Continuous Positive Airway Pressure (CPAP) therapy is the most common and effective treatment for obstructive sleep apnea. It works by delivering a stream of pressurized air through a mask to keep the upper airway open during sleep. While CPAP resolves breathing issues, a frequent side effect is the leakage of saliva, commonly called drooling. Drooling can soak the pillow, compromise the mask seal, and reduce the overall effectiveness of the treatment, often leading to non-compliance.
Pinpointing the Source of Saliva Leakage
Saliva leakage is often a symptom of an underlying issue related to how the body interacts with the pressurized air system. The primary cause is typically open-mouth breathing, where the jaw relaxes during sleep, allowing the mouth to drop open. When the mouth is open, air pressure from a nasal or nasal pillows mask escapes, and saliva is no longer contained, leading to pooling or drooling.
A second factor is a mask misfit or an improper seal. Even a small leak can channel air directly onto the mouth or face, creating a sensation that sometimes mimics drooling or pushes existing saliva out of the mask. Excessive saliva production, known as sialorrhea, is a less common but possible cause that may be related to certain medications or underlying health issues like gastroesophageal reflux disease.
Equipment Modifications and Setup Solutions
Selecting the appropriate mask type and ensuring an accurate fit are fundamental steps in controlling saliva leakage. For individuals who primarily breathe through their mouths, switching from a nasal mask to a full-face mask, which covers both the nose and mouth, can contain both the air pressure and any saliva. Some users, however, find that saliva still pools uncomfortably inside the full-face mask, leading them to prefer alternative solutions.
The combination of a nasal mask with a chin strap or an oral shield provides a direct method for addressing open-mouth breathing. A chin strap gently supports the jaw to keep the mouth closed, preventing air pressure loss and containing saliva within the mouth. Specialized oral shields, such as those that fit inside the lips, can also physically seal the mouth without the bulkiness of a head-worn strap. Mask liners, typically made of soft fabric, can be placed between the mask cushion and the face to absorb moisture, reducing pooling and maintaining a better seal.
Adjusting the temperature and humidity settings on the CPAP machine’s humidifier can also influence saliva production. Low humidity can dry out the nasal passages and throat, prompting the body to produce more saliva. Conversely, too much humidity can lead to “rainout,” which is condensation buildup in the tubing that feels like drool. Finding the correct balance of heat and moisture helps maintain a comfortable environment that discourages both mouth opening and condensation.
Behavioral and Positional Strategies
Adjusting the sleep position can significantly influence the effect of gravity on saliva retention. Sleeping on the back, or using a wedge pillow to slightly elevate the head, helps saliva flow toward the back of the throat for natural swallowing. Side sleeping can increase drooling because gravity naturally pulls saliva toward the pillow.
Specialized CPAP pillows with cutouts for the mask can help side sleepers maintain the mask seal. Avoiding excessive liquid intake immediately before bed reduces the volume of fluid available for leakage during sleep. Reviewing any medications with a healthcare provider is also prudent, as certain drugs, including some antidepressants, may have the side effect of increasing salivation.
Orofacial Myofunctional Therapy
For a long-term solution that strengthens the muscles, orofacial myofunctional therapy involves specific exercises targeting the tongue, lips, and facial muscles. These exercises are designed to retrain the oral rest posture, improving the tone and strength of muscles responsible for keeping the lips sealed and the tongue correctly positioned. Consistent practice of these movements promotes proper nasal breathing and reduces the muscular hypotonia that contributes to drooling and mouth opening during deep sleep.