Drooling in sleep

The medical term for drooling is ptyalism, and the excess production of saliva in the mouth is also called hypersalivation or sialorrhea. Drooling is also known as slobbering, dribbling, salivating or drivelling, and can be noticed from the following symptoms:

• Waking up to a wet pillow or bedsheet
• Damaged or stained clothes
• Crusted drool on the side of the mouth
• A roommate or spouse might tell you if you have been drooling in your sleep

Many people who experience drooling during sleep tend to sleep on one side or sleep with their mouth open (this could also be due to nasal congestion). Sometime, the muscles in their mouth may relax while in REM sleep as well. Some health conditions like pregnancy, sleep apnea and sore throat can also lead to drooling during sleep. Neurological conditions such as cerebral palsy and Parkinson's disease have also been known to cause excessive drooling in some cases.

Drooling in one's sleep may seem embarrassing. However, it is important to see beyond this social impediment and find out the reason—so you can get treated for any underlying or serious conditions.

Any condition that can impair your control over the muscles of the face and mouth, or lead to increased production of saliva, or difficulty swallowing can cause drooling during sleep. Some of the reasons why a person drools while sleeping are:

• Age-related factors: Drooling at night is common among babies—the muscles in their mouths may still be developing. Babies who are teething also tend to drool a lot. Usually, this stops by the age of two
• Diet: Consuming certain foods or a diet high in acidic content can also lead to the production of excess saliva in the mouth, leading to drooling in your sleep.
• Pregnancy: Most women experience excessive drooling during pregnancy—this is attributed to the hormonal changes in the body at this time.
• Medical conditions: There are several medical factors such as infections or chronic conditions that can also lead to drooling during sleep. Some of the conditions include:
  • Sinusitis, where the blocked sinuses force a person to breathe through their mouths, leaving the mouth open while asleep.
  • Allergies, in which the body may produce excess saliva to expel the irritant and help it get better faster.
  • Gastrointestinal reflux disorder (GERD), a digestive disorder where the digested food is pushed back up towards the oesophagus that leads to difficulty while swallowing (dysphagia), which in turn causes excessive drooling.
  • Obstructive sleep apnea,in which the muscles at the back of the throat relax too much and obstruct the breathing when the person is lying down on their back. Research shows that abnormal nerve and muscle function in the supra-pharynx (region above the pharynx) in such patients also makes it hard for them to swallow. Drooling could be one of the symptoms of sleep apnea.
  • Throat infections like strep throat or tonsillitis which causes inflammation and difficulty swallowing could also be causing excessive drooling.
  • Neurological conditions such as Alzheimer's disease, Parkinson's disease, cerebral palsy, stroke or amyotrophic lateral sclerosis (ALS). are also associated with difficulty in controlling the muscles of the face and mouth, which may result in drooling.
  • Drooling can also occur due to a reaction to certain medications like antipsychotics such as clozapine and some myasthenia gravis medicines.
  • Fractured jaw and other conditions that make it hard to close the mouth also lead to excessive drooling.
  • Conditions like tuberculosis and rabies infection are also marked by excessive production of saliva, and therefore drooling.

Although drooling in sleep can present itself as an embarrassing situation for many, the occurrence of it isn’t usually a cause for concern. Whether there is no underlying medical cause for drooling in sleep, it may be prevented by:

• Changing sleep position: The easiest way to stop drooling while asleep is to begin sleeping on the back, instead of on either side of the body. Whether one sleeps with their mouth open or not, lying down on the back helps the saliva gather at the back of the mouth and induces swallowing.
• Home remedies: Certain home treatments can also help prevent excess drooling in sleep, such as chewing on a lemon or a citrus fruit before going to bed, which causes the saliva to become thinner and easier to swallow.
• Facial exercises: Doing some exercises to strengthen the muscles of the face and mouth may also help.
• Staying hydrated: Sipping water throughout the day can also reduce overall saliva production, and prevent drooling.

The treatment for drooling in sleep may vary, depending on the underlying cause and severity of the condition. Here are some ways in which this condition is treated:

• Treatment of allergies and blocked nose: Allergies during certain months can aggravate the production of excess saliva and cause difficulty breathing. Medicines or inhalation of steam, or other forms of treatment to ease your breathing, can help you to breathe through your nose and help you sleep with your mouth closed.
• Speech therapy: An out-of-the-box method, speech therapy can help a person strengthen their jaws and the muscles in their mouth. This can lead to better control over the muscles in the mouth that can control the drooling, although it may take longer than other methods.
• Botox injections: Those with neurological disorders may be prescribed botox injections to control the production of saliva. A botox injection paralyses the muscles in the mouth which stops the salivary glands from producing excess saliva. The effects of this treatment can last up to six months.
• CPAP machine: In cases of sleep disorders such as sleep apnea, treatment methods also include the use of a CPAP (continuous positive airway pressure) machine, which requires the person to wear a mask that delivers oxygen to the airway in order to deliver a consistent flow of oxygen to the body. Such oral appliances also require the patient to be sleeping on their back due to the mask.
• Surgery: Surgical interventions are usually the last-resort effort to correct bodily functions. That said, excessive drooling can be treated by removing the salivary glands located in the mouth, to control the production of saliva.

Some instances of drooling during sleep resolve on their own, as with drooling in babies or drooling during pregnancy. Where there is a common medical problem like a sore throat or allergies at the core, the drooling stops once the medical issue is resolved. However, in some chronic or long-term problem, excess drooling can lead to some physical and psychosocial problems such as:

• Dehydration: Loss of too much saliva from the mouth can cause dehydration.
• Perioral chapping: The lips and skin around the mouth can become irritated and cracked due to continuous contact with saliva.
• Secondary infections: Where drooling is caused by an infection, it can also lead to secondary infections.
• Speech-related problems: People with sialorrhea (they produce too much saliva during the day and night) may also have difficulty speaking.
• Foul smell: The mouth can acquire a bad smell in people with excess saliva and drooling problems.
• Stigma and embarrassment: Some people with this problem may feel embarrassed and isolated.
• Other problems: Research shows that some people with excessive saliva production may also have a poor gag reflex, which in turn can cause problems like spit or food going into the lungs.