Symptoms, Causes, and Treatment of a Sore Throat at Night
It can be confusing when you only have problems with a sore throat at night — are you sick, or not?
This article will try to help you understand what is causing your sore throat, as well as how to treat it by seeing your doctor, trying home remedies, or using over-the-counter medication.
Most Likely Causes of a Sore Throat That's Only at Night
Cold, flu, or other viruses
A sore throat is a symptom of many common viral infections. It tends to be worse at night and in the morning
Varies depending on the virus, but can include fever, runny nose, watery eyes, headaches, cough, and fatigue
Rest and time; can treat the symptoms with over-the-counter drugs
Dry air, pollutants, or irritants like smoke or chemicals can irritate the throat
Avoid potential irritants and use a humidifier to increase moisture in the air
Allergies can cause congestion and post-nasal drip, which irritates the throat and can make it feel scratchy
Itchy eyes, runny nose, sneezing, coughing
Breathing through your mouth
Can be caused by chronically stuffed nose
Resolve congestion problem
Speaking loudly or frequently during the day can cause a sore throat at night
Changing speaking habits
GERD (acid reflux)
Chronic condition when acid flows back up into the esophagus and irritates its lining
Hoarseness, burning sensation in chest, dry cough, chest pain, sour taste in mouth
Over-the-counter medications and change of lifestyle habits; serious cases may need medical attention
Strep (unlikely to cause sore throat only at night)
Bacterial infection causing extremely sore throat
Fever, white spots on the throat, loss of appetite
When to Get Help
Before taking a deeper look at each of these possible causes, it's important to know when you might need to seek medical help right away.
You should see a doctor if you're experiencing any of the following symptoms, especially if you've already tried limiting exposure to potential environmental factors or changing your habits:1
- Hoarseness lasting over two weeks
- Frequently recurring sore throats that don't go away with increased moisture or reduced contact with allergens or irritants
- A sore throat that is severe and lasts over one week
- A lump in your neck
- Blood in your saliva or phlegm
- A fever over 101° F (38° C)
- Joint pain
- Difficulty opening your mouth
- Difficulty swallowing
- Difficulty breathing
- For children, look for any signs of drooling and inability to swallow. If the child suffers from compromised breathing, go to the doctor immediately.
Cold, Flu, or Other Viruses
If you're suffering from a sore throat that only happens at night, you may simply be recovering from a mild cold, or possibly a case of the flu.
Cold and flu symptoms are often worse in the morning and at night, shortly before bedtime.2
One possible explanation for the increase in symptoms at night has to do with the body's internal circadian rhythms and its immune function. According to Jason Tetro, a microbiology and health and hygiene expert, the immune system switches functions in the evening, leaving the body to rely on the one that's responsible for inflammation (and your symptoms), while the other one "recharges" and gets ready to fight again in the morning.3
Sore throats resulting from a viral infection should usually go away after five to seven days, though they can last up to ten.1
Since your nose might be congested if you're recovering from a cold or the flu, you may be prone to breathing through your mouth — another factor that can irritate your throat.
Here are some more details about the viral illnesses that may be giving you trouble:
According to HealthLine,4 the common cold is an upper respiratory system infection that creates inflammation in the nose and throat.
Other symptoms include:4
- Runny nose
- Stuffy ears
- Low-grade fever
- Watery eyes
Colds typically resolve on their own within about 10 days with plenty of rest and fluids. You can treat the symptoms with home remedies or over-the-counter medications (see the section on home remedies.)
The flu attacks the throat, nose, and lungs (respiratory system) and usually resolves on its own. However, it can lead to complications that can be deadly when not promptly treated, especially in people with compromised immune systems.
The symptoms for the flu are similar to those of a cold, though generally much more intense. They also have a much quicker onset than the cold.
- Aches and pains
- Runny nose
- Sore throat
Flu symptoms usually last five to seven days and cannot be treated with antibiotics. The best course of treatment is rest, fluids, and over-the-counter medications or home remedies to relieve the symptoms.
The Epstein-Barr virus, or EBV, is the cause of a cluster of symptoms known as mononucleosis. Mononucleosis is the “kissing disease” that you can get at any age, although it is more common in teenagers. It is spread via saliva.
Other symptoms include:6
- Sore throat
- Swollen lymph nodes in the neck and armpits
- Swollen tonsils
- Skin rash
- Soft and swollen spleen
If you're having the above symptoms, and rest and a healthy diet don't cure them within a week or two, you may have mono. You should see your doctor to have it confirmed. However, the prescription for treating it, like with other viral illnesses, is simply rest, fluids, and OTC medications.
