Drooling into your pillow could be a sign of a more serious issue

By Sandee LaMotte, CNN

(CNN) — The evidence is irrefutable — a pile of drool atop a drenched spot on your pillow. As you awake with a start, you might even wipe that bit of spittle still dangling from your mouth.

Drooling can be embarrassing, especially if you’re waking up to a newly minted lover beside you. But if you’re sleeping alone or next to a seasoned partner who isn’t disturbed by bodily functions, experts say it’s not a big deal — unless it’s a frequent occurrence.

“Everyone drools at one time or another when we have too much to drink the night before or fallen asleep on the couch after a big holiday dinner,” said Dr. Landon Duyka, a clinical assistant professor of otolaryngology — head and neck surgery at Northwestern University Feinberg School of Medicine in Chicago.

“If this is more of a persistent thing — you’re waking up every night and your pillow is drenched — we want you to see a doctor, especially if it’s recent,” Duyka said. “It could be a sign of a more serious sleep disorder or even a neurological condition such as Parkinson’s.”

What causes drooling

There are numerous causes of drooling — some benign, others less so, experts say.

“If you’re concerned, the first thing I suggest is an at-home sleep study to determine if there is a more serious reason behind the drooling,” said Dr. Neil Hockstein, founder and the chief medical officer of Parallel ENT & Allergy and a clinical assistant professor of otolaryngology at Sidney Kimmel Medical College at Thomas Jefferson University in Philadelphia.

Sleep apnea: A potentially dangerous reason for drooling is sleep apnea, in which people stop breathing multiple times an hour for up to a minute during the night. In severe cases of sleep apnea, people stop breathing hundreds of times each night.

“When that happens people often switch to breathing through their mouth to get more air, which allows saliva to pool and escape,” Duyka said. “Sleep apnea is a serious medical condition — if your partner tells you that you snore at night or you often wake up with a dry mouth or drooling, consider seeing a sleep specialist.”

About 23.5 million people in the US who have sleep apnea are undiagnosed, according to the American Academy of Sleep Medicine. Yet the condition can lead to heart disease, diabetes, stroke, depression and even premature death if left untreated.

Mouth breathing: Being a mouth breather is a key cause of drooling, experts say. Some people are born with a tendency to breathe through their mouth, due to extremely small nasal passages or a recessed jaw. A congenital deviated septum, where the thin wall between the nostrils is displaced, blocking one of the airways, can also be a cause.

“If you suspect you might have a blockage due to a deviated septum, enlarged adenoids or the like, it’s a good idea to see an ear, nose and throat specialist who can decide if surgery would be helpful,” Hockstein said.

Celebrities and TikTok influencers frequently recommend mouth tape to limit breathing through the mouth. However, the science is still out on any benefits of mouth taping — and there are harms, especially for people with sleep apnea, according to experts.

A recent analysis found taping or sealing the mouth closed or strapping the chin to keep the mouth closed “could pose a serious risk of asphyxiation in the presence of nasal obstruction or regurgitation.”

The study’s senior author, sleep specialist Dr. Brian Rotenberg, previously told CNN that the benefits promoted on social media aren’t necessarily backed by science.

“Improving apnea, improving snoring, making your nose look better, making your jaw look better — it just doesn’t come out in the wash that that actually is what’s happening,” said Rotenberg, a professor of otolaryngology — head and neck surgery at Western University’s Schulich School of Medicine & Dentistry in London, Ontario.

Acid reflux: Having a nasty taste in the mouth, chest pain and regurgitation are all signs of acid reflux, the backward flow of stomach acid or food into the esophagus. It occurs when the lower esophageal sphincter muscle fails to close properly and can be a cause of drooling.

“A lot of patients with acid reflux will notice they have more coughing at night because they are making more saliva,” Duyka said. “They may wake up in the morning with a throat full of mucus. That’s a protection mechanism, in which your body is trying to compensate by changing the pH of your esophagus to neutralize and wash away the acid.”

Stuffy nose: Seasonal allergies, colds, strep throat, tonsillitis and sinus infections can inflame nasal tissues and block airways as well, leading to increased drooling, Duyka said.

“An infection like a tonsillitis is going to make you salivate more and then drool; even a cold sore in your mouth will do that,” Duyka said. “The body will produce more saliva as a defense mechanism to flush out bacteria.”

Dental issues: Drooling can also be caused by dental issues, such as teeth grinding or a misalignment between the upper and lower teeth that might be affecting how your mouth closes at night.

“I suggest people speak with their dentist and see if there’s something going on with their bite, to make sure that there isn’t something simple that could be done with an oral appliance,” Hockstein said.

Sleeping position: Side and stomach sleepers are most likely to see signs of drooling as gravity will pull the excess saliva onto the bed or pillow. For back sleepers, saliva may either stay in the mouth or travel down the throat.

However, people with swallowing issues could be in danger due to weaker muscle tone and a loss of sensory input, Duyka said.

“Most of us have a mechanism that would make us cough, sputter and wake up if we are on our backs and have too much saliva in our mouths,” he said. “Some older people don’t have the same sensory system in their throat they used to, so saliva may trickle into their lungs. That’s a risk for what we call silent aspiration.”

A lack of ability to swallow can also be a sign of a more serious condition, Hockstein said.

“I don’t want to instill fear in everyone, but there are rare instances where someone presents with difficulty swallowing and you ask them to walk and notice they’re shuffling a little bit or their facial expressions are somewhat blunted, which can be some of the first signs of Parkinson’s or some other neurodegenerative disease,” he said.

Any concern about drooling should be taken up with an ear, nose and throat doctor, who may recommend a sleep study, Hockstein said.

“I’m going to ask questions such as, ‘Do you snore or wake up with headaches? Are you clenching or grinding your teeth? Do you have fatigue or sleepiness in the afternoons?’ From that I’ll decide if a sleep study would be helpful,” he said.

“If they don’t have sleep-disordered breathing or a physical cause such as a deviated septum, the first thing I will do is reassure my patient that drooling is typically no problem,” Hockstein added. “If colds or allergies appear to trigger it, I may also suggest an over-the-counter antihistamine.”

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