Waking up suddenly, gasping for air, after choking on your own saliva is a common and often alarming experience. This sensation can cause momentary panic as your body reacts to clear the airway. While typically harmless, it leaves many individuals wondering why this occurs during sleep.
How Saliva and Swallowing Work During Sleep
During waking hours, your body continuously produces saliva, a clear fluid made by glands in your mouth, which helps with digestion and keeps your mouth moist. You subconsciously swallow saliva many times per minute, a reflex coordinated by your brainstem. This constant swallowing prevents saliva from pooling.
As you drift into sleep, your body undergoes physiological changes. Muscles throughout your body, including those in your throat and jaw, relax considerably. This relaxation impacts the swallowing reflex.
The frequency and strength of your swallowing reflex decrease during sleep. This reduced swallowing efficiency, combined with muscle relaxation, allows saliva to accumulate at the back of your throat. When enough saliva pools, it can inadvertently enter the larynx, triggering a sudden cough or gag reflex to clear the airway.
Underlying Reasons for Choking
Several factors can contribute to saliva pooling and choking during sleep. Your sleeping position can influence where saliva collects. When you sleep on your back, gravity can cause saliva to pool at the back of your throat, making it easier for it to enter the airway.
Acid reflux, also known as gastroesophageal reflux disease (GERD), is a common contributor. Stomach acid can irritate the esophagus and throat, leading to increased saliva production as the body attempts to neutralize the acid. This irritation can also impair the normal swallowing mechanism, making you more prone to choking.
Nasal congestion or allergies often lead to mouth breathing during sleep. This alters typical airflow and can lead to an accumulation of post-nasal drip, which mixes with saliva. Such changes in breathing patterns can also affect swallowing coordination, increasing the likelihood of choking.
Sleep apnea, a condition characterized by pauses in breathing during sleep, can also cause choking. When breathing stops, the body’s reflex is to gasp for air, which can inadvertently draw pooled saliva into the airway. These sudden gasps often accompany loud snoring and can be a direct cause of choking.
Certain medications can relax throat muscles or diminish the swallowing reflex. Muscle relaxants, sedatives, and some antihistamines are examples that might contribute by reducing the body’s natural protective reflexes during sleep. Anatomical factors, such as enlarged tonsils or a deviated septum, can also affect airflow and saliva movement, increasing the risk of choking.
When to Consult a Doctor
While occasional choking on saliva during sleep is common and usually harmless, certain circumstances warrant medical attention. You should consider consulting a doctor if these episodes become frequent (several times a week) or severe enough to cause distress or disrupt sleep.
Seek medical advice if choking is accompanied by other concerning symptoms, such as loud, persistent snoring, gasping for air, or pauses in breathing during sleep, as these may indicate sleep apnea. Persistent symptoms of acid reflux, like heartburn or a sour taste, that do not improve with lifestyle changes also suggest professional assessment. Unexplained daytime fatigue, chronic sore throat, or difficulty breathing, especially if new or worsening alongside choking, should prompt a doctor’s visit.
Tips to Reduce Choking Episodes
Adjusting your sleeping position is a straightforward way to minimize choking episodes. Sleeping on your side can reduce the likelihood of saliva pooling at the back of your throat, allowing gravity to assist in its drainage. You might use a body pillow to help maintain a side-sleeping position.
Managing acid reflux can also reduce episodes. Elevating the head of your bed by six to eight inches, using a wedge pillow, can help prevent stomach acid from flowing back into your esophagus. Avoiding large meals close to bedtime (within two to three hours before sleep) and identifying trigger foods like spicy or acidic items can also make a difference.
Addressing nasal congestion can improve nighttime breathing and reduce mouth breathing. Using a saline nasal spray before bed can help clear nasal passages, and a humidifier in your bedroom can keep the air moist. If allergies are a factor, managing them with medication or environmental controls can alleviate congestion.
Maintaining hydration throughout the day helps keep saliva at a consistent, less viscous consistency. Regularly reviewing your current medications with your doctor is advisable, especially if you suspect they contribute to throat muscle relaxation or reduced reflexes. Avoiding sedatives and alcohol, particularly in the hours leading to bedtime, is also beneficial, as these substances can relax throat muscles and suppress the swallowing reflex.