Why You Have a Sore Throat in the Morning

When you wake up with a sore, scratchy throat, you might wonder: Was it because you left the window open or a fan running?

Maybe. But experts say there are a variety of reasons this happens.

Here’s the good news: Most of the causes of AM throat irritation can be addressed with home remedies. Otolaryngologist Michael Benninger, MD, walks us through the most common causes of waking up with a sore throat — and offers up a few quick fixes.

What can cause you to wake up with a sore throat

Waking up with a sore throat is sometimes an indication that you’ve caught a cold or have strep throat.

But unless you’re experiencing other symptoms, it’s more likely something irritated your throat while you slept, such as dry air, mouth breathing, acid reflux, sleep apnea or dehydration.

Dry air

Is there any truth to the idea that having a window open or fan running can cause problems with your throat? If you have seasonal allergies or live in an area with bad air pollution, it’s possible. But the irritants in the air aren’t always the primary culprits.

Whether leaving a window open can cause a sore throat depends on the air quality, says Dr. Benninger. “Cool air from an open window can help people breathe better, unless the air is very dry,” he adds.

Fans can also dry the air in some circumstances. But it doesn’t always. And the soothing white noise may lead to better sleep.

“I suggest setting up the fan so it faces away from you. It will still circulate the air while producing background noise,” Dr. Benninger says.

Mouth breathing

Breathing from your nose helps keep moisture in your mouth and throat. Sometimes if your nasal passages aren’t clear, you end up breathing out of your mouth instead.

Mouth breathing can cause a wide range of unpleasant symptoms, including a sore throat. When you sleep with your mouth open, your saliva has two options. It either dries out or makes a daring escape in the form of drool. Either way, it’s not helping keep your throat lubricated.

Acid reflux

People are more likely to experience acid reflux when they’re lying down, Dr. Benninger says. And if it’s severe enough, you may:

• Become nauseated
• Struggle to swallow (dysphagia)
• Feel like there’s a lump in your throat (globus sensation)
• Vomit stomach acid

All of those issues can leave your throat and vocal cords irritated.

Allergies

Do you have allergies? If so, you probably know that they're a major cause of sore throat.

Allergies are basically an overreaction by your immune system. They happen when it reads dust, pollen, or grandma’s homemade peanut butter pie as a threat. It attacks the threat by (among other things) producing lots of mucus.

Mucus protects you by grabbing and filtering the allergen out of your body. Some of that mucus exits via your nose — hopefully into tissue. But some of that extra mucus usually ends up running down your throat. It’s called postnasal drip. And it’s a common reason people wake up with a sore, scratchy throat.

Snoring or sleep apnea

When we snore, we’re doing a few different things that can seriously annoy our throats.

That beautiful sound everyone’s always complimenting you on? It happens because the tissues in your throat are vibrating and, in many cases, rubbing up against each other. Add mouth breathing and nasal congestion to the equation and, Dr. Benninger says, you have a recipe for a sore throat.

Smoking or vaping

When you smoke or vape, you’re introducing chemical irritants into the lining of your throat. Those chemicals can rob your throat of the moisture it needs to function comfortably. In some cases, inhaling these substances also causes overproduction of mucus, adding the soreness of a bad postnasal drip to the equation.

Overuse

You don’t have to spend three hours singing to a stadium full of fans to get laryngitis. A day-long meeting, a two-hour phone call with a friend or a few extremely enthusiastic cheers at your kid’s tee ball game might be enough to inflame your vocal cords.

So, Dr. Benninger suggests, check your calendar. It could be that your sore throats coincide with the days you place the greatest demands on your voice.

Dehydration

When your body’s dehydrated, you produce less saliva. And when you produce less saliva, your mucous membranes don’t work as well, compounding the problem still further.

Now think about an ideal night’s sleep: eight to ten hours of uninterrupted rest. That’s a long time to go without a drink. If you go to sleep already dehydrated, it’s a recipe for a dry, irritated throat.

Your sleeping position

If you’ve ever had a bad cough or particularly gnarly heartburn, you know that adjusting how you sleep can make a big difference.

Well, the same thing’s true when you’re perfectly well. Dr. Benninger explains that, when you lay flat, your mucus has nowhere to go. And, like many uninvited guests, it gets aggravating pretty fast. Even slight elevation will encourage that post-nasal drip to drain. (More on that in a bit.)

Air pollution

Traffic fumes. Indoor swimming pools. Heck, even that cozy fire in your fireplace could be contributing to the irritation in your throat.

If you have lung conditions like asthma, have bad allergies or live in an area with poor air quality, Dr. Benninger recommends getting an air filter. And, whenever possible, keep your windows and doors closed.

What helps

It may take a while to identify the cause — or causes — of your early morning throat aches. In the meantime, Dr. Benninger says, making a few small changes could have a big impact.

• Get a humidifier. If you suspect the air is dry, which tends to be a problem in the winter, use a humidifier. Drinking extra water throughout the day can also help. Just don’t drink too much water right before bed. A couple generous sips will do the trick, and shouldn’t cause too many nighttime bathroom breaks.
• Address nasal congestion. If you’re mouth breathing, there’s a reason. And that reason is often — at least in part — that your airways are congested. For short-term relief, try taking a nasal decongestant at bedtime for a few days. For longer-term relief, Dr. Benninger recommends using a steroid nasal spray or nasal strips. Bonus: You might end up snoring less!
• Reduce acid reflux. Think your sore throat’s a result of acid reflux? Dr. Benninger suggests trying some adjustments to relieve your acid reflux, such as elevating your bed, using an an acid reflux pillow, taking over-the-counter medications and reducing the amount of acidic food you eat. And talk to your doctor. If you’re getting acid reflux on a regular basis, you may have a condition like gastroesophageal reflux disease (GERD).
• Treat and prevent allergies. You can’t banish allergens from the world, but you don’t have to surrender to them either. In addition to taking over the counter or prescription medications, Dr. Benninger recommends making little modifications. Examples include changing your air filters more often, buying an air purifier, using a hypoallergenic mattress and pillow protectors and more. (Also note: If you’re dealing with seasonal allergies, sleeping with your window open actually could be contributing to your symptoms. If possible, keep your windows closed. )

When is it concerning enough to see a doctor?

If you answer “yes” to these questions, it’s time to make an appointment with your provider:

• Do you have a sore throat (not associated with a virus) that lasts all day?
• Is your sore throat not improving after a couple of weeks?

It’s especially important to get your throat examined by a professional if you have the above symptoms and you also:

• Smoke
• Have acid reflux
• Drink a lot of alcohol

“Any change in voice or swallowing is worrisome,” Dr. Benninger says.

Primary care doctors can help. But if the soreness persists, it may be time to see an otolaryngologist (ENT). It could be a sign of a more serious condition.

“HPV (human papilloma virus) is becoming an epidemic for oral-pharyngeal cancers,” Dr. Benninger says. “A person with multiple partners or with papilloma elsewhere should be particularly cautious.”

Fortunately, a sore throat in the morning that goes away after some food or drink rarely is a sign of something serious.