Why Do People Drool in Their Sleep and How to Prevent It?

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Why Do People Drool in Their Sleep

Sometimes we wake up with a wet spot on our pillows, a dry mouth and realize we were drooling while sleeping. Let’s examine why we drool in our sleep, how to prevent it, and when to seek medical attention.

Is Drooling While Sleeping Normal?

Drooling is defined as the existence of excess saliva in the mouth beyond the lip margin. It is caused by a range of reasons, from simply having too much saliva to neurological conditions complicating the process of containing saliva in the mouth.

Drooling while sleeping can be normal depending on how it happens. If you notice you have begun drooling while sleeping, there is no cause for panic. Salivation during sleep does not immediately mean you need to seek medical attention. Sometimes people drool in their sleep simply because their muscles are too relaxed to keep the saliva in their mouth.

If you do not have any other underlying conditions that began showing symptoms roughly at the same time as you began drooling while sleeping or if the drooling is not too excessive, it is perfectly normal to experience drooling every once in a while.

Does Drooling During Sleep Mean You Slept Well?

Sometimes, drooling during sleep does indeed mean you slept well. Sleep is a natural process that naturally relaxes the muscles in your body, including the ones in your mouth and your chin.

If you are having a relaxed, unbothered night of sleep combined with a sleeping position that leaves your head tilted to the side, you might experience drooling during sleep. Relaxation of the muscles from your sleep will leave your mouth open and gravity will do the rest of the work.

That being said, drooling during sleep does not always mean you slept well. If the overflowing of saliva originates from more complex causes, such as chronic conditions or other underlying factors, then these factors might actually harm the quality of sleep. Therefore, drool doesn’t indicate a good night’s sleep definitively.

Why Does It Happen?

Before getting into medical reasons for drooling in sleep, it is important to point out that drooling can occur without any specific underlying causes. Sleeping with your mouth open or your head tilted to the side may cause you to drool due to gravity. A simple way to test if this is the case would be to try out a few different sleeping positions to see if the drooling stops.

Drooling happens for one or multiple of the three categories of possible reasons: 

  • Neuro-muscular conditions, which mean your nervous system cannot contain the saliva in your mouth.
  • Anatomic abnormalities, which mean the anatomy of your body has a deficit, making it incapable of containing saliva.
  • Excessive saliva production, which means the salivary glands in your mouth produce excess saliva that overflows. 

Below, we’ll have a look at the specifics of the most common causes of drooling in sleep:

  • According to research done by University College London professors, the most common cause of drooling in children is cerebral palsy. It is a group of movement disorders caused by abnormal development or damage to the brain in the parts that control balance, movement, and posture.

    It is mostly seen in children, and the same research has recorded that abnormal and persistent drooling is seen in up to 38% of patients with cerebral palsy. The other disorders include stiff muscles and difficulty, or even incapability, of walking comfortably.
  • For adults, Parkinson’s disease is the leading cause of drooling. According to University College London professors, about 45% of the individuals with Parkinson’s disease have trouble with drooling, whereas about 15% of them have started experiencing it in the early phases of the disease.

    Parkinson’s disease occurs when a person’s nerve cells (neurons) in their basal ganglia, the part of the brain controlling movement, start dying or getting impaired. Fewer nerve cells produce less dopamine, which causes issues in controlling muscles and eventually leads to drooling. Parkinson’s disease can affect anyone, although the number of people suffering from it goes up significantly by age, so people over 65 are especially at risk.
  • Accidental consumption of heavy metals may also result in excessive drooling due to the fact that heavy metals such as mercury, thallium, copper, arsenic, and antimony act as neurotoxic agents and create neurological deficiencies in the brain. Industrial areas are prone to heavy metals in aerosol form, leading to risks of heavy metal exposure by air.

    Some polluted water sources might also contain these metals above the healthy threshold. Drinking water from these sources can lead to heavy metal neurotoxicity. Drooling, especially in children, causes neurological complexities such as cerebral palsy and can lead to drooling.
  • Another neurological condition is Wilson’s disease, which causes excess copper to build up in the body and affects the liver and the brain. It is identified by Kayser-Fleischer brown rings around the iris of the eye, hinting at neurological symptoms. Since the excess copper in the body affects the functions of the brain, patients might suffer from difficulties in swallowing and excessive drooling.
  • Another cause is Moebius syndrome, which is congenital, meaning it is present at birth. It is a condition where the child’s facial muscles are underdeveloped, causing a lack of control over facial expressions, eye movements, chewing, and swallowing. People who suffer from Moebius syndrome have difficulties containing the saliva in their mouths, which can lead to drooling.
  • Macroglossia, an anatomic abnormality, might cause drooling during sleep. It is defined as having an unusually large tongue, and it may originate at birth due to complications such as Beckwith-Wiedemann syndrome or Down syndrome, or it can occur after birth due to tumors or neurofibroma. An unusually large tongue stimulates salivatory glands in the mouth more than usual, therefore creating excess saliva, which drools over time.
  • Anterior open bite is another anatomic condition that can result in excessive drooling while sleeping. It is typically defined as having an opening between the teeth in front of the mouth when it’s closed, meaning the anterior teeth do not touch while the molar teeth do. The gap in between the teeth lets air inside the mouth, which causes the mouth to dry out. As a reaction, more saliva is produced by the body, which drools over time through the same gap between the upper and lower front teeth.
  • Another reason for excessive salivation and thus drooling might be a symptom of gastroesophageal reflux disease (GERD). It is medically defined as the severe and long-lasting condition of the stomach contents coming back up into the esophagus. As a symptom of GERD, the body produces too much saliva, which either mixes with the stomach acids and causes reflux or drools onto the pillow during sleep.
  • Some drugs have side effects that cause hypersalivation. Using these medications might result in excess saliva production and drooling during sleep. These drugs include antipsychotics such as clozapine and risperidone, sleeping medicines such as nitrazepam, or medicines that contribute to saliva production to alleviate dry mouth, such as bethanechol.