You could experience complications with all of these viral infections, so it's important to see your doctor for symptoms that last for over 10 days or symptoms that are severe or seem to be getting worse.
Environmental and Behavioral Factors (i.e. Allergens, Dry Air, and Breathing Through Your Mouth)
If your sore throat is not caused by illness, look closely at your home or work to see if there might be environmental or behavioral factors contributing to your discomfort. Are there pets? Pollutants? Other potential allergens? Dryness? These can all contribute to a sore throat.1
Dry air irritates the throat.7 Many people often wake up with a sore throat in the winter that is relieved by a drink of water. You can increase the amount of moisture in the air by using a humidifier.
Breathing Through Your Mouth
Breathing through your mouth, usually caused by chronic nasal congestion, can also cause a sore throat. It can be solved by identifying the cause of the blocked nasal passages.
Pollutants or Other Irritants Like Smoke or Household Chemicals
Irritants in the air can cause you to have a sore throat, especially if they are present in your home environment. These include cigarette smoke, pollution, or household chemicals.
Drinking alcohol and eating spicy foods can also irritate your throat.
Try to avoid being around smoke and stop smoking, wear a face mask outside or close your windows, and get an air purifier to remove potential irritants from your home environment.
Experiment with removing different elements and see if any of them have an effect on your throat.
Allergies can make you create more mucus, leading to post-nasal drip (which is when mucus drips down the back of your throat). Post-nasal drip is most often the cause of allergy-induced sore throat.8
A sore throat caused by allergies is often described as tickling or scratching. You may also be experiencing coughing, excessive swallowing, throat irritation, and difficulty speaking.
Other allergy symptoms include:
- Itchy eyes
However, if you also have body aches or a fever, you likely have a virus.
Some of the most common allergens include:8
- Cigarette smoke
- Dust mites
- Mold and mildew
- Pet dander (especially from cats and dogs)
You can get tested for allergens by an allergist, and you can also experiment with limiting or removing your exposure to these elements and see if that helps your throat.
The use of your voice during the day can cause you to have a sore throat at night. If you are yelling, talking loudly, or even just talking a lot during the day, you may be straining your voice.1
You may find you have a sore throat especially if you have recently started talking loudly or more frequently on a regular basis.
To treat, make sure to rest your vocal cords and drink plenty of liquids. Keep from clearing your throat frequently or whispering, as these are both irritating to the throat.
GERD (Acid Reflux)
GERD stands for gastroesophageal reflux disease — it is a chronic disease that happens when stomach acid or even the contents of your stomach flows back into your esophagus, which irritates it.9
Acid reflux and heartburn are common conditions that most people experience at some point in their life. If it is an on-going problem, however, and you're experiencing symptoms at least twice a week, the symptoms interfere with your life, or if your doctor can see esophageal damage, then it can be diagnosed as GERD.
- Burning sensation in your chest, sometimes spreading to throat, with a sour taste in your mouth
- Chest pain
- Difficulty swallowing
- Dry cough
- Hoarseness or sore throat
- Regurgitation of food or sour liquid
- Sensation of a lump in your throat
See a doctor if you have frequent or severe GERD symptoms or if you take OTC medications for heartburn more than twice a week.9
To help manage acid reflux and heartburn:9
- Maintain a healthy weight
- Avoid tight-fitting clothing
- Avoid food and drink that trigger heartburn, like alcohol, caffeine, fatty or fried foods, onion, garlic, mint, and tomato sauce
- Eat smaller meals
- Wait at least three hours before laying down after a meal
- Elevate the head of your bed
- Don't smoke
Strep throat is a painful bacterial infection of the throat and is one of the most common causes of sore throat — typically, however, the symptoms are severe enough that you would also have them during the day.
Strep is more common in kids ages 5 - 15 and is usually accompanied by the following symptoms:7
- Loss of appetite
- Painful swallowing
- White spots on the throat and tonsils.
Your strep throat will need to be confirmed by a doctor with a simple strep test. The illness is treated with antibiotics.
More Rare Causes of Sore Throats
Sometimes a sore throat and other flu-like symptoms appear after someone has been infected with HIV. An HIV-positive person might also have a chronic sore throat due to other infections that are more likely to cause problems in people with compromised immune systems.1
If you are sexually active, you should be tested regularly for STDs.
Cancerous tumors of the throat, larynx, or tongue can sometimes be the cause of a sore throat. Other signs or symptoms may include:1
- Difficulty swallowing
- Noisy breathing
- A lump in the neck
- Blood in the saliva or phlegm
See your doctor if you've been experiencing these symptoms.
Regardless of the cause of your sore throat, there are some things you can do at home that can help you feel better.
