Why do adults and children drool during sleep?

When children drool in their sleep, for most it only causes touching smiles. The reasons are clear - in infants, increased salivation is caused by teething, and older children, having worked hard during the day, sleep so soundly that the muscles supporting the jaws completely relax, and a thin stream of liquid flows freely from the mouth.

For adults, the picture does not look so touching, and waking up on a pillow wet from your own saliva is not very pleasant. In addition, it is completely unclear why an adult drools during sleep and whether it is possible to somehow combat such an unaesthetic phenomenon.

What factors influence the secretion of saliva during sleep?

There are also more serious reasons for drooling from the mouth that need to be identified. Some cases require timely treatment. They may be related to:

1. An existing disease in the nasal cavity - the inflammatory process in the nasal mucosa is not a harmless disease that can be left to chance. The mucous membrane performs a number of important functions that are disrupted when a runny nose occurs. It can be allergic, infectious, vasomotor, traumatic, medicinal, hypertrophic, meteotropic and atrophic. In any case, the breathing process becomes difficult for a person; during sleep, the mouth is slightly open, which is why salivation occurs.
2. A deviated septum in the nose also makes breathing difficult, which forces a person to sleep with their mouth slightly open.
3. An infectious process in the nasal cavity - diseases of the teeth and gums can provoke drooling during sleep.
4. Disruption of the gastrointestinal tract - during inflammatory processes in the stomach, acidity increases, which leads to copious secretion of saliva. The same thing happens if there are other chronic diseases of the gastrointestinal tract.
5. Worms and other parasites in the body.
6. Disorders of the nervous system, taking medications that place increased stress on the body. Problems associated with disruption of normal sleep, manifested in insomnia or excessive sleepiness.
7. The presence of a foreign body in the oral cavity - these can be braces or dentures, which irritate the nerve endings, causing copious salivation at the reflex level.
8. Smoking and drug use irritate the salivary glands and taste buds, which increases salivation.
9. Imbalance of hormones in diseases of the endocrine system.
10. Inflammation of the salivary glands.
11. Parkinson's disease.

The child is drooling: what to do?

An average person produces between 500 ml and 2,000 ml of saliva per day. It plays an important role in our body: moistens food, promotes chewing and swallowing, moisturizes the tongue and lips during conversation, promotes normal speech, cleans teeth and gums and maintains normal oral hygiene. Saliva regulates acidity in the esophagus (saliva has an alkaline pH), destroys microorganisms and cleanses toxic substances, enhances the perception of taste, and begins the digestion of carbohydrates (contains enzymes for this). However, with some diseases, the amount of saliva increases and it flows out of the mouth, which, in turn, causes discomfort.

Why this happens and what to do about it, we figure it out with Natalya Savva, Candidate of Medical Sciences, Associate Professor, Director of the Children's Palliative Charitable Foundation for scientific and methodological work.

What is drooling?

Saliva leaking from the mouth can occur when:

• Increased production of saliva (hypersalivation).
• Impaired swallowing of saliva and sputum (impaired lip closure and impaired swallowing - dysphagia).

Each child has its own reason or combination of these factors. Therefore, to select the correct treatment, you need to find out what underlies drooling in each child individually.

Do healthy children drool?

Typically, drooling occurs in children under one year of age (the peak occurs at 5-6 months). This age-related feature completely disappears by the age of two - by this time the child’s oral cavity has functionally matured.

In addition, increased salivation in children occurs when their teeth grow, they are in psycho-emotional agitation, if they feel sick and vomit.

Drooling can occur due to the taste or smell of food, spices, acid, pleasant or unpleasant physical and emotional stimuli, as well as in anticipation of food or fear of pain.

What can cause or worsen drooling?

Diagnosis of swallowing dysfunctions What are the main signs of dysphagia, when is it necessary to test using the three-swallow test method Kristina OsotovaCaring Workshop
Nursing

Causes of drooling or its intensification can be:

• Loss of drool control.
• Inadequate lip closure and open mouth.
• Impaired or lack of sensitivity in the oropharynx.
• Impaired tongue movement.
• Impaired tone of the tongue and lips.
• Dysphagia (impaired frequency of swallowing and difficulty swallowing).

These conditions may cause or worsen positional problems (poor head and neck control), problems with teeth and dental structures, and the use of medications (eg, for the treatment of epilepsy).

What diseases cause increased salivation?

There are diseases in which drooling increases: temporarily or chronically, depending on whether the cause of drooling can be treated.

