It’s tripledemic season, with rising cases of COVID, flu, and RSV, so waking up with a sore throat can be pretty alarming. Do you have one of these potentially serious viruses? Strep throat? Just a cold?
“When you first wake up with a sore throat, it’s difficult to know if you have a bacterial infection or virus without being tested for them directly,” says Dr. Barbara B. Bawer, a family medicine physician at the Ohio State University Wexner Medical Center. It’s also possible that something such as allergies, acid reflux, or the lack of humidity in your bedroom is to blame.
To help sort it out, ask yourself the following questions.
Does it go away after I shower or drink a warm beverage?
A sore throat, by itself, could signal COVID or strep, or it could mean that a nasty cold is about to take hold. But viruses and strep are less likely to be the root cause if the discomfort dissipates as you get further into your morning, says Dr. Mark Russo, an otolaryngologist at MedStar Health at Lafayette Center in Washington, D.C.
A sore throat in the a.m., especially if it happens regularly, might stem from irritation caused by dry air; in that case, running a humidifier in your bedroom while you sleep, in addition to taking a steamy shower when you get up, should help. A hot cup of tea is also a good idea, says Bawer. “The warmth helps to soothe the throat by relaxing the muscles, promoting salivation, and lubricating the throat,” she says.
Allergies are another common culprit; they may cause postnasal drip, which means extra mucus drips down and irritates your throat while you’re sleeping. Russo recommends consulting an allergist or trying over-the-counter nonsedating allergy medication to see if it makes a difference.
Obstructive sleep apnea, a condition in which you stop breathing for several seconds at a time during the night, is also a possibility, says Russo. If your partner complains that you snore loudly, or you often feel fatigued during the day despite logging a solid eight hours in bed, ask your primary care doctor or a sleep specialist if you should be checked for this condition.
Another option is acid reflux, which, when it happens chronically, is known as GERD (gastroesophageal reflux disease). Waking up with a sore throat may result from stomach acid making its way back into your esophagus. You might also have a burning sensation in your chest (heartburn) or a dry cough, says Bawer.
Research has shown that the transition from sleep to wakefulness is associated with increased GERD symptoms in some patients and that getting out of bed as soon as possible once you’re up might help. Also try to eat more lightly in the evening and elevate your head while sleeping. If these simple strategies don’t work, talk to your doctor about medication.
Do I have any other symptoms?
If your throat pain is accompanied by a fever, runny nose, or congestion, you’re almost certainly dealing with some sort of contagious ailment. Flu often comes with body aches and fatigue; COVID might be accompanied by a cough and fatigue, as well as loss of taste and smell. RSV mostly impacts kids, says Bawer, but if you catch it you might find yourself sneezing (on top of having a fever, sore throat, and runny nose).
If it’s strep, which is bacterial rather than viral (like COVID, flu, and RSV), you probably won’t have congestion or a cough. Instead, you may have a fever, red or white spots on the back of your throat, and swollen lymph nodes in your neck.
Strep is the only one of the above-mentioned bugs that calls for antibiotics. If it’s COVID (a home test should quickly sort it out) or flu (your doctor can test you), you might be a candidate for antiviral medication. Otherwise rest up, drink lots of fluids, and take pain/fever medication as needed.
Gargling with salt water, sucking on lozenges and popsicles, drinking tea with honey, and using a numbing spray may specifically help ease your throat pain, says Bawer. Meanwhile, she recommends avoiding potentially irritating foods and drinks like dry toast, acidic foods like orange juice, coffee, alcohol, and spicy foods.
Should I stay home or not?
If you don’t have other symptoms that suggest something contagious—and if your sore throat gets better later in the day—you’re probably (but not definitely) in the clear. To play it safe, “I do recommend wearing a mask if you have a sore throat in case you are contagious,” says Bawer, who also advises coughing or sneezing into your elbow and washing your hands frequently.
