Doctors Explain When Sleep Drooling May Point to A More Serious Problem

The last time I caught a cold, I woke up to find my pillow soaked. It wasn’t sweat from a fever — it was drool, still stuck to the side of my face.

Luckily, the only witness to the mess on my pillow was my dog, Rusty. If he could talk, he’d probably say I drool even when I’m perfectly healthy. As it turns out, occasional drooling is entirely normal.

“People often drool in their sleep because the body keeps making a normal amount of saliva, but we swallow much less while asleep,” Dr. Cynthia Odogwu, a family and lifestyle medicine physician, told HuffPost. That saliva can leak onto a pillow or bedding. For otherwise healthy people, drooling is usually not a concern. In some cases, though, it can signal a health condition or sleep disorder. We spoke with Odogwu and other sleep experts about common causes of drooling and when it deserves attention.

What are common causes of drooling in your sleep?

Experts say several factors can lead to nighttime drooling:

Mouth Breathing

Drooling often happens because the mouth stays open during sleep. “If you’re a mouth breather, that is certainly likely to increase your risk of drooling,” said Chelsie Rohrscheib, a neuroscientist and head of sleep at Wesper. Mouth breathing can dry out the mouth, and the body may respond by making more saliva.

Dry air, such as in an arid climate or from a ceiling fan, can have a similar effect. Some people also have structural issues, like a deviated septum, that limit airflow. That can push them toward mouth breathing and lead to drooling during sleep, she added.

Sleep Position

“Unless they are a 100% back sleeper, most people will occasionally drool in their sleep,” said Alice Hirschel, head of scientific affairs at Natrol, a sleep and supplement company. Side sleeping and stomach sleeping raise the odds because saliva can escape more easily onto the pillow.

Sleep Disorders

Some people drool because of sleep disorders that affect breathing. For instance, “people who have sleep apnea stop breathing periodically throughout the night,” Rohrscheib said. That condition is often caused by an upper airway obstruction, which can increase mouth breathing and drooling while asleep, she said. Hirschel agreed that sleep apnea is a common cause of drooling.

She added that certain habits can also interfere with sleep and make drooling more likely. Eating a large meal or drinking alcohol before bed, for example, can lead to more awakenings or make you feel less rested.

Age And Lifestyle Factors

In children, heavy drooling may point to enlarged tonsils or adenoids. Being overweight or having diabetes can also raise the risk of a sleep disorder such as sleep apnea, Hirschel said. As we get older, the muscles that help keep the airway open and the mouth closed tend to weaken. Older adults are also more likely to develop neurological problems that can increase drooling, Rohrscheib said.

Cold Viruses And Allergies

Breathing through the nose helps lower the chance of problems tied to allergies, flu and colds because the nasal passages warm, filter and add moisture to the air. “Ideally, most people would breathe through their nose,” Hirschel said. But congestion from a cold or hay fever can block the nose, leading to mouth breathing and drooling at night.

Acid Reflux

Excess saliva is common with acid reflux. When you lie flat, stomach contents can more easily move upward and trigger heartburn. “When stomach acid travels up into the esophagus, it can kick salivary glands into overdrive,” Dr. Khoshal Latifzai, a longevity physician, told HuffPost. “That saliva helps dilute and neutralize the acid, but it can also contribute to drooling.”

Dental Issues

Some oral and dental problems can also increase drooling, Odogwu said, including mouth ulcers and infections. People with an open bite are more likely to drool; that means the upper and lower teeth do not meet when the jaw is fully closed. Likewise, devices such as night guards or poorly fitting dentures can cause extra saliva and nighttime drooling, Rohrscheib said.

Neurological Conditions

Some neurological conditions can interfere with swallowing or keeping the mouth closed. “Drooling that is new, heavy and doesn’t go away should be checked by a doctor, because it can point to a health problem such as a nerve condition like Parkinson’s disease,” Odogwu said. In adults with Parkinson’s disease, excessive saliva is one of the most difficult symptoms.

Medication Side Effects

Certain medications can lead to more drooling. For example, Klonopin and Xanax are in the same class of drugs. “However, whereas Klonopin can increase saliva production, Xanax is more often associated with dry mouth,” Latifzai said.

