Nocturnal drooling, medically termed sialorrhea, is the involuntary leakage of saliva from the mouth while sleeping. This occurs because the muscles controlling the mouth and the swallowing reflex relax during deep sleep, making it less likely that excess saliva will be swallowed. While common, this can lead to wet pillows and embarrassment. The issue is often a combination of gravity and inefficient swallowing. This article explores immediate adjustments, reviews common underlying causes, and discusses long-term clinical management options.
Simple Changes to Reduce Drooling Tonight
The simplest immediate adjustment involves countering gravity’s effects on relaxed facial muscles. Saliva pools and escapes most readily when sleeping on the side or stomach. Shifting to a supine position (sleeping on the back) allows gravity to keep saliva contained within the oral cavity or direct it down the throat for natural swallowing.
If maintaining a back-sleeping position is difficult, slightly elevating the head is an effective strategy. Using a wedge pillow or raising the head of the bed by a few inches helps prevent saliva from escaping the mouth. This elevation keeps the head higher than the salivary glands, making it harder for pooled liquid to run out.
Ensuring clear nasal passages before sleep is important, as mouth breathing facilitates nocturnal drooling. When the nasal airway is blocked, the mouth opens involuntarily to compensate, providing an easy exit for saliva. Simple measures like using a saline nasal rinse or a neti pot can clear congestion caused by irritants or allergies.
Over-the-counter nasal strips can mechanically widen the nasal passages, promoting easier nasal breathing while asleep. Decongestant sprays can also be used temporarily to shrink swollen nasal tissues, but avoid long-term use due to the risk of rebound congestion. Hydration is helpful, as drinking enough water can thin thick mucus in the nasal passages, further encouraging nasal breathing.
Common Causes of Nocturnal Sialorrhea
While sleep position is a major factor, drooling often relates to conditions that either increase saliva production or force the mouth open. Acute respiratory infections, such as a cold or sinusitis, frequently cause nasal congestion, compelling a person to breathe through their mouth. This mouth-open position allows saliva to escape onto the pillow.
Chronic conditions like seasonal allergies or a deviated septum can lead to persistent nasal blockage, resulting in chronic mouth breathing. Conditions that affect swallowing efficiency can also result in pooled saliva. Gastroesophageal reflux disease (GERD) is one such condition, where esophageal irritation triggers a reflex known as water brash, causing the body to produce excessive neutralizing saliva.
Obstructive sleep apnea (OSA) is a significant contributor, causing temporary pauses in breathing that lead to open-mouth breathing and snoring. The jaw and throat muscles relax further with OSA, increasing saliva leakage. Recent dental work, such as new braces or a retainer, can temporarily stimulate salivary glands or interfere with swallowing until the mouth adjusts.
Certain medications list increased saliva production (hypersalivation) as a side effect. Drugs for conditions like Alzheimer’s disease or some antipsychotic medications affect the nervous system’s control over salivary glands. If nocturnal drooling begins after starting a new prescription, discuss alternative options with a healthcare provider.
Addressing Underlying Conditions and Advanced Treatments
When simple changes do not resolve the issue, addressing underlying medical conditions or exploring clinical interventions is necessary. Managing chronic nasal congestion through prescription allergy treatments or long-term sinus care can eliminate the need for mouth breathing. For individuals with diagnosed GERD, consistent treatment with acid-reducing medications lessens the esophageal irritation that stimulates excessive saliva production.
A custom-fitted oral appliance, such as a mandibular device or specialized mouthguard, can help individuals whose drooling is linked to sleep apnea or teeth grinding (bruxism). These devices work by slightly repositioning the jaw or encouraging lip closure, which helps keep the mouth closed and facilitates swallowing during sleep. A dentist or sleep specialist typically prescribes and fits these appliances.
For more persistent or severe cases, especially those linked to neurological conditions, a healthcare provider may recommend specific medications. Anticholinergic drugs, such as glycopyrrolate or scopolamine (often administered via a patch), block the nerve signals that stimulate the salivary glands, reducing saliva volume. These treatments require medical supervision due to potential side effects like dry mouth and drowsiness.
Botulinum toxin (Botox) injections represent another targeted approach for severe hypersalivation. A physician injects the toxin directly into the major salivary glands, which temporarily paralyzes the nerves and significantly reduces saliva production for several months. This is typically reserved for cases where other treatments have failed or the drooling is linked to a neurological disorder.
Seek professional medical advice if drooling is severe, started suddenly, or is accompanied by other concerning symptoms. Red flags include difficulty swallowing, a feeling of choking, or loud gasping sounds during sleep, which could indicate a serious condition like undiagnosed sleep apnea. Consulting a physician is also necessary before making any changes to prescribed medications.