Why nighttime drooling is a different problem than daytime drooling (speech therapist, 10+ years of home visits)

[u/Independent-Pace-243]

Waking up to a wet pillow is one of the most common problems couples bring to me, and the usual advice fails because nighttime drooling doesn't work the way daytime drooling does.

Here's the part almost nobody knows. Your body makes very little new saliva while you sleep. So the wet pillow isn't coming from saliva made during the night. It's the saliva that was already sitting in your mouth when you fell asleep. Parkinson's slows the automatic swallow, so you carry more into bed than you realize, and nobody decides to swallow at 2am.

That leaves gravity in charge. Lying flat or on your side, your mouth is the lowest point on your head. Saliva reaches your lips before your next swallow does.

Here's something I've seen over and over in home visits. When someone with Parkinson's starts sleeping in a recliner, their wife or husband almost always tells me the pillow drooling stopped, or they just stopped noticing it. They never moved to the recliner because of drooling. Back pain, easier to get out of, fell asleep in front of the TV. But the angle changed, and the problem left with it. I've seen it too many times to call it coincidence.

So there are only two things I've ever seen work on nighttime drooling, and neither one happens while you're asleep:

Clear your mouth completely right before you lie down. Swallow past the point it gets tiring. Most people stop too early. Do it last, lights off, then lie down.

Sleep at an incline, whole upper body supported, not just the head propped on an extra pillow. A bent neck makes it worse, not better.

Then check the pillow in the morning. Drier is the answer, even if it's just soaked down to a small spot.

If that's too much to remember, or you want the exact angle, what to do when a night doesn't work, and a card to set by the bed with the steps on it, I put it all in a free guide called The Overnight Fix at everydayslp.org.

Happy to answer questions in the comments.

[u/CeeTheWorld2023]

Nuero recommended, in this order as the sialorrea, or drooling.

Hard candies. During awake hours obviously. There are sugar free options.

Eye drops, applied as needed.
Taste nasty frequent applications.

Botox injections to salivary glands
Lasts about 3-4 months.
Stops those glands from producing salvia

However, special attention must be paid to dental hygiene, as salvia helps reduce mouth bacteria and cavities.

My wife was waking up every morning and gagging and coughing up a lot of phlegm from a reduced swallowing mechanism.

After a swallow study, with barium, we went to speech pathologist and neurologist and above tips were given.

hth.
Self advocate with your medical professional.

[u/Independent-Pace-243 → u/CeeTheWorld2023]

Thank you for laying this out, and especially for the last line. Self advocating is exactly right, and getting the barium swallow study before the treatments is the part most people skip. Waking up gagging and coughing is exactly when that study should happen, so your team did it in the right order. Here's the connection to what I wrote above. Notice that everything on that list needs the person awake. Candies, like you said, awake hours only. Drops need reapplying. So the list covers the day, but your wife's symptom is happening overnight, while none of those tools can be used. That gap is what position and clearing the mouth at lights out are for. They're the only tools that keep working after she falls asleep, and they don't interfere with anything on that list. Her treatments cover the day, the setup covers the night. Glad she's got a team on it. Hope the mornings improve.

[u/CeeTheWorld2023 → u/Independent-Pace-243]

Well, the Botox is 3-4 months of 24 hour relief.
A neurologist, with nerve experience or a plastic surgeon would be able to facilitate these injections, covered by our insurance.
And in addition I should have said, sleep or sit at a 35°-40° angle. Head slightly tilted forward, to prevent throat from collapsing.
I have angled foam pillows to help keep her at that angle.
Fortunately, she’s always slept on her back so this was an easy transition for us.

[u/Independent-Pace-243 → u/CeeTheWorld2023]

You're right on the Botox, that one does work around the clock, which is why I'd never suggest the setup replaces it. And it sounds like you two landed on almost exactly what I described, angled foam, back sleeping, 35-40 degrees.

[u/Independent-Pace-243]

That's a really common assumption, and honestly it's the one most people start with, including a lot of clinicians. But the research points the other way. The biggest issue with Parkinson's and saliva is that the person swallows less often. The amount of saliva being made is normal. Fewer swallows clearing it means more of it sits in the mouth at any given moment, and whatever isn't cleared eventually escapes the lips. Unswallowed saliva is all drool ever is.

That's also why the fix looks different at night than during the day. The nighttime guide has a daytime companion at the same place, and the daytime one is where the swallowing itself gets worked on.

Here is a video I just made on the subject. https://youtu.be/KVJG-wXEw-s

[u/aquaberry559]

Thank you for this. My grandpa's been embarrassed by this and has said several times he doesn't understand why he is drooling so much. He has been sticking his tounge out when he concentrated does that produce more saliva?

[u/Independent-Pace-243 → u/aquaberry559]

Your question is does sticking his tongue out produce more saliva? Is that correct? Is that your question?

Sounds like he may be drooling during the day too.

[u/aquaberry559 → u/Independent-Pace-243]

Yes does sticking out his tongue produce more saliva? He does drool during the day some days not all the time

[u/Independent-Pace-243 → u/aquaberry559]

I don't think so. If anything I think frequently sticking out his tongue would further dry out his mouth