Waking up to a drool-soaked pillow, medically known as ptyalism or sialorrhea gravidarum, is a common but often unsettling side effect of pregnancy. While this excessive salivation can be annoying, it is typically harmless and a normal physiological response to the significant changes occurring in the body. The phenomenon is not simply an issue of poor mouth control during sleep, but a combination of increased saliva production and a decreased ability to manage that saliva overnight. Understanding the specific bodily mechanisms at play can help demystify why this symptom has become so noticeable.
Hormones and Pregnancy-Related Saliva Production
The root cause of the body producing more moisture lies largely in the dramatic hormonal shifts of pregnancy. Elevated levels of hormones like estrogen and progesterone, which surge during gestation, are thought to stimulate the salivary glands. This hormonal influence is believed to be the primary driver behind the actual increase in saliva volume.
Many pregnant women with excessive saliva also experience significant nausea or hyperemesis gravidarum. The constant feeling of sickness can cause a woman to subconsciously swallow less saliva throughout the day and night to avoid triggering the gag reflex or vomiting. This reduced swallowing frequency leads to a buildup of fluid in the mouth, creating a perceived increase in saliva. In normal circumstances, a person produces approximately 1.5 quarts of saliva daily, but for women experiencing ptyalism, this production can increase significantly.
Factors Inhibiting Swallowing During Sleep
The reason this excessive saliva escapes primarily at night is due to a confluence of physical and reflexive mechanisms specific to sleep. During the deeper stages of sleep, the body’s muscle tone relaxes, including the muscles around the mouth and throat. This relaxation reduces the strength of the lip seal and also significantly decreases the frequency of the unconscious swallowing reflex.
Another factor is the common issue of acid reflux, or Gastroesophageal Reflux Disease (GERD), which is exacerbated by pregnancy. The pregnancy hormone progesterone relaxes the valve between the esophagus and the stomach, allowing stomach acid to back up. When acid irritates the esophagus, it triggers a defensive reflex known as the “water brash.”
The water brash reflex causes the salivary glands to rapidly produce a thin, excessive amount of saliva rich in bicarbonate to neutralize the acid. This protective flood of fluid can quickly overwhelm the mouth’s capacity. Furthermore, nasal congestion, a common pregnancy symptom, forces mouth breathing, making it nearly impossible to keep the lips closed and contain the excess fluid.
Practical Steps for Reducing Drooling
While there is no instant solution for ptyalism, several actionable steps can help manage the symptoms and provide relief.
Managing Saliva and Hygiene
Maintaining excellent oral hygiene is important, as frequent brushing of the teeth and tongue, and using a mild mouthwash, can encourage swallowing and reduce the sensation of excess moisture. Chewing sugarless gum or sucking on hard, sugar-free candies throughout the day may also encourage more frequent, conscious swallowing.
Dietary and Positional Changes
Dietary adjustments can help mitigate the secondary causes of hypersalivation, such as reflux. Pregnant women should try to avoid trigger foods that increase acid production, including spicy, acidic, or fatty items, especially close to bedtime. Eating smaller, more frequent meals can also help prevent the stomach from becoming overly full.
To combat the effects of gravity and reflux at night, women should consider positional changes for sleep. Elevating the head of the bed by six to eight inches using blocks or a foam wedge can help keep stomach acid down and reduce the chance of the water brash reflex being triggered. If drooling becomes severely disruptive or leads to dehydration, consult a healthcare provider.