Increased saliva production and/or impaired saliva retention in the mouth occurs when:

• Organic lesions of the central system (cerebral palsy (CP), trigeminal facial palsy, neurodegenerative diseases of the central nervous system). Most children with cerebral palsy have impaired swallowing and control of saliva flow; they cannot close their lips while swallowing. Impaired swallowing of saliva is affected by spasticity and muscle dystonia: this causes problems with tongue control, high tone of the tongue and muscles of the oropharynx, spastic contraction of the upper esophageal sphincter, and poor coordination between the pharynx and this sphincter. In addition, the loss of control over holding the head and neck affects swallowing disorders.
• Neuromuscular diseases (spinal muscular atrophy, Duchenne muscular dystrophy, myopathies, myasthenia gravis, myositis). In neuromuscular diseases of muscle tone (for example, SMA, Duchenne muscular dystrophy), salivation occurs due to increasing atony of the muscles of the lips, oropharynx, esophagus, stomach, intestines, the addition of gastrostasis (delayed gastric emptying) and gastroesophageal reflux.
• Cognitive and mental disorders. Drooling can develop due to delayed psychomotor development (impaired formation and development of swallowing movements, ineffective and infrequent swallowing, incomplete closure of the lips during swallowing).
• Diseases of the ear, nose and throat. Acute infectious processes of the oral cavity and pharynx (gingivitis, stomatitis caused by viruses, bacteria, fungi) cause damage to the mucous membrane, as well as pain and problems with swallowing. This causes drooling, for example, with tonsillitis, peritonsillar or retropharyngeal abscess, epiglottitis.
• Diseases of the gastrointestinal tract, esophagus (gastro-esophageal reflux, gastroparesis, gastrostasis, pancreatitis).
• Familial autonomic dysfunction (Riley-Day syndrome), Wilson's disease, Rett syndrome.
• Vitamin B3 deficiency.
• When taking medications. Hypersalivation is caused by various drugs: antiepileptics (clonazepam), painkillers (morphine), pilocarpine, haloperidol; benzodiazepines.

How is drooling treated?

• Conservative non-pharmacological therapy

How to properly treat the oral cavity of a seriously ill patient We show exactly how and in what positions you can brush your teeth Kristina OsotovaCaring Workshop

Care

It is important to promptly identify and begin treatment for the cause of drooling, monitor oral hygiene, regularly brush your teeth, and remove plaque. It is advisable to replace medications that cause or increase salivation (only after consulting a doctor). Take your child to the dentist more often - every 4-6 months.

Physiotherapy will improve jaw closure and tongue function, develop tongue mobility, strength and placement in the oral cavity, and improve lip closure, especially during swallowing. Positioning and swallowing development (speech therapy massage) are also helpful.

If a child has moderate drooling, normal or nearly normal intelligence, and is highly motivated to stop drooling, behavioral or biofeedback therapy may help. The correctness of swallowing is monitored by parents or using special computer programs.

To prevent saliva from irritating the skin or if maceration occurs (swelling and wrinkling of the skin from prolonged contact with water), use a barrier cream or ointment.

• Pharmacotherapy

Important: Drugs are started with minimal doses and increased to maximum doses carefully depending on the clinical effect.

1. Anticholinergic drugs - atropine, benzatropine mesylate, scopolamine, hyoscine - reduce the volume of saliva. But they may have side effects: blurred vision, dry mouth, constipation, urinary retention.
2. Scopolamine or hyoscine patch (in the photo - behind the child’s ear). They last 48 or 72 hours and are glued to the skin behind the ear.
3. Glycopyrrolate is a long-acting medicine (8-12 hours) with minimal side effects. The drug is 5-6 times more effective than atropine, effective in 90% of patients with hypersalivation.

Photo by Alexandra Glagoleva

• Botulinum therapy

Botulinum therapy is used to treat muscle spasticity, for example, with cerebral palsy. The medicine blocks nerve impulses in the muscles, sweat and salivary glands. In case of drooling, the medicine is injected directly into the salivary gland under ultrasound control and local anesthesia in a day hospital (24-hour observation is not required).

The therapy consists of four injections, which are placed in the submandibular and parotid glands. On average, salivation decreases for 6 months. Side effects are minimal and usually occur at the injection site. Speech and swallowing may be slightly impaired.

• Surgery

Surgical treatment is prescribed for children over 6 years of age with profuse uncontrolled drooling (if conservative therapy has no effect within 6 months).

There are different types of surgical procedures to treat drooling (eg, deinnervation of the salivary gland, excision of the salivary gland (eg, submandibular), ligation of the salivary gland duct, etc.). The operation lasts 60-90 minutes, requires general anesthesia and a 24-hour hospital stay for several days.

When excision of the salivary glands there is a high risk of damage to nearby nerves and paralysis of the muscles that this nerve innervates. Side effects early after surgery may include bleeding, swelling, infection, and difficulty swallowing.

Complications of drooling

Drooling is a cosmetic defect. It can lead to social isolation and have very severe psychological consequences for the child and the entire family. Drooling can cause emotional and physical discomfort in a child. Children with drooling can soak not only their own toys and books, but also the things of those around them, which is especially negatively perceived in public places and organized children's groups. Severe drooling increases the burden on parents: they need to constantly change things and blot the saliva.

Drooling contributes to the spread of infection, loss of fluid and electrolytes, and in severe cases can cause dehydration (dehydration), deterioration of articulation and speech.

How to dress a child with severe drooling?

