A cough drop, or lozenge, is a small, medicated candy designed to dissolve slowly in the mouth, often containing soothing compounds like menthol. The primary danger arises when this object, meant to be actively dissolved, is introduced into the body while the user is unconscious. Understanding the physiological changes that occur during sleep is necessary to grasp the hazard posed by these small, hard objects.
Why Lozenges Pose a Risk During Sleep
The body possesses protective mechanisms, such as the cough and gag reflexes, which prevent foreign objects from entering the trachea and lungs. These reflexes are significantly impaired when a person is asleep, especially during deeper sleep stages. Sleep reduces sensory awareness and muscle tone, severely compromising the body’s ability to detect and forcefully expel an obstruction.
If a lozenge is placed in the mouth before falling asleep, or if a person drifts off while one is dissolving, the object can slip into the throat. Since protective reflexes are suppressed, the lozenge may not trigger a sufficient cough or gag response to clear the airway. This creates an immediate risk of mechanical obstruction, similar to that posed by any other small, hard food item.
A further complication arises from the lozenge’s physical properties. If the cough drop partially dissolves, it turns into a sticky, semi-solid mass instead of remaining a smooth, hard object. This viscous material can adhere to throat tissues or block the upper airway. Alternatively, fragments can break off and be inhaled into the trachea, causing a partial or complete blockage before weakened reflexes can respond.
Factors That Increase the Danger
Several factors related to the user’s health or behavior can substantially elevate the danger. Age is a significant variable, as both the very young and the elderly face increased risk. Infants and toddlers lack the mature muscular coordination required for safe swallowing, meaning lozenges are not recommended for this age group.
Older adults may experience diminished muscle control or dry mouth, which can impair the coordinated movement of the tongue and throat muscles needed to manage an object like a lozenge. Furthermore, underlying health conditions that already compromise the airway or the swallowing mechanism can dramatically increase the risk. Gastroesophageal Reflux Disease (GERD), for instance, can cause stomach contents to back up into the throat, triggering a choking sensation, and the presence of a foreign object only compounds this existing vulnerability.
Conditions like Obstructive Sleep Apnea (OSA) also increase the hazard, as the airway is already prone to narrowing or closing repeatedly throughout the night. Introducing a lozenge into this already-compromised passage creates an additional potential point of obstruction. Behavioral factors also play a large role in suppressing the body’s defenses. Consuming alcohol or taking sedatives relaxes the muscles in the throat and further dampens the protective cough and gag reflexes, making a choking incident far more likely to occur without arousing the sleeper.
Safe Alternatives for Nighttime Cough Relief
A person can manage a nighttime cough effectively without resorting to the use of solid lozenges that pose a choking risk during sleep. One simple yet effective strategy involves modifying the sleeping environment to soothe the irritated airways. Running a cool-mist humidifier in the bedroom adds moisture to the air, which helps to calm the airways and break up thick mucus.
Positional adjustments can also use gravity to prevent irritants from pooling in the throat. Elevating the head of the bed by six to nine inches, perhaps using a wedge pillow or blocks under the bedposts, can help manage post-nasal drip and mitigate the effects of acid reflux. This inclined position prevents mucus and stomach acid from flowing back into the throat, which often triggers coughing fits when lying flat.
For non-solid remedies, a spoonful of honey before bed has been shown to act as a natural cough suppressant for adults and children over the age of one. Alternatively, sipping warm liquids, such as herbal tea or warm water, can hydrate the body and help thin out mucus, making it easier to manage. If a cough suppressant is required, opting for a liquid cough syrup containing an ingredient like dextromethorphan is a safer choice than a solid lozenge, as the liquid form eliminates the foreign body risk.