Experiencing the sensation of choking on your own saliva while asleep is a common and often startling event. It occurs when saliva, instead of being properly swallowed, inadvertently enters the airway, triggering a sudden, reflexive cough or gasp to clear it. While alarming due to momentary breathing disruption, it is typically harmless for most individuals, representing a temporary glitch in the body’s protective mechanisms during sleep.
The Physiology of Airway Protection During Sleep
The body possesses sophisticated mechanisms to prevent substances from entering the lungs. The epiglottis, a flap of cartilage at the base of the tongue, plays a central role by closing over the windpipe (trachea) during swallowing, directing food and liquids into the esophagus. This coordinated action is part of the swallowing reflex.
The cough reflex acts as a secondary defense. If foreign material, including saliva, bypasses the epiglottis and enters the upper airway, the cough reflex immediately activates to forcefully expel it. During sleep, these protective reflexes are naturally less acute. Muscle tone in the throat and airway decreases, and the sensitivity of cough and swallowing reflexes is reduced. This relaxation allows saliva to slip into the trachea, leading to choking and abrupt awakening.
Common Reasons for Nocturnal Saliva Aspiration
Several factors can increase the likelihood of saliva entering the airway during sleep. Sleeping on your back, for instance, allows saliva to pool at the back of the throat due to gravity, making it easier for it to inadvertently enter the windpipe. Adjusting sleep position can often mitigate this issue.
Excessive saliva production (hypersalivation) can also contribute. This can be a side effect of certain medications, such as some antipsychotics or cholinergic drugs. Conditions like allergies, common colds, or sinus infections can also lead to increased drooling. Dental issues or oral infections might also stimulate more saliva.
Nasal congestion often forces mouth breathing during sleep, which can alter normal swallowing patterns and make the airway more susceptible to saliva entry. Gastroesophageal reflux disease (GERD) is another frequent contributor. Stomach acid refluxing into the esophagus and throat can irritate tissues, potentially leading to an impaired swallowing reflex or throat spasms that increase the risk of aspiration.
Weakened swallowing reflexes can also play a part, occurring with aging as muscle strength and coordination naturally decline. Certain neurological conditions, such as stroke, Parkinson’s disease, or multiple sclerosis, can significantly impair swallowing. Additionally, alcohol or sedatives can relax throat muscles and suppress protective reflexes, increasing vulnerability to saliva aspiration.
When to Seek Medical Advice
While occasional episodes of choking on saliva during sleep are generally benign, certain signs warrant medical evaluation. If the occurrences become frequent or persistent, it might indicate an underlying issue that needs attention. It is particularly important to consult a healthcare provider if these episodes are accompanied by other concerning symptoms.
These symptoms include chronic coughing, wheezing, shortness of breath, or chest pain. Signs of aspiration pneumonia, a lung infection caused by inhaling foreign material, also necessitate prompt medical care. These can include fever, chills, fatigue, a productive cough with foul-smelling or discolored phlegm, or difficulty breathing.
New onset of choking on saliva in older adults or individuals with pre-existing neurological conditions should also be discussed with a doctor, as it might signal a worsening of their condition or a new problem.
Strategies to Reduce Occurrences
Several practical strategies can help reduce the frequency of choking on saliva during sleep. One effective approach is to adjust your sleep position; sleeping on your side can prevent saliva from pooling at the back of the throat and make aspiration less likely. Elevating the head of your bed by a few inches, particularly if acid reflux is a factor, can also help gravity keep stomach contents down and reduce irritation in the throat.
Addressing any underlying conditions that contribute to the issue is important. Managing allergies or nasal congestion with appropriate treatments, such as nasal sprays or humidifiers, can encourage nasal breathing and improve swallowing patterns. If you experience acid reflux, avoiding late-night meals, spicy foods, or large portions before bedtime can be beneficial.
Reviewing your current medications with a doctor is also advisable, as some drugs might contribute to increased saliva production or relaxed throat muscles. Limiting alcohol consumption and avoiding sedatives, especially close to bedtime, can prevent the excessive relaxation of throat muscles and suppression of protective reflexes. Maintaining good oral hygiene can contribute to overall oral health and may help manage saliva consistency. Staying adequately hydrated throughout the day also ensures that saliva remains thin and easier to swallow, rather than becoming thick and sticky.