Case Study: Idiopathic Paroxysmal Sleep-Onset Xerostomia Causing Insomnia in a Young Adult Female

Case at a Glance

A 23-year-old female presents with a perplexing case of severe, abrupt-onset xerostomia occurring exclusively at the transition to sleep. This condition causes significant sleep-onset insomnia and is unresponsive to conventional measures but uniquely alleviated by a specific brand of throat lozenge.

Patient's Story

The patient, a 23-year-old female, reported a recurring and highly specific sleep-related issue. She described that on some nights, precisely at the moment she is about to fall asleep, she experiences a sudden and intense sensation of dryness in her mouth and upper throat. She likens the feeling to severe mouth breathing, although she is confident she is not doing so. Her own description is that it feels as if her 'saliva glands fall asleep too.' This jarring sensation immediately awakens her, preventing sleep and causing significant frustration and irritation.

Initial Assessment

Upon presentation, the patient complained of nocturnal xerostomia that was strictly limited to the point of sleep onset. The primary consequence of this symptom was sleep-onset insomnia. The patient had attempted typical remedies, such as drinking water before bed, but found that the dryness and thirst would return the instant she began to drift off to sleep. She had previously consulted multiple physicians about this issue but reported that they were unable to provide a diagnosis or explanation, stating they 'don't know what's going on' and dismissing it as insignificant.

The Diagnostic Journey

The patient's diagnostic journey was largely self-directed due to a lack of conclusive findings from medical consultations. Frustrated by the lack of answers, she experimented with various remedies. She discovered by chance that a specific brand of lemon-flavored throat lozenge, 'Triplex,' was uniquely effective. Sucking on the lozenge stimulated sufficient saliva production to counteract the dryness, allowing her to fall asleep. Intriguingly, she noted that other sweets, candies, or flavors did not have the same effect; the relief was specific to this product. The highly localized and time-specific nature of the symptom, without other associated signs of autoimmune disease or systemic conditions, made diagnosis challenging for the clinicians she saw.

Final Diagnosis

Idiopathic Paroxysmal Sleep-Onset Xerostomia. This is a descriptive diagnosis, as a specific underlying etiology has not been identified. The condition is characterized by episodic (paroxysmal) dry mouth (xerostomia) that is tightly linked to the neurophysiological transition from wakefulness to sleep. The absence of other findings suggests it is an isolated phenomenon.

Treatment Plan

The patient's management plan is self-developed and focuses on symptom control. On nights when the xerostomia occurs, she uses the specific lemon-flavored 'Triplex' lozenge as a sialogogue (a substance that promotes salivation). This provides immediate relief from the dryness and breaks the cycle of being awakened, thereby enabling sleep. No other formal medical treatment has been prescribed or found effective.

Outcome and Follow-up

The patient has found a functional, albeit unconventional, method to manage her symptoms and mitigate their impact on her sleep and quality of life. The underlying condition persists, but its primary complication—insomnia—is successfully controlled with her chosen remedy. While the patient has not received a formal diagnosis, she is able to function well with her management strategy. Future follow-up could involve referral to an Otolaryngologist (ENT) or a sleep medicine specialist to investigate potential autonomic nervous system dysregulation at sleep onset, but the patient remains hesitant given her previous unhelpful consultations.