Drink a Warm Beverage
Drinking herbal tea can help soothe an irritated throat. If you like, you can add honey to it as honey has been shown to have other beneficial healing properties. The warmth of the drink helps relax the muscles and the honey coats the throat, alleviating the pain. Drinking liquid also helps with dehydration.10
Gargle With Warm Saltwater
A gargle of saltwater can help reduce swelling and relieve discomfort. Mix a teaspoon (5 g) of salt in a cup (240 mL) of warm water and gargle roughly every three hours. Make sure the water is warm, not hot.10
If the soreness only happens occasionally, over-the-counter medicine might help do the trick. Purchase some lozenges and use them as instructed in the label. They are considered a safe and effective way to numb the pain.
Your throat will benefit from the soothing effect of the lozenges due to increased production of saliva. Do not let young children try this remedy though, as it poses a risk of choking.
Using an over-the-counter decongestant can help reduce the amount of mucus you're experiencing (if you're recovering from a viral condition), and help alleviate the postnasal drip. This will help your throat feel better
If your sore throat is the result of dry conditions, you should try using a humidifier. If you don't have access to one, try sitting in a steamy bathroom. You can also pour boiling water into a bowl and lean over it, draping a towel over your head to create a steam chamber. This will help clear up the passageways and moisten your throat, alleviating pain.
Ice Cream, Popsicles, or Ice Cubes
Sucking on something cold can reduce the inflammation and irritation associated with a sore throat
Try drinking hot chicken soup to make eating and swallowing with a sore throat less difficult. This will help keep you from being dehydrated, and the warm liquid will also help heal your throat.
Aside from gargling with salt to soothe a sore throat, you can also gargle with salt water mixed with baking soda. This mixture will prevent the growth of fungi and yeast as well as kill bacteria you may be harboring in your throat. Try mixing warm water (1 cup), baking soda (1/4 teaspoon), and salt (1/8 teaspoon) and swish gently in your mouth. Repeat the process as needed every three hours.10
Acetaminophen and other OTC pain medications are a good source of relief from a sore throat at night. But keep in mind that giving aspirin to children should be avoided.
You may also try alternative medicine — usually in the form of sprays, teas, and lozenges — to treat your sore throat. Just keep in mind that you shouldn't just depend on these alternative treatments alone, especially since evidence about what is effective is limited.
In the US, herbal remedies also don't have to adhere to FDA standards, which means the contents of the bottle might vary significantly from the packaging. You should consult your doctor before taking herbal remedies if you are pregnant or taking any other medications.
Slippery elm has long been used to treat sore throats because of the mucus-like substance it contains. When you mix it with water, it creates a slick gel that you can use to coat and soothe your throat. Try pouring boiling water over powdered slippery elm bark and stir well before drinking. Slippery elm lozenges are also available to help relieve a sore throat.10
Try making a goldenseal gargle by mixing 1 ½ teaspoons of goldenseal tincture with eight ounces of water. It may soothe the inflamed tissue in your throat while fighting bacteria.11
Echinacea has also been long been used as a sore throat pain reliever. Simply add echinacea tincture (two teaspoons) to a cup of water. Gargle the mixture three times a day to ease throat pain.12
Licorice root is known for its anti-inflammatory properties that enable it to decrease swelling and irritation as well as soothe the throat’s mucous membranes.
You can brew your own licorice root tea by placing the following in a mixing bowl:
- One cup of dry licorice root (chopped)
- Two tablespoons of cloves (whole)
- One-half cup of cinnamon chips or a few cinnamon sticks
- One-half cup of chamomile flowers
Make sure everything is blended, then take three tablespoons of this mixture and mix with 2 ½ cups of water (cold). Heat on medium and allow to boil before reducing heat to low. Let simmer for about ten minutes before straining into a mug.10
The marshmallow root is similar to the slippery elm since it also contains a mucus-like substance that can coat and soothe your sore throat. You can make marshmallow root tea by adding dried marshmallow root to boiling water. Sip this mixture twice or three times a day to relieve throat pain.10
Aside from giving you fresh breath, peppermint is also effective in relieving sore throat. The menthol it contains has the ability to thin mucus as well as calm coughs and sore throats. Peppermint has also been found to help heal with its antibacterial, antiviral, and anti-inflammatory properties.10
Ideally you could keep from getting a sore throat in the first place! The best method for prevention, of course, depends on what's causing your pain.
The following tips will help you avoid infections and reduce and remove allergens and irritants.
- Make sure to thoroughly and frequently wash your hands before eating, after using the bathroom, and after coughing or sneezing.
- It is best to avoid sharing your food, utensils, and drinking glasses.
