Choking on your own saliva while asleep, often accompanied by a cough or gasp, is a common experience. This nocturnal episode occurs when saliva pools in the pharynx and flows toward the larynx, triggering a protective reflex that is not fully active during sleep. While frightening, this is frequently a benign failure of the body’s protective mechanisms. Understanding the interplay between your sleep state and your reflexes can help demystify why this happens.
The Physiology of Swallowing During Sleep
Swallowing is a complex, coordinated action that occurs automatically dozens of times an hour while awake to clear pooled saliva. Airway protection depends on a sharp cough reflex and continuous, involuntary swallowing. When you transition into deeper stages of sleep, particularly REM, the body experiences reduced muscle tone.
Muscle relaxation extends to the throat muscles and the upper esophageal sphincter, making the airway less rigid. Simultaneously, the sensitivity of the cough reflex is suppressed during both non-REM and REM sleep, making it less responsive to minor irritants. This suppression is a normal part of the sleep cycle that prevents constant coughing from interrupting rest.
Gravity plays a significant role when the body is horizontal, allowing saliva to pool in the back of the throat instead of being cleared toward the esophagus. Although saliva production decreases during sleep, reduced muscle tone and suppressed reflexes mean that accumulated saliva is not managed effectively. When this pooled fluid crosses into the laryngeal area, the delayed protective response results in the violent coughing fit that wakes you.
Common Conditions That Increase Risk
While the failure of protective reflexes is the direct cause of the choking sensation, several underlying health and lifestyle factors can increase the likelihood of it occurring. One major contributor is Gastroesophageal Reflux Disease (GERD), where stomach acid flows back up into the esophagus, sometimes reaching the throat. This acid irritates the laryngeal lining, triggering a protective response called water brash, which causes the salivary glands to produce excessive, watery saliva.
This sudden increase in fluid volume is poorly managed by the sleep-suppressed reflexes, increasing the risk of aspiration and choking. Chronic nasal congestion or allergies force many people to breathe primarily through their mouths while sleeping. Mouth breathing bypasses the nose’s natural function of warming and filtering air, leading to a drier throat and potentially thicker, harder-to-clear mucus and saliva.
Obstructive Sleep Apnea (OSA) is another common factor, where the airway temporarily collapses, causing breathing cessation. This collapse often results in a sudden gasp or snort to restart breathing, which can pull pooled saliva or refluxed material into the airway. This forceful movement leads to the choking sensation that wakes the individual. Certain medications, such as muscle relaxers or sedatives, can depress the central nervous system, further reducing the sensitivity of the cough and swallowing reflexes.
Practical Strategies for Immediate Prevention
Making changes to your sleep environment and bedtime habits can resolve frequent nocturnal choking episodes. Adjusting your sleep posture is an effective immediate strategy, particularly by sleeping on your side. If GERD is suspected, sleeping on the left side is recommended, as it helps keep the stomach below the esophagus, reducing the chance of reflux.
Elevating the head of the bed by six to nine inches using a wedge pillow, rather than stacking pillows, uses gravity to keep saliva and stomach contents down. This angle promotes better drainage of fluids away from the throat and upper airway. Timing your food and liquid consumption is also beneficial, avoiding large meals or excessive liquids within two to three hours of lying down.
To address congestion, using a saline nasal spray or a nasal strip to clear the nasal passages before bed can encourage nose breathing, which is more protective of the airway. Maintaining hydration throughout the day ensures that any saliva or mucus produced is thin and watery, making it easier for the body to manage and clear, even with reduced reflex activity.
When to Consult a Healthcare Professional
While occasional choking on saliva is an isolated event, persistent or worsening symptoms warrant a medical evaluation. Consult a healthcare provider if the choking episodes are accompanied by concerning symptoms, such as chest pain or significant shortness of breath. These could be indicators of a more serious underlying cardiac or pulmonary issue.
Chronic, loud snoring, witnessed pauses in breathing, or feeling excessively tired despite a full night’s sleep signal an underlying sleep disorder, such as Obstructive Sleep Apnea. Likewise, frequent heartburn, a sour taste in your mouth, or a persistent need to clear your throat suggest GERD. A medical professional can help determine if the issue is a simple reflex failure or a symptom of a condition requiring targeted management.