Some medications can also make swallowing harder. “Risperdal, an antipsychotic, can cause increased saliva and swallowing difficulties,” he said. “That two-pronged effect can certainly increase nighttime drooling.” Medications that reduce the swallowing reflex also include painkillers such as opioids, Rohrscheib said.

As noted earlier, a dry mouth can prompt the body to produce even more saliva. “Many antidepressants, some bladder-control medications, and antihistamines such as diphenhydramine, found in Benadryl and some nighttime ‘PM’ products, can dry out the mouth,” he said. “Too little saliva can lead to bad breath, mouth irritation, cavities, and oral yeast infections.”

When should you be concerned about nighttime drooling?

Waking up with a damp pillow now and then is normal. “Drooling doesn’t necessarily mean you’re making too much saliva,” Latifzai said. “Oftentimes it simply means saliva is escaping from your mouth rather than being swallowed.” If you’re worried about it, Hirschel suggested watching for changes in your sleep habits. If your bedtime routine, sleep environment and usual habits stay the same but drooling suddenly increases, that’s a reason to talk with a doctor.

Odogwu added that drooling is more concerning when it happens frequently or soaks your pillow or clothes night after night. “Tell your doctor if drooling is new, heavy, or comes with choking, coughing, or trouble swallowing,” she said. You should also seek medical attention if it worsens, irritates the skin around your mouth or affects your speech.

Besides new or worsening drooling, symptoms such as loud snoring, pauses in breathing, waking up gasping or major daytime sleepiness should also be evaluated, Latifzai said. These can be signs of a sleep disorder. “Sudden facial drooping, one-sided weakness, or slurred speech is an emergency,” he said, adding that you should call 911 if any of those symptoms appear.

What should you do?

Good sleep habits and overall health are the best starting points for occasional nighttime drooling, Hirschel said. A simple step is to try sleeping on your back. For seasonal allergies, a nasal decongestant may help you breathe more easily through your nose, Rohrscheib said. As for mouth tape or a chin strap to keep the mouth closed, it’s best to ask a doctor first because of the risk of choking or suffocation.

“Many causes of drooling are treatable once found, like a stuffed-up nose, acid reflux, or a medication side effect,” Odogwu said. “Don’t wait to see a doctor, especially if the drooling is new, heavy, or comes with choking, coughing, trouble swallowing, or losing weight without trying.” If possible, keep a record of when the drooling started, how often it happens, how much there is, and whether you have other symptoms such as pain or swallowing trouble.

Along with tracking symptoms, she suggested going to the appointment with questions such as these:

• What is causing my drooling?
• Could one of my medicines be causing it?
• Is my drooling a sign of a problem with swallowing or with my nose, throat or stomach?
• Is spit or food going down the wrong way into my lungs? How can we lower the risk?
• What can help? Are there things I can do at home?
• Should I see a specialist, like an ear, nose and throat (ENT) doctor, a neurologist, sleep specialist, speech therapist or a dentist?

She also recommended telling your doctor if you have a history of chest infections or pneumonia, since repeated infections could suggest that food or saliva is going down the wrong way. It’s also wise to bring a list of your current medications so your doctor can review whether any of them are contributing to extra saliva or swallowing problems.

If you think a medication may be behind the drooling, pay attention to timing. Did it begin after a new prescription or a dose increase? “That’s a useful clue, but not a reason to stop a prescription abruptly,” Latifzai said. Suddenly stopping medications like Xanax or Klonopin can cause serious side effects, including seizures.

Depending on what the doctor finds, they may refer you to a sleep clinic. A sleep specialist could use a medical-grade wearable or a home sleep test to monitor body temperature, heart rate variability or the amount of time you spend in deep sleep, Hirschel said.

Other testing may include a swallowing evaluation. “This is usually done with a speech therapist and can sometimes include a special X-ray done while swallowing,” Odogwu said. “They may refer you to a specialist such as an ENT, neurologist, or speech therapist, to evaluate for a throat, brain, nerve or swallowing problem.”