The feeling of suddenly choking or coughing violently after swallowing your own saliva is a common and often alarming experience. This momentary panic occurs when the body’s protective reflexes fail, allowing a tiny amount of liquid to enter the airway instead of the esophagus. The immediate and forceful cough is your body’s effective mechanism for clearing the material and restoring normal breathing. While the sensation is intense, it is almost always a temporary misdirection of liquid, not a true choking event. This article explains the mechanism behind this failure and offers practical ways to reduce its frequency.
Understanding the Difference Between Aspiration and Choking
The sudden coughing fit triggered by misdirected saliva is medically known as aspiration, not choking. Aspiration occurs when any substance meant for the stomach—including food, liquid, or saliva—inadvertently passes into the trachea, or windpipe, which leads to the lungs. This is often described as something “going down the wrong pipe” and usually results in a forceful cough as the body tries to expel the irritant.
True choking, in contrast, involves a complete or near-complete blockage of the windpipe by a solid object, which prevents air from entering the lungs. This requires emergency intervention, such as the Heimlich maneuver. Aspiration of saliva is generally a transient event cleared by the cough reflex, while choking represents a life-threatening obstruction. Choking on saliva to the point of a full airway blockage is extremely rare and typically only occurs in individuals with severe, pre-existing medical conditions that impair neurological function or swallowing.
The Physiology of Saliva Misdirection
The act of swallowing is a complex process that relies on a perfectly timed sequence of muscular contractions and reflex actions. When you swallow, the back of your tongue pushes the saliva or food toward the pharynx, triggering the involuntary swallowing reflex. During this precise moment, the larynx moves upward and forward, and the epiglottis tilts down to cover the entrance to the trachea.
This coordinated closure ensures the liquid or food is directed safely into the esophagus, the tube leading to the stomach. Saliva misdirection, or aspiration, occurs when this protective mechanism fails momentarily. The epiglottis may not close completely or quickly enough, or the vocal cords may have a brief lapse in coordination, allowing a small droplet of saliva to slip past them and enter the airway. The resulting cough is the immediate, protective response to prevent the substance from traveling further down into the lungs.
Common Triggers That Cause Misdirection
Several common circumstances can disrupt the timing of the swallowing reflex, making misdirection more likely. A frequent trigger is a temporary loss of conscious control, which often happens during sleep, particularly when lying flat. When the body is sedated or relaxed, protective reflexes are slower to engage, increasing the chance of passively inhaling saliva.
Consuming substances that depress the central nervous system, such as alcohol or certain sedative medications, can also significantly slow the reflex response. Gastroesophageal Reflux Disease (GERD) is another common factor, as stomach acid backing up into the throat can irritate tissues and impair the function of swallowing muscles and nerves. Finally, eating or speaking too rapidly while swallowing can interfere with the proper coordination of the epiglottis, increasing the risk of liquid misdirection.
Strategies for Prevention
Adjusting posture, especially during rest, minimizes the risk of saliva misdirection. Elevating the head of your bed by six to eight inches, perhaps using a wedge pillow, helps use gravity to keep saliva and stomach contents away from the airway. For those who experience frequent events during the day, practicing mindful swallowing by pausing and focusing before each swallow is beneficial.
Managing underlying health issues is a primary preventive strategy. If acid reflux is suspected, treating GERD can reduce throat irritation and restore proper reflex function. Avoid large meals or excessive alcohol consumption close to bedtime, as both contribute to the relaxation of throat muscles and potential reflux. Maintaining good oral hygiene reduces bacteria in the mouth, which is important because a cleaner mouth reduces the risk of developing aspiration pneumonia if misdirection occurs.