How to Stop Drooling in Your Sleep

The first step toward preventing drooling in your sleep is to identify the cause of the issue. An easy and non-intrusive method you can try at home is changing your sleeping position.

Most commonly, drooling at night is caused by sleeping with an open mouth or with the head tilted to the side, causing gravity to pull the saliva naturally produced inside the mouth to drool over the sheets. Changing your sleeping position might prevent drooling.

Another easy option is to change the environment around the sleeping area. Various factors, like temperature, humidity, the quality of air inside the room, and the material used in the sheets, contribute to drooling. Changing up the atmosphere where you sleep might help stop drooling. You may also try using stiffer pillows, as surfaces that are too soft can cause drooling for some people.

If none of the methods above works and the drooling persist, the safest thing to do is to consult a professional about your situation. There are a lot of ways to treat drooling with medicine, which vary in complexity depending on the origin of the issue. Here are some of the treatment methods:

  • In the case that drooling is caused by oral complications, oral motor training and therapy might be a viable solution. Oral motor therapy includes massaging or exercising the gums, lips, and facial muscles to gain more advanced motor control over the oral area. Especially in kids, persistent therapy has been proven by researchers at University College Cork to improve oral motor skills and decrease drooling.
  • Pharmacotherapeutics (medicine treatment) is another treatment option for drooling. There are many different types of medicine to combat different causes of excess saliva production, so a professional must be consulted before taking any medication.
    • Benztropine is a medicine used for treating symptoms of Parkinson’s disease, which can cause drooling, or it can be used to combat the side effects of antipsychotic medications that can also cause drooling. It blocks acetylcholine and decreases muscle stiffness, rigidity, and the production of saliva.
    • Scopolamine is another medication widely used for preventing nausea and vomiting caused by motion sickness. Its antisecretory properties suppress salivatory glands in the mouth, decreasing the production of saliva. It is even used preoperatively before surgeries to decrease the saliva of the patient.
    • Glycopyrrolate is a drug that acts as a preoperative medication, inhibiting the production of saliva before surgery due to its antisecretory properties. They also help reduce severe drooling of neurological origins in cerebral palsy patients. But it should be used carefully as it could worsen the situation of patients with GERD.
  • Another treatment option for hypersalivation is the injection of botulinum toxin A into the salivary glands in the mouth that are responsible for the production of saliva. They are simulated by a molecule called acetylcholine.

    Botulinum toxin A irreversibly blocks the nerve to prevent the release of this molecule, thereby significantly lowering the amount of saliva produced. Repeated injections are necessary to manage hypersalivation and this treatment is widely used among cerebral palsy patients.
  • Surgery, albeit somewhat intrusive, is another method of treatment when it comes to excessive drooling. Reconstructive surgeries can be done on people with anatomic abnormalities, whereas patients with cerebral palsy have different types of operations done on their salivary glands to reduce hypersalivation.

    The risk of complications due to surgery is existent, although a majority of surgeries aimed to treat drooling are relatively simple operations with minimal risks.
  • Intraductal laser photocoagulation is a relatively newer approach to reducing chronic drooling as an alternative to surgery. The method includes a laser intervention to the parotid glands to reduce hypersalivation. It has been reported that the procedure takes about half an hour to sixty minutes and it significantly decreases drooling in cerebral palsy patients.
  • Radiotherapy in patients with amyotrophic lateral sclerosis (ALS) has proved to control drooling with very small amounts of radiation. Despite not being a common treatment, radiotherapy is sometimes used as an option to combat drooling for ALS patients.

Additional Care You Must Take

There is some additional care you must take along with following the frequency and persistence of drooling while sleeping. Here are a few:

  • You should change and clean your sheets and pillowcases regularly as drool shouldn’t be left there even after it dries. Your saliva is home to over six hundred species of bacteria.

    Even though the skin’s exposure to them is relatively harmless, saliva is produced inside the mouth for a reason. Changing your sheets and pillowcases regularly means you will avoid exposing your skin to your saliva.
  • Another thing to look out for is making sure you sun-dry and clean the pillows and mattresses regularly. Because of its chemical composition, the saliva leaves yellow marks on most mattresses and pillowcases.

    In addition to a bad look, the yellow stain on mattresses and pillowcases might harm their material and shorten their lifespan. The longer the drool stays on the mattress, the more likely it will smell. so regular washing and sun drying will prevent the smell.

Drooling in When Sleeping: When to See a Doctor

Drooling when sleeping may require the consultation of a professional, so knowing when to see a doctor is essential. Our recommendation is to see a doctor in case the drooling persists for more than a week despite changing sleeping position and environment.

It is also advised to keep an eye out for any other symptoms besides drooling. If there is any, you should seek medical attention as soon as possible as it is beneficial to diagnose an underlying condition early.

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