- Throw away a tissue after coughing or sneezing into it. You can also sneeze or cough into your elbow to prevent spreading the infection.
- Keep yourself from breathing dry air by using a humidifier.
- Clean your TV remotes, telephones, and computer keyboards with a cleanser/sanitizer. Do the same with your hotel room's phones and remotes when traveling.
- Avoid bringing cleaning products, cigarette smoke, and other throat irritants into your home.
Managing Allergies and Exposure to Allergens
This article won't go into detail regarding the various methods of managing your allergies, which can include lifestyle and behavioral changes as well as medications.
That said, here are some basic tips for managing mold, dust, and pollen allergies. You should talk to your doctor to learn more.
- Try keeping your pet out of a family member's bedroom if he or she suffers from asthma or other allergies. Never allow the pet to rest on upholstery or other furniture as well as carpets. Make sure to frequently clean the house to prevent dust from accumulating.
- If you are sensitive to pollen and mold, make sure to protect yourself with a mask whenever you are doing yard work or have increased exposure to the outdoors.13
- Take your allergy medications beforehand if you know you will be exposed to allergens. Once you get home, rinse your nose using a saline solution and take a shower.13
- For mold, make sure any leaks and spills in the home are quickly cleaned up. This will help in preventing any mold spores from growing. You might also consider opening windows or using exhaust fans to bring down the moisture and humidity levels in your bathrooms as well as other rooms in the house. Clean your refrigerator drip pans and garbage cans on a regular basis. Make sure that your home's foundation is protected from flowing drainage and clear your gutters regularly.
- Manage your dust allergy by removing or regularly cleaning your bedroom's carpets. Cover your pillows and mattresses with cases that are made of “mite-proof” materials. Make sure to use hot water and wash your bed linens frequently. Remember to have a media filter (high-efficiency) installed in your air conditioning unit and furnace.
- For a pollen allergy, you can line the edge of your nostrils with an allergen barrier gel or balm. You might also give petroleum jelly a try. This will help catch pollen particles before entering your nasal passages.13
- When driving, close your car windows and make sure to set the car's air intake on the re-circulate mode. Also, make sure your car has an efficient pollen filter or air filter installed in it.13
I hope this article helped you understand more about what was causing your sore throat. I wish you the best of luck!
- Mayo Clinic Staff. "Sore Throat: Symptoms and Causes." April 27, 2016. Mayo Clinic. Accessed June 7, 2017.
- Smith, Andrew, and David Tyrrell, Kieran Coyle, Peter Higgins, and John Willman. "Diurnal Variations in the Symptoms of Colds and Influenza." December 1, 1987. The Journal of Biological and Medical Rhythm Research. Accessed June 7, 2017.
- Tetro, Jason. "Why Colds and the Flu Feel Worse at Night." January 23, 2017. Huff Post: Canada Living. Accessed June 7, 2017.
- Story, Colleen. Medically reviewed by Elaine Luo, MD. "Will This Cold Go Away on Its Own?" March 16, 2017. Healthline. Accessed June 7, 2017.
- Godman, Heidi. "How Long Does the Flu Last?" December, 2016. Harvard Health Publications. Accessed June 7, 2017.
- Mayo Clinic Staff. "Mononucleosis: Symptoms and Causes." December 11, 2015. Mayo Clinic. Accessed June 7, 2017.
- Medically reviewed by Carol DerSarkissian. "Is Your Sore Throat a Cold, Strep Throat, or Tonsillitis?" February 25, 2016. WebMD. Accessed June 7, 2017.
- Faris, Stephanie and Kristeen Cherney. Medically Reviewed by Steve Kim, MD. "Allergies and Sore Throat: Treating the Cause." May 5, 2015. Healthline. Accessed June 7, 2017.
- Mayo Clinic Staff. "GERD." July 31, 2014. Mayo Clinic. Accessed June 7, 2017.
- Story, Colleen M., and Ana Gotter. Medically Reviewed by Debra Rose Wilson, PhD, MSN, RN, IBCLC, AHN-BC, CHT. "12 Natural Remedies for Sore Throat." March 29, 2017. Healthline. Accessed June 7, 2017.
- Reviewed by Steven D. Ehrlich, NMD. "Goldenseal." March 25, 2015. University of Medicine Maryland Medical Reference Guide. Accessed June 7, 2017.
- Reviewed by Steven D. Ehrlich, NMD. "Echinea." February 2, 2016. University of Medicine Maryland Medical Reference Guide. Accessed June 7, 2017.
- Morris, Adrian, MD. "Hay Fever and Allergic Rhinitis." November 2016. Surrey Allergy Clinic. Accessed June 7, 2017.