Morning Sore Throat | Causes of Pain, Discomfort upon Waking

Most patients experiencing a sore throat  tend to report an exacerbation of the pain or discomfort upon waking. This may be related to mouth breathing, the reduced saliva production during sleep or exacerbation of symptoms as a result of the lying in the supine position for long periods.

However, there are certain causes that are notably aggravated during sleep/lying flat or only arise during these times. The term ‘sore’ is subjective and non-specific – it may be used to describe a sensation ranging from pain to mild discomfort or irritation of the throat , like itching or tickling.

Causes of Sore Throat in the Morning

The more common and prominent causes of a morning sore throat include :

Acid Reflux

The rising acid associated with gastroesophageal reflux disease (GERD) may reach the level of the throat when sleeping or lying flat. The acid can pool at the back of the throat for periods of time as swallowing is significantly decreased during sleep. This causes severe irritation of the throat lining (reflux pharyngitis), and can even extend to the palate or rarely into the nose. Heartburn (burning chest pain) is commonly reported and may also be present upon waking due to pain in the esophagus.


Snoring is the sound produced as a result of the vibration of extremely relaxed or loose tissue of the airway or an obstruction of the air passages. The force and motion that the tissue undergoes usually causes irritation of the passages, especially the tonsils and back part of the roof of the mouth (soft palate). It may also be related to a swollen uvula.  Snoring is often associated with :

  • obesity
  • alcohol consumption
  • nasal congestion
  • anatomical defects of the mouth or throat.

Dry Air

Dryness of the air, usually related to cold conditions, may cause excessive drying of the nose and throat. This is compounded by the fact that saliva secretion is reduced at night and this decreases the moistening effect on the mouth and throat. Sleeping with air conditioning may also have the same effect. A person who is acclimatized to the dry air will not be affected significantly as the air passages have adapted accordingly.

Mouth Breathing

Most cases of mouth breathing are related to nasal congestion or obstruction or dyspnea (difficulty breathing). The causes of dyspnea that arises when lying down or sleeping is discussed below.


Most patients with allergic rhinitis report an exacerbation of symptoms like nasal congestion, runny nose and sneezing upon waking. Sneezing tends to occur in fits  and the force of the expired air can irritate the throat. In the event of a post nasal drip, an itchy throat or tickling in the throat can progress into a sore throat which may be prominent upon waking.


Hypersensitivity to dental products like toothpaste or mouth wash may cause a morning sore throat as a result of the nighttime dental care regimen. This may also account for a sore throat which occurs after brushing in the morning. Hypersensitivity to medication taken at bedtime may also account for throat inflammation which may persist till the morning.

Other Causes

  • Difficulty breathing when lying down :
    • COPD (chronic obstructive pulmonary disease)
    • Heart failure
    • Sleep apnea
  • Sleep bruxism
  • Abnormal extension or flexion of the neck during sleep, often seen in patients who sleep in the sitting position

Related Articles

  1. Chronic Sore Throat
  2. Mouth Pain
