Why Does My Cold Feel So Much Worse at Night?

As I sit down to write this article, I can’t help but think that the timing is uncanny. I have a super mild cold right now—so mild that, to the casual observer, I probably seem completely healthy. But I must’ve picked up some germ, because I have the classic cold symptoms: My eyes are glassy, my throat is scratchy, I’m a bit sneezy, and my energy’s low. It’s no big deal overall—I’m still able to walk my dog and work from home as usual. It becomes an issue around 10 p.m. though, when I crawl into bed ready for a restful sleep, only to start coughing and sniffling more than I did all day.

About a week ago, I spoke with Dan Pastula, MD, chief of neuroinfectious diseases and global neurology at the University of Colorado School of Medicine and Colorado School of Public Health, for this very assignment about why upper respiratory infection symptoms like a cough, sore throat, and runny nose, tend to ramp up while you’re trying to sleep. Dr. Pastula walked me through all the factors that join forces to make colds feel so much worse at night.

So a few days later, when my own cold set in and I was desperate for a restful sleep but couldn’t stop coughing, I knew exactly what was going on. (Like I said, uncanny timing!) Here’s why your cold becomes such a nightmare after dark.

Why do cold symptoms get worse at night?

Your body fights the virus harder at bedtime.

Many pathogens can cause the common cold: adenoviruses, coronaviruses (yes, beyond the kind that causes COVID-19), and most commonly, rhinoviruses—to name a few.¹ Respiratory syncytial virus (RSV) and even mild flu and COVID infections can also feel quite cold-like. When you get infected with one of these viruses, your body mounts an immune response to fight and kill the bug, which creates inflammation throughout your body and makes you feel crummy, Eric Ascher, DO, a family medicine physician at Northwell Lenox Hill Hospital in New York City, tells SELF.²

The ebb and flow of your symptoms and how they appear during the day versus at night is largely influenced by your circadian rhythm, which is a mix of physiological, mental, and behavioral changes that operate around a 24-hour cycle.³ (Hence why it’s commonly referred to as the body’s internal clock.) In the daytime, your energy goes toward tasks like working, taking care of your family, exercising, or grocery shopping; but at night, when your to-do list is behind you, your body is able to direct way more energy toward powering up your immune system, Dr. Ascher says.⁴

To get more specific, cortisol (your body’s main stress hormone) tends to increase in the daytime.⁵ Higher levels of cortisol are known to quiet your immune system, says Dr. Pastula.⁶ So when cortisol drops off at night, the immune system revs up; and as a result, so does inflammation, he explains.^{7 2} “While this is a normal and necessary process to heal, it also causes your common cold symptoms to feel worse,” Dr. Ascher says.

The fact that you’re lying down also doesn’t help.

Another reason you might cough more and feel extra congested at night: You’re literally horizontal. When you’re sitting upright or walking around, gravity’s at play, pulling your snot down and out of your clogged-up face—which is why you may need a box of tissues within arm’s reach at all times.^{8 9} When you lie flat in bed, though, all of that mucus can collect in your head and exacerbate a cough, stuffy nose, or post-nasal drip (when snot accumulates in the back of your throat). “People will feel worse at night because you’re removing the effect of gravity that was helping you throughout the day,” says Dr. Pastula.

When the lights go out, it’s just you and your cold.

Finally, there are a ton of distractions during the day. You’re likely thinking less about your cold and more about that work project you need to finish by 3 p.m. or when you have to pick your kid up from school, perhaps. Even if you’re taking a sick day, you’re probably reading a comforting novel, watching Netflix, or maybe scrolling for funny memes or reels on Instagram. “But when you lie down to go to bed at night, it’s just you and your symptoms,” Dr. Pastula says. When there’s not much else going on, your watering eyes and intense head pressure become more noticeable—and unbearable.

How to make cold symptoms more tolerable at night

Prioritize hydration—in your body and in the air.

Before you go to bed, sip some water. You become less hydrated overnight, since you’re (hopefully) sleeping and therefore not taking in liquids. If you’re worried about waking up to pee a trillion times (very real!), try to drink enough water throughout the day and just have a few sips before you turn in. Being dehydrated will thicken up your mucus and clog your sinuses, Dr. Pastula explains, so staying hydrated will loosen things up and make it easier to cough up and clear out the snot.¹⁰

It may also help to put a cool-mist humidifier in your bedroom, especially if you’re super congested. It’ll increase the amount of moisture in the air which can help thin out your mucus, as well as soothe your irritated throat or nasal passages, Dr. Pastula adds.^{11 12}

Know that, uh, if you booze, you lose.