Adaptive clothing for children What clothes can be chosen for children with contractures and prostheses, and why teenagers with disabilities want to look like ordinary kids Katerina Pechurichko

Palliative care for children

Bibs and scarves

If drooling is severe, use waterproof bibs (for example, silicone ones with a pocket for collecting saliva or double ones with a waterproof bottom layer). An older child can wear a beautiful saliva-absorbing colored scarf with a pattern over the bib (so getting wet is less noticeable). Stock up on several scarves of the same color: this way you won’t notice their replacement (you need to change scarves often so that bacteria don’t multiply and things don’t smell).

Vests

If your clothes get wet, it is often inconvenient to change them: wear vests over your clothes, which are easy to remove and change when they get wet. You can use windbreaker fabric to make the vest get wet more slowly.

Velcro

Collars and other parts of clothing may have Velcro, which can be quickly unfastened and allow you to quickly change clothes, even in public places.

Created using a grant from the Absolut-Help Charitable Foundation

Stock image used from Depositphotos.

Causes of nighttime salivation in children

To find out why a child is drooling, let’s consider the main reasons; they may be related to:

• psychological diseases;
• brain tumors;
• taking certain medications;
• viral diseases;
• stomatitis;
• the presence of parasites;
• stomatitis;
• damage to the central nervous system;
• diseases of the gastrointestinal tract.

In infants, increased secretion is considered normal, since the salivary glands have not yet formed. This may also be due to the fact that the baby has started teething. But still, if there is a lot of drooling, then it is worth showing the child to the doctor to exclude the development of pathologies. Too much saliva can cause problems with speech development. Therefore, it is necessary to show the child to a specialist who prescribes medications or decoctions to normalize the baby’s condition. You should not self-medicate without consulting a doctor and risk your child’s health. Herbal infusions and decoctions, if given thoughtlessly, can cause a serious allergic reaction.

Complications

Excessive drooling from the mouth affects the skin; a person sleeps for some time with his cheek on a wet pillow, so one of the unpleasant consequences may be a violation of the integrity of the facial skin or the appearance of an infectious pustular rash.

Normally, the body secretes one and a half to two liters of saliva per day. With severe drooling, a person can lose up to 10-12 liters of salivary fluid, which can lead to dehydration that is dangerous for the body. And, of course, there is incomparable psychological discomfort, stress and sleep disturbances.

How to get rid of hypersalivation

It is important to visit a doctor in time for examination, to identify the cause of drooling and adequate treatment. To establish the exact cause, it is necessary to undergo a comprehensive examination. The doctor collects the patient’s life history, symptoms, his working conditions, the presence of bad habits and possible diseases. The dentist carefully examines the oral cavity and identifies diseases of the mucous membrane, teeth or gums. If the specialist did not find any abnormalities and it turned out that salivation is related to physiology, then salivation can be reduced thanks to:

• fighting bad habits;
• eliminating spicy and salty foods from the diet;
• drinking quince juice;
• rinsing the mouth with herbal decoctions - chamomile, oak bark and sage;
• trying to sleep on your back and not on your side;
• caring for the nasal cavity - before going to bed, it is advisable to rinse it with saline or sea water, breathe over essential oils (camphor or eucalyptus).

Drooling during sleep during pregnancy

• Drooling in a dream during the period of bearing a child due to the complete restructuring of the female body and, in particular, hormonal levels.
• profusely during sleep , but this should not frighten the expectant mother. It should be remembered that with the birth of the child this phenomenon will pass by itself. Often, increased salivation ends when placentation is completed and the organs of the embryo are formed - around the 16th week.
• If drooling causes inconvenience or anxiety in a pregnant woman, it is better to consult a supervising doctor.

May also occur in pregnant women

Treatment of excessive salivation with surgery

In particularly severe cases, surgery may be prescribed. In this case, particularly large parotid salivary glands can be removed. The operation is quite complex and can lead to certain consequences. If the facial nerve is damaged, symmetry can be seriously disrupted. The decision on surgical intervention and the advisability of such actions is made only by an experienced and highly qualified specialist.

The operation helps stop excessive drooling for up to 8 months. This is not a radical measure. It is impossible to completely get rid of the disease in this way. Therefore, in any case, you need to start with an examination of the body and its traditional treatment.

Remember that saliva not only interferes with comfortable sleep and rest, but also threatens human life. A sleepy person can easily choke in it. To prevent the consequences of hypersalivation, we recommend that you do not delay and make an appointment with a professional therapist who can find the cause of the malfunction in the body.

Why does the problem occur in a dream?

If you find that you are drooling during sleep, then the reason for this may well be:

• sleep disorders;
• curvature of the nasal septum;
• asthma or allergies;
• nasal congestion.

In such cases, copious secretion of excessively thin saliva occurs exclusively at night. At the same time, during the day a person does not suffer from such an ailment. It is common to talk about nocturnal hypersalivation.

It happens that a completely healthy person also leaks a lot of fluid from his mouth at night. One-time drooling during sleep can happen if a person is very tired over the past day, quickly passed out and completely relaxed. The jaws opened slightly and saliva began to flow out. In such situations there is absolutely nothing to fear. This is a completely understandable and extremely rare phenomenon that does not pose any threat.

If you go to smoke or just eat at night, and then quickly fall asleep, then at night you can also see wet sheets. But this has nothing to do with pathologies, serious diseases or consequences for the body.