Reflexive vs. Conscious Swallowing: Your Saliva Control

Reflexive actions or conscious actions?

Hello, doctor.
Recently, while chatting with my classmates, I mentioned that I often forget to swallow my saliva.
Everyone found it quite astonishing, thinking that this should be an automatic action controlled by the brainstem in an unconscious state.
However, I have noticed that since I can remember, almost all of my saliva is swallowed subconsciously when I am awake.
In other words, I consciously swallow it when I feel there is too much saliva, rather than it being an automatic, unconscious action.
When I am asleep, as long as I am not lying on my back, saliva will continuously flow onto my pillow, blanket, and bed.
Even when I am lying on my back, I often wake up several times during the night due to saliva overflowing into my airway.
My classmates have also reminded me that saliva is about to drip when I seem to be daydreaming or lost in thought, prompting me to quickly swallow the saliva in my mouth.
I always thought this was not a problem, but hearing their comments made me feel uneasy, so I came to consult you.
Is swallowing saliva mostly an instinctive reflex action? Is it normal for me to need conscious control to swallow saliva? If it is not normal, are there any medications or therapies that can help? Additionally, could this be related to my previous diagnosis of mild Attention Deficit Hyperactivity Disorder (ADHD)? Thank you!

Chen, 20~29 year old female. Ask Date: 2016/01/10

Dr. Jiang Junyi reply Neurology

According to your description, the salivary glands in normal adults secrete 1 to 1.5 liters of saliva daily.
The secretion of saliva is a neurogenic reflex regulated by the cerebral cortex and the autonomic nervous system.
During eating, food stimulates the sensory nerves in the oral mucosa, sending signals to the salivary center in the brain, which then reflexively transmits impulses through the nervous system to the salivary glands, prompting them to secrete saliva.
Saliva can also be secreted through conditioned reflexes involving the cerebral cortex.
Anxiety can inhibit saliva secretion.
Clinically, patients with brainstem strokes may experience loss of swallowing function, resulting in an inability to swallow saliva as well as difficulties with eating and drinking.
Wishing you good health, peace, and joy.
Dr.
Tao, Shen Nei, cares about you.

Reply Date: 2016/01/10

More Info

Swallowing is a complex physiological process that involves both reflexive and conscious control. Typically, swallowing occurs automatically, thanks to the brainstem's control over the swallowing reflex. This means that most of the time, we don't have to think about swallowing; it happens naturally as saliva accumulates in the mouth. However, there are instances where conscious control comes into play, especially when we are aware of excess saliva or when we are in social situations where we might feel self-conscious about our bodily functions.

From your description, it seems that you have a heightened awareness of your swallowing process, which is not necessarily abnormal but could be linked to your previous diagnosis of Attention Deficit Hyperactivity Disorder (ADHD). Individuals with ADHD often experience challenges with attention and focus, which can lead to increased awareness of bodily functions that others might not notice. This heightened awareness could make you more conscious of when you need to swallow, leading to the perception that you are actively controlling the process rather than it being an automatic reflex.

In terms of your experience of drooling while sleeping, this can occur for several reasons. It may be related to the position in which you sleep, the relaxation of the muscles during sleep, or even the production of saliva itself. If you are not swallowing reflexively during sleep, it could lead to the accumulation of saliva, resulting in drooling. This is not uncommon, and many people experience it, especially if they sleep on their sides or stomachs.

If you are concerned about your swallowing and the associated symptoms, it might be beneficial to consult with a healthcare professional, such as a neurologist or an ear, nose, and throat (ENT) specialist. They can evaluate your swallowing reflex and determine if there are any underlying issues that need to be addressed. In some cases, occupational therapy or speech therapy can help improve swallowing techniques and address any concerns related to saliva control.

As for potential treatments, there are no specific medications designed to alter the swallowing reflex itself. However, if your symptoms are linked to anxiety or attention issues, addressing those underlying conditions may help improve your overall awareness and control over bodily functions. Cognitive-behavioral therapy (CBT) or mindfulness techniques can also be beneficial in managing anxiety and improving focus, which may indirectly help with your swallowing awareness.

In summary, while swallowing is primarily a reflexive action, your conscious control over it may be influenced by your awareness and previous ADHD diagnosis. If this is causing you distress or impacting your quality of life, seeking professional advice would be a prudent step. Remember, it’s important to listen to your body and seek help when something feels off, even if it seems minor.

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