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Over the past few nights, you’ve noticed that your throat has felt a little tender and scratchy —you might even say “sore.” It feels fine during the day, but for some reason, it’s hurting by the time night rolls around. What causes this? Is there anything you can do?
There are a number of conditions that can cause your throat to hurt at night, from talking all day to having a serious infection. Some of these conditions include:
If you’re allergic to something, and you’re exposed to it during the day, your immune system reacts as if your body is being attacked. And often, the allergens are benign substances, such as:
- pet dander
- cigarette smoke
These allergens could cause you to have a sore or scratchy throat during the evening and nighttime hours.
Most of the time, other commonly reported airborne allergy symptoms include:
- itchy eyes
- watery eyes
- runny nose
- postnasal drip
Postnasal drip occurs when you have too much mucus draining from your sinuses into the back of your throat. This drainage can cause your throat to hurt or feel scratchy and raw. Multiple triggers can set off postnasal drip, such as:
- eating spicy foods
- coming in contact with allergens
- changes in the weather
- having a deviated septum
Other symptoms you might experience include:
- foul-smelling breath
- feeling nauseated from drainage moving into your stomach
- feeling like you need to clear your throat or swallow constantly
- coughing that gets worse at night
Dry indoor air
If the air in your home is particularly dry, your nasal passages and throat could dry out during the night, causing you to wake with a scratchy or sore throat.
It’s common for indoor air to be dry during the winter months. Running your heating system during the night dries it out further.
Gastroesophageal reflux disease (GERD)
GERD, also known as acid reflux or heartburn, is a common condition of the digestive tract. In GERD, the sphincter at the bottom of the esophagus is too weak to stay closed as tightly as it should. This causes regurgitation of your stomach acid, which can cause a burning sensation in your chest or the back of your throat. The acid can irritate your throat and make it hurt. It can also damage the tissue in both your throat and esophagus.
GERD tends to be worse right after meals or at bedtime, as lying down flat can encourage reflux. If you’re experiencing a recurring sore throat at night, it’s possible you might have GERD.
Besides sore throat, some common complaints related to GERD include:
- difficulty swallowing
- regurgitating stomach acid or small amounts of stomach contents
- getting a sour taste in your mouth
- heartburn or discomfort in your chest
- burning and irritation in your upper middle stomach
If you’ve been talking excessively (especially over loud noise, like a concert), yelling, singing, or raising your voice for an extended period of time, this could cause you to become hoarse or develop a sore throat by the end of the day.
This means you’ve likely strained the muscles in your throat and need to rest your voice. If you’ve had a busy day packed with talking, particularly if you had to raise your voice often, it’s possible your nighttime sore throat could be caused by muscle strain.
In epiglottitis, the epiglottis, which covers your windpipe, becomes inflamed and swollen. This can be caused by a bacterial or viral infection. When the epiglottis swells, it can cause a life-threatening breathing obstruction. It can also cause a severe sore throat. If you have epiglottitis, you may need emergency medical care.
Some symptoms of epiglottitis include:
- muffled or raspy voice
- noisy and/or harsh breathing
- feeling of breathlessness or being winded
- fever and sweats
- trouble breathing
- trouble swallowing
Viral or bacterial throat infections
An intensely painful sore throat that isn’t relieved by eating or drinking could be caused by a viral or bacterial throat infection. Some of these infections include strep throat, tonsillitis, mono, the flu, or the common cold. Depending on your diagnosis, you might need antiviral medication or a round of antibiotics before you start to feel better.
Some signs of an infected throat can include:
- severe sore throat that interferes with talking, sleeping, or eating
- swollen tonsils
- white patches on the tonsils or in the back of the throat
- appetite loss
- enlarged, painful lymph glands in the neck
- muscle weakness
A sore throat that lasts more than two to three days warrants a trip to your doctor’s office. And there are certain symptoms you shouldn’t ignore. If you’re experiencing a recurrent sore throat with the following symptoms, it’s time to see your doctor:
- blood in your saliva or phlegm
- trouble swallowing
- swelling or pain that interferes with eating, drinking, or sleeping
- sudden high fever over 101˚F (38˚C)
- a lump in your throat that can be felt on the outside of the neck
- red rash on the skin
- trouble opening your mouth
- trouble turning or rotating your head
- trouble breathing
Treating your sore throat at home is your first line of defense against discomfort, and in most cases, you’ll be able to find pain relief.
It can be helpful to:
- gargle with salt water
- sip a little grape juice mixed with a small amount of apple cider vinegar
- suck on hard candies or lozenges
- take over-the-counter pain medication like acetaminophen, naproxen, or ibuprofen
- sip warm tea or water with honey and lemon
- eat chicken noodle soup
- use pain-relieving throat sprays or gargles available over-the-counter
If the air in your home is dry, try running a humidifier at night; this could alleviate drying of your nasal passages and throat overnight. And if you need a little extra help managing allergies, you can purchase allergy medication over the counter or request a prescription from your doctor. If you’ve simply strained your vocal cords, resting them should help.
You may need your doctor to diagnose GERD, if they haven’t already. Medications to reduce and control acid reflux are available both over the counter and by prescription. You can also elevate the head of your bed or prop your head up on pillows or a sleeping wedge to reduce acid regurgitation into your throat during the night.
If a bacterial infection is the cause of your throat pain, your doctor will prescribe an antibiotic. For severe swelling in the tonsils, you may need steroid medication. And in rare cases, you might require hospitalization or surgery to remove chronically infected or dangerously enlarged tonsils.
A sore throat at night that’s caused by allergies, GERD, dry air, or vocal strain, is often easily managed with home remedies and over-the-counter medications. If you’re dealing with an infection, antibiotics, antivirals, or steroids should relieve your symptoms within about a week. If you continue experiencing a sore throat at night, follow up with your doctor.