Waking up to a damp pillow can be an embarrassing or annoying part of getting a good night’s sleep, but occasional drooling is usually nothing to worry about. Saliva naturally continues to be produced while we sleep, and when the muscles involved in swallowing relax, some saliva can escape from the mouth. Your sleeping position can also play a role: people who sleep on their sides or stomachs may be more likely to notice saliva on their pillow because of gravity.
However, if drooling is new, unusually heavy, or happening along with other symptoms, it may deserve a closer look. Excessive drooling can sometimes be associated with difficulty swallowing, problems controlling the muscles of the mouth and throat, certain infections or conditions that affect saliva production, and neurological disorders. In some cases, persistent drooling can even increase the risk of saliva entering the lungs.
Why Do People Drool in Their Sleep?
Drooling generally happens for one of three reasons: the body is producing more saliva than usual, saliva is not being kept inside the mouth, or a person is having difficulty swallowing it.
During waking hours, swallowing occurs frequently and often automatically. While sleeping, those processes change. If the mouth falls open or a person sleeps in a position that allows saliva to flow outward, drooling can occur without indicating an underlying disease.
Nasal congestion can also contribute indirectly. When it becomes difficult to breathe comfortably through the nose, people may breathe through their mouths, which can make nighttime drooling more noticeable. Allergies, infections and acid reflux are among the conditions that can also be associated with increased drooling.
When Drooling May Point to a Swallowing Problem
One of the more important reasons to pay attention to persistent drooling is difficulty swallowing, medically known as dysphagia. If someone cannot swallow saliva normally, it can pool in the mouth and eventually spill out.
Signs that drooling could be connected to a swallowing problem include coughing or choking while eating or drinking, a sensation that food is sticking in the throat, a wet or gurgly voice after swallowing, or frequently needing to clear the throat.
Problems with swallowing can have several causes. They may occur with certain neurological conditions, structural problems in the throat, or illnesses that interfere with normal muscle control. MedlinePlus notes that people with drooling problems can be at increased risk of inhaling saliva, food or liquids into the lungs when normal protective reflexes are impaired.
Neurological Conditions Can Sometimes Cause Excessive Drooling
Persistent or significant drooling can sometimes be associated with disorders that affect movement, muscle control or swallowing.
For example, drooling is a recognized symptom of Parkinson’s disease. The Parkinson’s Foundation explains that it is often related not to the body making too much saliva, but to reduced or slowed automatic swallowing, which allows saliva to accumulate in the mouth.
Other neurological conditions that have been associated with drooling include stroke, multiple sclerosis, amyotrophic lateral sclerosis (ALS) and cerebral palsy. The connection is generally related to problems controlling the muscles used to close the mouth or swallow rather than simply producing excessive amounts of saliva.
That does not mean that waking up with a wet pillow is evidence that someone has a neurological disorder. These conditions are only one possible explanation among many, and ordinary nighttime drooling is common.
Could Sleep Apnea Be Related?
Drooling itself does not diagnose sleep apnea, but nighttime drooling can sometimes occur alongside mouth breathing and other sleep-related breathing issues.
Sleep apnea is a condition in which breathing repeatedly stops and starts during sleep. Obstructive sleep apnea, the most common form, occurs when the upper airway becomes blocked. Loud snoring, gasping or choking during sleep and excessive daytime sleepiness are among the symptoms that can warrant discussing sleep apnea with a healthcare professional.
If someone has suddenly started drooling heavily and also snores loudly, wakes up gasping, experiences witnessed pauses in breathing, or feels unusually sleepy during the day, the combination is more worth discussing with a doctor than drooling alone.
Other Possible Causes
Not every case of excessive drooling is connected to a serious disease. A range of relatively common issues can affect saliva production or swallowing.
Allergies and upper-respiratory infections can contribute to congestion and changes in how a person breathes. Acid reflux may also be associated with increased saliva production. Certain medications can affect saliva levels as well.
Dental and oral problems may also contribute. Persistent saliva around the mouth can irritate the skin, and chronic drooling may cause problems such as cracked, painful skin around the corners of the mouth. In more serious cases, saliva entering the lungs can contribute to pneumonia.
When Should You See a Doctor?
Occasional drooling during sleep usually isn’t a reason to panic. However, it is sensible to speak with a healthcare professional if the problem is persistent, becomes significantly worse, or appears suddenly without an obvious explanation.
You should be particularly attentive if drooling occurs with:
- Difficulty swallowing food, drinks or saliva
- Frequent coughing or choking
- A change in speech or voice
- Facial weakness or difficulty controlling facial movements
- Repeated episodes of waking up gasping or choking
- Loud, persistent snoring
- Significant daytime sleepiness
- Other new neurological symptoms
- Recurrent chest infections or unexplained breathing problems
Sudden drooling accompanied by facial drooping, weakness on one side of the body, difficulty speaking, confusion or other possible stroke symptoms requires emergency medical attention.
What Can You Do About Nighttime Drooling?
The best solution depends on the underlying cause. If the problem is simply related to sleeping position, changing positions may reduce it. Addressing nasal congestion or allergies may also help if mouth breathing is contributing to the problem.
For persistent or severe drooling, a healthcare professional can determine whether an underlying swallowing, neurological or other medical issue is involved. Depending on the cause, treatment may include addressing the underlying condition, swallowing or motor therapy, medication, or other treatments designed to reduce saliva production.
The important point is not to assume that every wet pillow signals a serious health problem. Drooling during sleep is common. But when it is new, excessive, persistent, or accompanied by other symptoms, it can be a useful clue that something else deserves attention.
Sources:
- Cleveland Clinic — Drooling: Definition & Causes
- MedlinePlus — Drooling
- Healthline — Drooling: Causes, Risk Factors, and Treatments
- National Heart, Lung, and Blood Institute (NIH) — Sleep Apnea
- Parkinson’s Foundation — Drooling
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