Choking on saliva during sleep is the sudden, startling sensation of inhaling or aspirating one’s own saliva, leading to a cough or gasp. This common experience is typically harmless and usually does not indicate a serious underlying health problem, though it can disrupt sleep. This involuntary reaction occurs when the body’s natural swallowing reflex momentarily fails or becomes uncoordinated while asleep, causing saliva to enter the airway instead of the esophagus.
Understanding Why It Happens
The body’s normal swallowing reflex becomes less robust during sleep. During deeper stages of sleep, particularly REM sleep, muscle tone relaxes significantly, including those muscles that control the mouth and throat. This relaxation can make it harder for the epiglottis, a small flap of cartilage, to fully close over the windpipe, allowing saliva to enter the airway instead of the esophagus.
Saliva production, while generally lower at night, still occurs continuously. If saliva accumulates due to reduced swallowing or other factors, it can pool in the back of the mouth, increasing the chance of aspiration.
Sleep position also plays a role in how saliva is managed. Sleeping on one’s back can allow saliva to collect in the throat, increasing the likelihood of it entering the airway. Gravity can also cause the tongue or soft tissues in the throat to fall backward, obstructing airflow and leading to choking sensations. Side sleepers, on the other hand, may experience gravity pulling saliva towards the pillow, resulting in drooling rather than choking.
Breathing through the mouth during sleep can also contribute to this issue. When nasal passages are blocked, individuals resort to mouth breathing. This can make existing saliva difficult to manage, increasing the risk of choking.
Acid reflux, also known as Gastroesophageal Reflux Disease (GERD), is another common contributor. Stomach acid can flow back into the esophagus and irritate the throat, leading to increased saliva production or a sensation of choking. When lying flat, gravity no longer assists in keeping stomach contents down, allowing acid to remain in the esophagus longer and be aspirated.
Allergies and nasal congestion can also indirectly cause saliva choking. Blocked nasal passages often lead to mouth breathing, as the body seeks an alternative airway. This can result in thick mucus or saliva collecting in the mouth, which may not easily flow down the throat, leading to choking.
Certain medications can impact saliva production or muscle relaxation, increasing the risk of choking. Drugs that cause drowsiness or muscle relaxation can reduce the effectiveness of throat muscles and swallowing reflexes. Some medications can also cause excessive saliva production as a side effect, further contributing to the problem.
When to Seek Medical Advice
While occasional episodes of choking on saliva during sleep are generally not a cause for concern, certain signs may indicate a need for medical evaluation. If these episodes become more frequent or severe, or if they cause significant distress, consulting a healthcare professional is advisable.
A doctor’s visit is warranted if saliva choking is accompanied by other symptoms. These include persistent coughing or difficulty breathing. Chest pain, hoarseness, or a sour taste in the mouth upon waking could point to underlying acid reflux issues. Unexplained weight loss or difficulty swallowing food or liquids (dysphagia) are also concerning symptoms.
Signs of sleep apnea, such as loud, chronic snoring, gasping, or pauses in breathing during sleep, should also prompt medical attention. If choking episodes consistently wake an individual, leading to chronic sleep deprivation and excessive daytime tiredness, seeking professional advice is reasonable. Neurological conditions, muscular disorders, or anatomical abnormalities can impair swallowing function, leading to persistent issues. Lesions or tumors in the throat can also narrow the esophagus, making swallowing difficult. A healthcare professional can help identify the root cause and recommend appropriate treatment.
Preventing Future Episodes
Adjusting your sleep position can help reduce the occurrence of saliva choking. Sleeping on your side or stomach can prevent saliva from pooling in the throat. Elevating the head of the bed by a few inches can also use gravity to help keep saliva and stomach contents from flowing back into the airway.
Maintaining proper hydration throughout the day is beneficial, as it helps thin out saliva, making it less likely to pool and easier to swallow. However, avoiding excessive fluid intake right before bedtime can prevent an overproduction of saliva during sleep.
Dietary changes can alleviate symptoms, particularly if acid reflux is a contributing factor. Avoiding heavy meals, spicy, fatty, or acidic foods, and caffeinated or carbonated beverages close to bedtime can reduce the likelihood of reflux. Opting for smaller, more frequent meals can also help.
Addressing allergies or nasal congestion is another effective strategy. Managing allergies with antihistamines or nasal sprays can promote nasal breathing, reducing the need to breathe through the mouth. Using a humidifier in the bedroom can also moisten dry air, which helps with nasal airflow.
Good oral hygiene contributes to overall oral health and can indirectly influence saliva management. Reviewing current medications with a doctor is advisable if they are suspected of increasing saliva production or relaxing throat muscles. A doctor may suggest adjusting dosages or exploring alternative medications.
General healthy habits can also play a role in prevention. Maintaining a healthy weight can reduce the risk of conditions like sleep apnea and GERD, which are linked to saliva choking. Avoiding smoking and limiting alcohol consumption before bed are also beneficial, as both can relax throat muscles and impair reflexes.