced. Common trigger foods for acid reflux include fried, fatty foods, spicy and pungent foods such as pepper, turmeric, ginger or garlic, acidic foods such as vinegar or citrus juices, or fermented foods such as yogurt or aged cheeses, and coffee and alcohol. See what foods to eat and to avoid for acid reflux.

If you have also experienced heartburn, a burning sensation in the chest which mimics heart pain, then it’s more likely it’s acid reflux. Other symptoms include bad breath in the morning or waking up with a sour, acidic or metallic taste in the mouth, or increased production of saliva and mucus (in an attempt to counteract the damaging effects of the stomach acids on the esophagus lining, your body compensates by producing more mucus for protection and relief). If it’s acid reflux, you may have also experienced coughing in the evening, especially after eating dinner. Nighttime acid reflux also causes you to wake up in the middle of the night choking and coughing. Find out more about acid reflux at night.

Morning coughing

  • Chronic acid reflux

Chronic acid reflux (GERD) is acid reflux that has been going on for more than 1-3 months, with at least 3 episodes a week. A chronic cough in the morning, meaning a recurrent cough that occurs first thing in the morning when you wake up, is a clear sign of severe acid reflux disease (although it’s not a symptom you would normally associate with the stomach condition). Eating breakfast can help calm the cough, so long as you don’t have strong trigger foods such as coffee or orange juice. Chronic GERD coughing doesn’t occur in the morning only – it manifests at night as well, causing heartburn so strong that it can wake you up from your sleep, or choking followed by a violent cough. If it’s chronic, the condition causes symptoms during the day as well, especially after eating or in the evening, after dinner.

  • Silent acid reflux

Acid reflux can be silent, that is, it might not produce typical symptoms such as heartburn (the burning sensation in the chest, near the heart). For some people, the only symptom of acid reflux is often a dry morning cough. A cough is usually associated with a respiratory infection or something accidentally going down the wrong pipe, not with conditions of the stomach. But coughing in the morning only is actually a common symptom of acid reflux, whether silent or symptomatic.

  • Pollen allergies

Coughing in the morning only, especially in spring or fall when pollen count is at its highest, is indicative of pollen allergies. Pollen allergies tend to act up more in the morning when flowers are opening up for the day. It’s not uncommon for people with pollen allergies to wake up in the morning sneezing or with a dry, but light cough or itchy ears or red, itchy, watery eyes. The cough is a symptom of laryngospasms or bronchospasms and can precede an asthma attack in some cases.

What should you do? If you cough when you first wake up in the morning and it’s because of allergies, sit up and drink some water in small sips (in my experience, sparkling water is better than flat water because it helps wash down allergens better and faster). It may help to wash your face with warm water (splashing cold water on your face right away after waking up may encourage an asthma attack) or turn on the hot water in the shower to fill the bathroom with steam to help you breathe better. If you feel an asthma episode coming on, breathe slowly and make sure you have your essential medication nearby. Take your medication as recommended and seek medical help.

Ragweed pollen is one of the most allergenic and ragweed plants are one of the most prolific pollen producers, two factors that explain the reason why ragweed allergy claims most of the late-summer and fall cases of pollen allergies worldwide. Find out more about ragweed allergy and how to deal with it. But no season is exempt. For example, grasses are probably the most common summertime allergen, especially considering grasses are found on every continent. Find out more about grass pollen allergy and what to do about it.

  • Smoking and related diseases

If you are a smoker and are coughing in the morning, every single day, then it’s likely your morning cough is related to your smoking. The only solution to it is to stop smoking, but that won’t guarantee the cough will go away soon (it might not go away at all, or take years to do so). More than likely, the damage produced up to that point will stay. A smoker’s cough will likely be productive, not dry. Coughing up phlegm that smells bad and is black, red or pink or thick, white with dark grey, black or pink strips, warrants a visit to your doctor’s to assess the damage to your lungs and airways.

Smoking-related diseases, also called COPD (chronic obstructive pulmonary diseases), such as chronic bronchitis and emphysema, often manifest with symptoms such as a chronic cough, often productive, with phlegm that smells bad or is an unusual color (pink, red, brown, black), hoarseness, wheezing, shortness of breath and other breathing difficulties, blue fingertips (a symptom of low oxygenation) or clubbed fingernails.

  • Coughing to eliminate mucus

Sometimes, coughing a little in the morning only is just a sign the body is trying to eliminate mucus that has accumulated during the night in order to clear the airways. It’s a protective reflex, just as it was intended by nature. This is likely a morning cough with phlegm, but the phlegm should look clean (clear, white or a little yellowish) and not smell bad. If you don’t have any risk factors (smoking, air pollution, working in a toxic environment etc.), a little phlegm stuck to the back of the throat every now and then, followed by coughing to eliminate it, is not usually a reason for concern.

This post was updated on Friday / August 14th, 2020 at 8:00 PM