Specialists Explain When Sleep Drooling May Signal A More Serious Issue

If you wake up with a little drool on your pillow, pay attention.

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

Thankfully, the only witness to the mess on my pillow was my dog, Rusty. If he could speak, he’d probably tell you I drool even when I’m perfectly healthy. As it turns out, the occasional sleep drool is completely 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 seep onto a pillow or bedding.

For otherwise healthy people, drooling is usually not a cause for alarm. But in some situations, it can point to a health condition or sleep disorder. Below, Odogwu and other sleep experts explain common reasons for nighttime drooling and when it deserves medical attention.

What can cause drooling during sleep?

Experts say there are several possible reasons for drooling at night.

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 living in an arid climate or sleeping with a ceiling fan, can also dry the mouth and increase drooling. Some people also have structural issues, such as a deviated septum, that make airflow harder and encourage mouth breathing, 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. The risk rises if you sleep on your side or stomach, since saliva can more easily escape onto your pillow.

Sleep disorders

Some people drool because of a sleep disorder that interferes with breathing. For example, “people who have sleep apnea stop breathing periodically throughout the night,” Rohrscheib said. That is usually due to an upper airway obstruction, which can lead to more mouth breathing and drooling while asleep, she said. Hirschel agreed, noting that sleep apnea is a common cause of drooling.

She also said certain habits can interfere with sleep and contribute to more drooling overnight. Eating a large meal or drinking alcohol right before bed, for instance, can cause more frequent awakenings or make you feel less rested in the morning.

Age and lifestyle factors

In children, excessive drooling may signal enlarged tonsils or adenoids. Being overweight or having diabetes can increase the risk of a sleep disorder such as sleep apnea, Hirschel said. With age, the muscles that keep the airways open and the mouth closed tend to weaken. Older adults are also more likely to develop neurological problems that can increase drooling, Rohrscheib said.

Colds and allergies

Nasal breathing helps lower the risk of allergies, flu and colds because the nasal passages warm, filter and moisten the air we breathe. “Ideally, most people would breathe through their nose,” Hirschel said. But congestion from a cold or hay fever can force mouth breathing and lead to nighttime drooling.

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 problems

Certain oral and dental issues can also increase drooling, Odogwu said, including mouth ulcers and infections. People with an open bite are more likely to drool, which means the upper and lower teeth do not touch when the jaw is fully closed. Dental devices such as night guards or poorly fitting dentures can also cause excess saliva and nighttime drooling, Rohrscheib said.

Neurological conditions

Some neurological conditions can affect the ability to swallow or keep 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, excess saliva is one of the most troublesome effects of the illness.

Medication side effects

Certain medications can increase drooling. For example, Klonopin and Xanax belong to 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.” Drugs that reduce the swallowing response also include pain relievers such as opioid medications, Rohrscheib said.

On the other hand, the body may produce more saliva to make up for dryness. “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 nighttime drooling be a concern?

Waking up with a damp pillow once in a while 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 drooling, Hirschel suggested paying attention to changes in your sleep. If you usually go to bed at the same time and keep your room dark and cool, but suddenly notice more nighttime drooling, it may be time to talk to a doctor.

Odogwu added that drooling becomes a concern when it happens often 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 care if the drooling gets worse, irritates the skin around your mouth or affects your speech.

Other warning signs include loud snoring, pauses in breathing, waking up gasping or major daytime sleepiness, Latifzai said. These can indicate 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?

Keeping up with good sleep habits and overall health is the best way to address occasional nighttime drooling, Hirschel said. One simple step is to try sleeping on your back. If seasonal allergies are the issue, a nasal decongestant may help you breathe better through your nose, Rohrscheib said. As for mouth tape or a chin strap to keep the mouth shut, it is best to check with a doctor first, since these can carry a 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.” Whenever possible, keep a record of your drooling, including when it began, how often it happens, how much there is, and any other symptoms such as pain or swallowing trouble.

She also suggested coming prepared with questions for your doctor, including:

• 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. Repeat infections could mean food or saliva is entering the airway. It is also wise to bring a list of your current medications so your doctor can check whether any are causing extra saliva or swallowing problems.

If you think a medication may be behind the drooling, consider the 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 symptoms, including seizures.

Depending on the findings, your doctor may refer you to a sleep clinic. A sleep specialist might 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 next steps can include a swallowing test. “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.”