Sore Throat Only at Night: Meaning & Treatment

A sore throat is a common experience. Many people have this symptom primarily at night or upon waking. Sometimes, a sore throat that occurs mainly at night could indicate an infection, which may lead to additional symptoms. While it's rare, if the sore throat is accompanied by difficulty swallowing or breathing, it is advisable to consult a medical professional.

Is it normal to have a sore throat at night only?

A sore throat can sometimes occur only at night. Many people experience this discomfort after a long day at work, following strenuous exercise, or for other temporary reasons that are typically not alarming. The good news is that most nighttime sore throats resolve quickly.

Causes of a sore throat only at night

Nighttime sore throats can have various causes. Some issues can be quickly resolved by making environmental changes, while others may require adjustments to diet and exercise. The following are some possible causes of a nighttime sore throat.

Fatigue

Many of us will experience nighttime sore throats if we have had a lot of activity during the day. There are several reasons for this sore feeling, which may be accompanied by hoarseness, including:

• Dehydration, the after-effects of strenuous exercise, or mouth breathing may all cause a sore throat at night.
• Eating spicy foods or drinking alcohol may fatigue the muscles of the throat, potentially leading to a sore throat.
• Muscle strain is a common fatigue-related cause of sore throat. Excessive use of our voice—through talking, singing, or shouting—can lead to strain. Overuse of our jaw muscles can occur from eating, swallowing, yawning, or coughing, also leading to muscle strain.

Allergies and environmental allergens

Environmental irritants such as dust, pollen, and chemicals can lead to a sore throat at night, regardless of whether you have allergies or are exposed to them in significant amounts. If you have environmental allergies, you will likely experience sore throats at night due to nasal congestion and postnasal drip.

Snoring, sleep disturbance, and sleep apnea

Snoring occurs due to vibrations in the nose and throat while a person is asleep. It doesn't always indicate a medical condition. The most common causes of snoring include:

• Nasal congestion or obstruction
• Anatomical variations in the mouth or nose
• Alcohol consumption
• Exhaustion

Sleep disturbances refer to various issues affecting your ability to fall asleep, stay asleep, or wake up. One specific type of sleep disturbance is sleep apnea, which can lead not only to a sore throat at night but may also indicate a more serious medical condition.

Gastroesophageal or laryngeal reflux

Gastroesophageal reflux (GERD) is a condition that occurs when stomach acid rises into the esophagus. When the stomach acid rises into the throat, it is called laryngeal reflux. Stomach acid can cause sore throat at night because of the following reasons:

• When we lie down, stomach acid cannot naturally fall back into the stomach
• We swallow less when we are asleep than when we are awake
• Our stomach acid is naturally more concentrated at night when we sleep

Infection

Viruses cause most sore throats that occur at night due to infection. Common examples include the common cold, flu, and COVID-19. The most frequent bacterial infection leading to a sore throat at night is caused by group A Streptococcus, commonly known as strep throat. Strep throat typically requires a doctor's visit and a prescription for antibiotics.

Throat cancer

Fortunately, experiencing a sore throat at night due to throat cancer is quite rare. Most patients typically have additional symptoms alongside a sore throat, such as pain, difficulty swallowing, coughing, trouble breathing, ear pain, a noticeable mass in the neck, and unexplained weight loss. Throat cancer is most commonly found in individuals who smoke cigarettes, chew tobacco, consume alcohol, or have been infected with human papillomavirus (HPV) or Epstein-Barr virus (EBV).

At-home treatment options for a sore throat only at night

Home remedies for a sore throat only at night may vary depending on the cause.

Hydration

Staying well hydrated during the day and avoiding a hot and humid environment while you sleep at night will help diminish your sore throat. Avoid salty foods during the day, especially at bedtime, because they can increase your thirst and worsen your sore throat while you sleep. Sleeping with a glass of water at your bedside and taking sips may alleviate your sore throat at night. Gargling with salt water may help, too.

A good night’s rest

Your sore throat at night can also be avoided if you:

• Get at least 6 hours of sleep
• Avoid drinking alcohol before going to sleep
• Avoid sleeping on your back
• Avoid medicines that make you tired, such as certain antihistamines (diphenhydramine)

Relieve any nasal congestion

When your nose is blocked or congested, or if you have post-nasal drip, you may breathe through your mouth at night while sleeping, which increases the chances of waking up with a sore throat. Possible remedies include:

• Using non-addictive nasal sprays that contain saline or mild steroids
• Use non-sedating antihistamines (loratadine, cetirizine, fexofenadine, or levocetirizine)
• Avoiding sleeping with feather pillows
• Avoid dusty environments
• Keep your windows closed when you sleep if you have plants or trees nearby
• Keep your house well-ventilated and dry to avoid mold or mildew
• Invest in house filtration systems

Throat lozenges or sprays

There are several over-the-counter throat lozenges or sprays that can help relieve your sore throat at night. They may contain phenol or topical pain relievers and do not cure the sore throat, but they can help you fall asleep and stay asleep longer.

