When it comes to babies, drooling is common and usually considered normal. It is connected to their limited ability to swallow. Even as an adult, you may have experienced your saliva flowing out of your mouth unintentionally. It may be because you were tired or your sleeping position was not comfortable. But excessive drooling can be a sign of underlying health issues like Gastroesophageal Reflux Disease or a neurological disorder. So, don't take your saliva pooling in your mouth and escaping lightly. Surgery can help in extreme cases, but there are other ways to stop drooling.

What is drooling?

Drooling, also known as sialorrhea or ptyalism, refers to the unintentional loss of saliva from the mouth. "This occurs when saliva is produced in excess or when the muscles around the mouth, lips, and throat are unable to contain it," says ENT specialist Dr Harshad Nikte. While saliva plays an important role in keeping the mouth moist, aiding in digestion, and maintaining oral hygiene, drooling can be problematic when it happens involuntarily, especially in adults.

Know why you drool while sleeping. Image courtesy: Freepik

Drooling is accepted as normal in children up to two years of age, according to a 2014 review published in Monographs in Oral Science. In infants and young children, drooling is common and often part of normal development, especially during teething. However, in older individuals, excessive drooling can be a sign of underlying health issues.

What are the causes of drooling while sleeping?

Drooling during sleep can result from several factors:

1. Sleep position

When you sleep on your stomach or side, gravity works against you, pulling saliva toward the edges of your mouth. "Since you are relaxed while sleeping, your saliva can leak out easily from your mouth," says the expert.

2. Mouth breathing

If you have nasal congestion due to a cold, allergies, or a sinus infection, you may find yourself breathing through your mouth. Mouth breathing naturally leads to a dry mouth, but it also affects your ability to control the flow of saliva, resulting in drooling.

3. Gastroesophageal Reflux Disease (GERD)

GERD is a digestive disorder where stomach acid frequently flows back into the esophagus, irritating the lining. This condition can increase the production of saliva as the body tries to neutralise the acid. This extra saliva, especially if it accumulates while you sleep, can cause drooling.

4. Swallowing problems

Some people have difficulty swallowing their own saliva, and this can lead to it gathering in their mouth and throat, causing drooling, aa per the UK's National Health Service. Some neurological disorders like stroke, Parkinson’s disease, or multiple sclerosis may affect your ability to swallow normally. When this happens, saliva tends to collect in the mouth and eventually escapes, particularly when you are sleeping.

5. Medications

"Certain drugs, particularly sedatives, antipsychotics, and medications that impact the nervous system, can interfere with normal muscle control," says the expert. This reduces a person's ability to swallow properly, leading to increased drooling.

6. Obstructive Sleep Apnea (OSA)

Obstructive Sleep Apnea is a condition where the airway is partially or fully blocked during sleep, causing frequent breathing pauses. Mouth breathing often accompanies OSA, which can result in drooling.

7. Enlarged tonsils or adenoids

When the tonsils or adenoids are enlarged, they can obstruct the airway, forcing you to breathe through your mouth. "This increases the likelihood of drooling, especially during sleep," says Dr Nikte.

What are the ways to stop drooling?

Here's how to stop drooling:

1. Adjust your sleeping position

Sleeping on your back allows gravity to help keep saliva in your throat, where it can be swallowed easily, instead of pooling in your mouth. If you have a habit of side or stomach sleeping, try using pillows to support your back and maintain this position throughout the night.

Change your sleeping position to stop drooling. Image courtesy: Freepik

2. Improve nasal breathing

Nasal congestion is a common cause of mouth breathing, which can lead to drooling. So, treating the root cause of nasal blockage is key. "If allergies are the culprit, over-the-counter or prescription antihistamines or nasal corticosteroids may help," says the expert. Using nasal saline sprays or nasal strips during sleep can help clear your nasal passage and reduce mouth breathing.

3. Stay hydrated

Staying hydrated by drinking enough water or having other fluids throughout the day helps regulate saliva production. When you are dehydrated, your saliva becomes thicker and harder to swallow, which can increase the risk of drooling. By drinking enough water, you maintain a balance in saliva consistency, making it easier to swallow even during sleep.

4. Speech therapy

For those whose drooling is related to neurological disorders or muscle weakness in the mouth, speech therapy can be highly beneficial. A speech therapist can teach you exercises to strengthen the muscles used for swallowing, enhance tongue coordination, and improve the overall control of your mouth and throat. This can significantly reduce drooling, especially for those with underlying neurological issues like Parkinson’s.

5. Change medications

If you notice that drooling began after starting a new medication like antidepressants, antipsychotics, speak with your doctor. Your doctor may be able to adjust the dosage or prescribe a different medication that has fewer effects on saliva management.

6. Use oral appliances

Oral appliances, similar to those used to treat snoring or mild sleep apnea, can be helpful in managing drooling. These devices, usually custom-fitted by a dentist, help reposition the tongue and jaw in a way that improves breathing through the nose and reduces saliva leakage during sleep.

7. Botox injections

Botulinum toxin (Botox) injections successfully helped to subside the symptoms of drooling, as per a 2012 study published in the British Journal Of Medical Practitioners. By injecting Botox into the salivary glands (usually the parotid and submandibular glands), it reduces the amount of saliva produced. "This is a non-invasive method and offers temporary relief, which means you can get relief for a few months then you need to go for another injection," says the expert. It’s especially recommended for people who drool due to neurological disorders or as a result of surgery.

8. Surgery

In extreme cases where drooling is severe and other treatments have failed, surgery may be considered. "As part of the surgery, your doctor may remove or reroute your salivary glands so that they produce less saliva or direct your saliva into your throat for effective swallowing," explains Dr Nikte.

Drooling is usually harmless, and can be due to something as simple as your sleeping position. But if drooling occurs frequently, especially when you are up, and interferes with daily activities such as eating or speaking, it may be due to a health problem.

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