Sleep Better When You're Sick

Last Editorial Review: 12/6/2007

Cold and flu symptoms can keep you from getting a good night's rest when you need it. WebMD talked to experts for advice on how to sleep better.

By Colette Bouchez
WebMD Feature

Reviewed by Louise Chang MD

A hacking cough, a throbbing head, a sore throat, and a nose so stuffed it feels as if you'll never breathe free and clear again. You've got a cold -- or maybe even the flu -- and all you want to do is crawl in bed and sleep.

Until you get there. That's when you realize your symptoms are turning any chance for a solid night's rest into the impossible dream.

"It's true that many cold and flu symptoms seem to get worse at night, and they can interfere with sleep just at the critical time when your body needs rest the most," says WebMD sleep expert Michael Breus, PhD, director of

But how and why does this happen?

In addition to the pure discomfort of the symptoms themselves, Breus explains that increased mucus production, along with overall congestion, forces us to breathe through our mouth instead of our nose. When we lie down, congestion can seem worse.

Tufts University sleep expert Edwin Trayner, MD, explains that mouth breathing also irritates airways, causing us to cough more often, which in turn can also disrupt sleep.

"Plus, when we are sick our body releases certain cytokines [immune factors] into the bloodstream, some of which are mediators of sleep. So that can also have a disrupting influence," says Trayner, director of the sleep disorders center at Caritas St. Elizabeth's Medical Center in Boston and an assistant professor at Tufts University School of Medicine.

The end result, say experts, is you toss and turn all night. And even if you do fall asleep, you wake up feeling drained and tired, with cold and flu symptoms seemingly worse.

For Better Sleep, Choose Cold Drugs Wisely

Although many of us turn to cold medicines at night, they may not always help you sleep better. In fact, depending on what you choose, it might actually make things temporarily worse.

"Everybody can react to these medicines differently. For some they can bring on sleepiness, but others may find it makes them feel jittery and nervous and actually keep them from falling asleep or staying asleep," says Nicholas Popovich, PhD, professor of pharmacy administration and department head at the University of Chicago at Illinois College of Pharmacy.

Among the ingredients Popovich says are most likely to keep you up at night: pseudoephedrine, a decongestant commonly found in cold pills and some cough medicines. This can make some people jittery.

Another common ingredient, diphenhydramine, found in Benadryl and many other all-purpose cold and allergy medications, can have a paradoxical effect -- making some sleepy, others not.

"Until you know how you personally react, it's best to avoid them after 6 p.m., particularly if you have to be at work the next day," says Popovich.

Fortunately, there are other things you can try. To unclog that stuffy nose before bedtime, Popovich recommends a topical nasal spray decongestant.

"The effects are mostly localized, so you're less likely to get that jittery feeling," he says. If you find you are still sensitive to the effects, he recommends a saline nasal spray, which is purified salt water.

"This will have no negative impact on your ability to sleep, and it can help flush out and irrigate your nose and make breathing somewhat easier -- and that means you'll sleep better," he says.

Sleep expert Michael Thorpy, MD, also recommends localized nasal sprays, along with external nasal strips designed to keep breathing passages open from the outside.

"If you put one of these strips on the bridge of your nose before bedtime you may find you get a better night's rest, not only because you are less stuffy and more comfortable, but also because you will be breathing better so your sleep will be more restful," says Thorpy, director of the Sleep-Wake Disorders Center at Montefiore Medical Center and professor of neurology at Albert Einstein College of Medicine in New York City.

What about those nighttime liquid cold medicines that promise you'll sleep like a baby? Breus doesn't recommend them, mostly because of their alcohol content.

"Alcohol can cause you to relax and fall asleep faster, but it's also been shown to interfere with deep sleep, which is what you need when you have a cold," he says. Moreover, he reminds us that alcohol also causes dehydration, which in turn can make cold symptoms feel worse.

For body aches and pains, a headache, or a fever, all the experts told WebMD that acetaminophen tablets are the best and safest remedy to use at bedtime. Keep in mind that many multi-symptom medicines may already contain acetaminophen, so be sure to check the label.