Pain relievers

Ibuprofen, Tylenol, or naproxen are good choices for temporarily relieving a sore throat at night. If you are infected with bacteria or a virus, these medicines may also reduce inflammation and alleviate fever. Pain relievers should only be used long-term after consulting with your healthcare provider.

Anti-reflux medicines or antacids

If your sore throat at night is caused by heartburn or stomach acid reflux, it is wise to avoid overeating in the evenings, particularly within two hours of going to bed. Sleeping with your head elevated about six inches with a large pillow will also help, along with wearing loose clothing.

Over-the-counter and prescription medicines may be beneficial as well for sore throat at night, including:

• Antacids (calcium carbonate, sodium bicarbonate, or magnesium trisilicate)
• H2 blockers (cimetidine, nizatidine, or famotidine)
• Proton pump inhibitors (pantoprazole, dexlansoprazole, or rabeprazole)
• Prokinetics (metoclopramide, domperidone, or prucalopride)

When you should see a doctor for a nighttime-only sore throat

While most of us experience a sore throat at night from time to time, there are some instances when it may be necessary for you to seek the advice of your healthcare provider.

You should see a doctor if:

• Your sore throat is accompanied by other symptoms, such as cough, chest congestion, fever, chills, fatigue, or other signs of possible infection
• Your sore throat worsens, and you have difficulty swallowing or breathing
• You have pus in the back of your throat
• Your sore throat does not improve with conservative measures such as rest and hydration
• You notice a lump or mass in your throat or neck

You should go to the emergency room if:

• You are having difficulty breathing or notice unusual sounds while breathing
• You have one-sided throat pain and difficulty opening your mouth
• You have chest pain
• You have a racing heartbeat
• You have abdominal pain
• You are vomiting or coughing up blood or pus

Questions to ask your doctor about a sore throat at night only

• What is likely causing my sore throat at night?
• When can I expect my sore throat at night to improve?
• Is my sore throat at night contagious?
• Can specific tests be done to find out what is causing my sore throat at night?
• What types of self-care are best to improve my sore throat at night?

How a doctor can help treat a nighttime sore throat

Depending on the cause of your sore throat at night, your doctor may prescribe medications to help relieve your symptoms. These medicines often solve the problem of a sore throat at night within a short time.

Antibiotics

Your doctor may determine that you have a bacterial infection based on the signs and symptoms accompanying your sore throat at night. If this is the case, a throat culture may be taken, and the antibiotic prescribed will be chosen based on the most likely organism causing your sore throat.

Antivirals

These medicines can reduce symptoms such as sore throat at night. Treatment is best if begun within 48 hours of the onset of symptoms.

Acid reflux medicines

Many of these medications are available over the counter, but some still require guidance from a physician. Taking these medications may provide long-term relief from a sore throat at night.

Corticosteroids

Corticosteroids, such as prednisone or dexamethasone, should be used with caution. They may be prescribed as a single dose, a tapering dose, or for several days. While these medications can be effective for managing sore throat symptoms at night, they do not lessen the severity or duration of the pain associated with a sore throat.

Frequently asked questions: nighttime sore throat

The following frequently asked questions may help clear up any confusion related to a sore throat at night.

What if you have a sore throat at night only and it’s been happening for weeks?

If your nighttime sore throat lasts for weeks, it may indicate an underlying medical condition that needs attention. Chronic sore throats can have multiple causes, including infections, allergies, acid reflux, exposure to environmental pollutants, and, in rare cases, cancer.

What if you’re experiencing a sore throat at night and you’re pregnant?

Home remedies are often a good choice for pregnant individuals experiencing a sore throat at night. Warm salt water rinses, honey, and throat lozenges can be helpful. However, it's important to consult with your healthcare provider before taking any medications to ensure they are safe during pregnancy.

What if you’re getting a sore throat at night, but have no other symptoms?

If you're experiencing a sore throat at night but have no other symptoms, it's likely due to dry air or the conditions in your sleeping environment. You might also be sensitive to dust, mold, or other allergens. Additionally, overusing your voice during the day or breathing through your mouth can contribute to this issue. If the soreness persists, consult a healthcare professional.

Final Thoughts

Many people experience a sore throat at night. To help alleviate it, consider trying some home remedies. Getting plenty of rest, staying hydrated, and avoiding alcohol or spicy foods can be effective ways to treat a sore throat and prevent it from returning.

General Medicine follows a strict editorial process, including using real experts to write our articles, vetted primary sources, fact-checking, a secondary medical review, and updates as necessary. This article was medically reviewed and fact checked by Dr. Lane Thaut, DO.

Sources

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Ebell, M H, et al. “The rational clinical examination. Does this patient have strep throat?.” JAMA vol. 284,22 (2000): 2912-8. doi:10.1001/jama.284.22.2912, https://pubmed.ncbi.nlm.nih.gov/11147989/.

Bergeson, Keri, et al. “PURLs: corticosteroids for a sore throat?.” The Journal of family practice vol. 62,7 (2013): 372-4, https://pubmed.ncbi.nlm.nih.gov/23957031/.