Dehydration and poor sleep—two major side effects of drinking alcohol—can impair your immune function and worsen cold symptoms as a result.^{13 14} Drinking “doesn’t allow your immune system to work as strongly to fight the cold, making you feel sick for longer,” says Dr. Ascher.

If you’re hellbent on getting better quickly, it’s best to skip the beer, wine, and liquor for at least a few days until your symptoms clear up. As Dr. Pastula puts it: Alcohol is a toxin, and it takes energy for your body to break it down—energy that could go toward fighting off an infection.

Consider adding peppers and pillows.

Another sick trick: Have something hot and peppery for dinner, Dr. Ascher recommends. Spicy foods, particularly those made with capsaicin (a compound in chili peppers), may decrease inflammation in your sinuses and help you breathe easier.^{15 16 17} (If you’ve ever had wasabi, you may recall your nasal passages opening right up, Dr. Ascher says). That said, if you know hot foods mess with your digestion, this tip isn’t for you—heartburn and acid reflux can also keep you awake.

Propping your head and neck up with an extra pillow at night may also help drain your sinuses, Dr. Pastula says.¹⁸ As mentioned above, when your head is elevated, gravity does its thing and your snot is more free to flow. It doesn’t work for everyone, he adds, but you might as well give it a shot. Who knows—it could be transformative. (It was for me!)

Hit the drugstore.

Finally, Dr. Pastula suggests taking an over-the-counter cold medication if your symptoms won’t give it (or you) a rest. There are a ton to choose from—including cough suppressants, nasal sprays, decongestants, and fever reducers—so it’s best to call or message your primary care doctor, if you can, to see what they suggest. You can also ask the drugstore pharmacist for their recommendations. If you don’t have a primary care provider and you’re feeling particularly rotten—i.e. you have a fever or your symptoms aren’t letting up or are getting worse—talk to a telehealth doctor (which many insurance plans cover and several pharmacies, like CVS, offer) or an urgent care physician.

In my case, just knowing that my cold symptoms were going to flare up at the end of the day, thanks to my chat with Dr. Pastula, made them slightly less bothersome (worrying and wondering if my cough was going to ruin my sleep was part of what was keeping me up at night). In the end: Propping my head up on 5,000 (three) pillows and using my trusty OTC nasal spray was an absolute game changer.

Having a cold is never fun—but hey, at least it’s comforting to know there are some things you can do to make it less miserable, and that you’re most likely going to bounce back in a few days. You can get through a couple of rough nights. That’s what I’m telling myself anyway (as I order spicy Thai coconut soup).

Sources:

1. Merck Manuals, Common Cold
2. Springer Nature, The Host Immune Response in Respiratory Virus Infection: Balancing Virus Clearance and Immunopathology
3. Journal of Molecular Medicine, Interplay Between Circadian Clock and Viral Infection
4. Sleep Science and Practice, Circadian-Based Inflammatory Response—Implications for Respiratory Disease and Treatment
5. StatPearls, Physiology, Cortisol
6. Stress Challenges and Immunity in Space,The Impact of Everyday Stressors on the Immune System and Health
7. Oncotarget, Inflammatory Responses and Inflammation-Associated Diseases in Organs
8. Wiley, The Role of Nasal Congestion as a Defense Against Respiratory Viruses
9. StatPearls, Nocturnal Cough
10. American Thoracic Society, The Relationship of Mucus Concentration (Hydration) to Mucus Osmotic Pressure and Transport in Chronic Bronchitis
11. MedlinePlus Medical Encyclopedia, Humidifiers and health: MedlinePlus Medical Encyclopedia
12. Multidisciplinary Respiratory Medicine, Criteria for Enhancing Mucus Transport: A Systematic Scoping Review
13. Public Health Nutrition, Alcohol Consumption and Sleep Quality: A Community-Based Study
14. Alcohol Research, Alcohol and the Immune System
15. StatPearls, Capsaicin
16. African Health Sciences, Comparative Anti-Inflammatory Properties of Capsaicin and Ethyl-aAcetate Extract of Capsicum Frutescens linn [Solanaceae] in Rats
17. Cochrane Database of Systematic Reviews, Capsaicin for Non‐Allergic Rhinitis
18. Elsevier, Upper Respiratory Infections

Related:

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• Here’s Why a COVID Cough Can Last So Miserably Long
• 3 Things to Do If You Drank Too Much and Feel Like Garbage