Sleep Better in a Better Environment

Although a cold or flu can leave you feeling so worn out it seems you could fall asleep standing up, experts say don't overlook the need for a comfy and peaceful sleeping environment while you are ill. Sleep expert Susan Zafarlotfi, PhD, says everything from your pillow and blankets to the temperature of the room can play an important role in how well you sleep when you have a cold.

"When you don't feel well, it's often the little things that seem more irritating and annoying and can keep you from getting the rest you need," says Zafarlotfi, clinical director of the Institute for Sleep-Wake Disorders, and the Breath and Lung Institute, at Hackensack University Medical Center in New Jersey.

Her recommendation: Keep the room cool and dark and the covers light, all of which may reduce the number of night awakenings; use a body pillow to help your body be more comfortable; and elevate your head to ease sinus pressure and make breathing less cumbersome.


A Cold or The Flu? How to Tell the Difference See Slideshow

Breus agrees, but warns us not to simply prop up our head with an extra pillow. "This leaves the neck area unsupported, allowing your chin to drop down toward the chest and actually restrict breathing," he says.

His solution: replace your pillow with a foam bed wedge. If that's not possible, stack your pillows so that you create a wedge, with at least some lift under your shoulders, increasing elevation as you go towards your head.

"The idea here is to lift the whole upper part of your body and make it easier for nasal passages to drain and make it easier to breathe," he says.

What can also help: Using a humidifier or vaporizer to keep the air in your sleeping environment moist, which can also make breathing easier and calm a cough. But Popovich cautions to make certain you drain and clean it thoroughly every night. "Otherwise you could end up putting some dangerous bacteria into the air," he says.

You can also give yourself a bedtime steam treatment right in your own bathroom. Experts say before you're ready to turn in, turn on the hot water in your shower full blast, shut the bathroom door, sit on a chair or on the toilet seat, and take in the steam. "You don't want to get wet, you just want to allow the steam to loosen congestion and hydrate your nasal and throat passages," says Zafarlofti. After 10 minutes or so, wrap up in something warm -- like a terrycloth or flannel bathrobe -- and then hop into bed.

6 More Ways to Sleep Better With a Cold

If you're still having problems sleeping during your cold or flu, the experts WebMD talked to offer six more tips that might help you feel better and get a better night's rest.

  1. Drink at least 64 ounces of fluid a day. Popovich says this will help maintain hydration in the nasal passages and throat, which in turn will help you feel more comfortable. If your liquids include fruit juices high in vitamin C, you'll also get a nutritional boost.
  2. Drink a cup of warm, caffeine-free liquid before bedtime: herbal tea and honey, honey and warm water, decaffeinated coffee, or clear broth. This can open nasal passages, soothe a sore throat, and help you sleep.
  3. Suck on hard candy before bedtime to moisten the throat, and keep a water bottle in easy reach to help quell a nighttime coughing spell.
  4. If you must take a medicine for symptoms, opt for single products -- such as a pain reliever, a decongestant, or a cough medicine -- rather than a combination cold pill. Popovich says less is more, and many cold remedies have more than you need.
  5. Read the labels of any medicines you do take, and make certain there is no crossover in ingredients. For example, if your multi-symptom pill also contains acetaminophen, you won't want to take an extra for pain or fever.
  6. Don't be tempted to take a sleeping pill when you have a cold or flu, even if you take them regularly. Thorpy says a sleeping pill can make it harder to get up in the morning. If you are using sleeping pills regularly, never take them with any cold medicines, particularly those containing alcohol.

SOURCES: Michael Breus, PhD, director, The Sleep Doctor web site. Edwin Trayner, MD, director, sleep disorders center, Caritas St. Elizabeth's Medical Center, Boston; assistant professor, Tufts University School of Medicine. Nicholas Popovich, PhD, professor, pharmacy administration, department head, University of Chicago at Illinois College of Pharmacy. Michael Thorpy, MD, director, Sleep-Wake Disorders Center, Montefiore Medical Center, and professor of neurology, Albert Einstein College of Medicine, New York City; Susan Zafarlotfi, clinical director, Institute for Sleep-Wake Disorders, and The Breath and Lung Institute, Hackensack University Medical Center, New Jersey.

Reviewed on November 14, 2007

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