Why does my throat hurt so much overnight that even swallowing saliva is painful, and what should I do?

Generally, sore throat and pain while swallowing saliva that develop overnight may be caused by dry sleeping environment, excessive voice use, acute pharyngitis, acute tonsillitis, epiglottitis, etc. Treatment can include general care and medications under a doctor's guidance. If discomfort occurs, it is recommended to seek medical attention promptly for standardized treatment under medical supervision. Detailed explanations are as follows:

1. Dry sleeping environment

During sleep, if the surrounding air is excessively dry, it can cause significant moisture loss from the mucous membranes of the throat. The dried mucous membranes become fragile and more susceptible to irritation. When swallowing saliva, the movement of throat muscles and friction against the mucous membranes increase, leading to pain. It is important to maintain an appropriate level of humidity in the sleeping environment and drink an adequate amount of water before bedtime.

2. Excessive voice use

If one engages in prolonged loud talking, singing, or crying before bedtime, the throat muscles may become overly fatigued, causing congestion and swelling of the vocal cords and throat mucous membranes. Pain occurs when the swollen tissues are compressed and rubbed during swallowing. It is important to manage voice usage reasonably and avoid prolonged, high-intensity vocal activities.

3. Acute pharyngitis

Acute pharyngitis is often caused by viral or bacterial infections. After invading the throat mucosa, viruses or bacteria trigger an acute inflammatory response, resulting in mucosal congestion, edema, and increased sensitivity. Pain occurs during swallowing due to the interaction between throat muscle contractions and inflamed mucosa. Symptoms may include a burning sensation in the throat and dry cough. Treatment may include medications such as compound borax mouthwash, Benzhushuang lozenges, and azithromycin tablets, as directed by a physician.

4. Acute tonsillitis

Acute tonsillitis is primarily caused by bacterial infections such as group A beta-hemolytic streptococcus. Bacteria multiply within the tonsillar crypts, causing the tonsils to become congested and swollen. The inflammation may spread to surrounding throat tissues, leaving the throat mucosa in an inflamed state. Pain intensifies during swallowing due to dual irritation from swollen tonsils and inflamed mucosa. Symptoms may also include high fever and chills. Treatment may include medications such as penicillin V potassium tablets, Lanqin oral liquid, and ibuprofen sustained-release capsules, as directed by a physician.

5. Epiglottitis

Epiglottitis is usually caused by bacterial or viral infections, trauma, or other factors. Once the mucous membrane of the epiglottis becomes inflamed, it swells rapidly. As the epiglottis is an important structure in the larynx, its swelling can severely impair normal physiological functions of the throat. Severe pain occurs during swallowing due to movement of the epiglottis and friction or compression against surrounding tissues. Symptoms may also include difficulty breathing and fever. Treatment may include medications such as cefixime dispersible tablets, cefuroxime axetil tablets, and amoxicillin-clavulanate potassium tablets, as directed by a physician.

In daily life, one should maintain fresh and humid indoor air, avoid excessive voice use—especially when fatigued or unwell—and engage in regular physical exercise to enhance immunity and prevent infectious diseases.