Anthony F. Jahn, M.D.

Articles and Tips

That Morning Voice!


It's an almost daily occurrence. I am examining a singer, and ask to hear their voice, only to get an apologetic "I haven't warmed up yet" or "I haven't sung today". Morning voice must be the singer's version of morning breath- everyone has it and everyone hates it. Actually, I have had only one singer tell me that they love their morning voice, and asked how they could maintain it throughout the day! Needless to say, this was not a bel canto tenor, but a rock and blues growler. But for most, morning voice is a problem, and those morning rehearsals and auditions are the bane of the working singer.

Morning voice is the result of several factors, and this column will address some causes, and suggestions for minimizing its effect on your singing.

Consider first, what happens to your throat during the night. When you sleep, many of your bodily functions also slow down, including the movement of the cilia in your respiratory tract. The famous morning smoker's cough is an extreme example of how mucus accumulaes during the night, while your cilia sleep.

We also (for the most part) stop swallowing, and mucus transport grinds to a near halt. Mucus therefore accumulates in the back of the throat. You of course continue to breathe, inhaling a certain amount of dust, and possible allergens. You secrete less mucus, and the residue accumulates in your upper respiratory tract. The effect is worsened if the air in your bedroom is heated and dry. The vocal folds do not produce mucus, and are dependent for lubrication on mucus secreted just above them, in the laryngeal ventricles. Mucus from the ventricles trickles down onto the vocal folds, and is also squeezed down onto the vocal fold surfaces with swallowing. Of course, wet or dry, the folds continue to gently move with quiet respiration, and are in direct path of the inhaled air, which may be hot, dry, and allergen laden. It's easy to see that, as mucus production and swallowing slow down at night, the folds may get dry.

Do you take medications to help you sleep? OTC sleep aids may contain antihistamines, which are drying to the vocal tract. Some singers take Benadryl to help them sleep which is a good OTC sedative but a strong antihistamine that can be quite drying to the vocal tract. Prescription sleeping medications are often not only drying but also alter the quality of sleep, further reducing

the swallowing reflex, and the ability to clear thickened mucus from the respiratory mucous membranes.

Acid reflux is another consideration. You may not be aware of this, especially if you have no symptoms during the day. Acid and pepsin (an enzyme found in the stomach) can travel up the esophagus when you are in a horizontal position, and can pool in the back of the throat. While the stomach lining is capable of dealing with this material (highly acidic, with a pH of 1.0), the mucous membranes of the pharynx and larynx are more reactive. You should suspect reflux if

your morning voice is worse after a late night of eating and drinking, especially if you also have discomfort in your throat, more prominently on the side that you usually sleep on.

Partying often goes along with loud music and loud talking. Vocal strain, especially in social situations, is common. We automatically speak at a sound intensity about 45 dB above background noise (the Lombard effect), and, aided by alcohol, the conversation becomes emotional and even louder- typically, good technique goes out the window. Remember that alcohol also dehydrates - it inhibits a hormone that controls urination, with the result that the more alcohol we drink, the more we pee. The resulting dehydration leaves the membranes more dry, less flexible, and can worsen your vocal hangover.

Consider next whether you have any nasal obstruction. This may be an intermittent or alternating blockage such as caused by swelling of the turbinates, a constant impairment caused by a deviated septum, or a combination of the two. If the blockage is significant, we usually breathe through the mouth. Patients often deny that they snore (unless their partner, sitting in the examination room, contradicts them!), but may be aware that they breathe through their mouth at night. Some patients who live alone are not even aware of this, but will admit that they wake up with a dry and uncomfortable throat in the morning- indirect evidence suggestive of mouth breathing.

Recent weight gain should also be considered. This can cause both acid reflux, and upper airway obstruction with snoring and mouth breathing. Interestingly, the weight gain to cause this (and they weight loss needed for its cure) can be as little as five pounds - you needn't be massively overweight.

Now comes the useful part- how to avoid or minimize morning voice? Going down our list, my first suggestion is that you hydrate well during the evening. Even at the risk of having to get up to go to the bathroom, you should drink plenty of water at dinner time, and keep a glass by your bedside. If you can sleep without sleep aids, do so. Obviously there may be times, such as times of anxiety or time zone change, when you might need help, but in general consider avoiding such medications. Consider visualization, breathing techniques and other methods of relaxation.

Keep the heat down in the bed room, and consider a humidifier or cool mist vaporizer to decrease drying of the vocal tract. This not only keeps your mucous membranes moist, but also reduces the effect of airborne particles such as dust, mold and animal dander.

If you suspect that you may have reflux, change your evening meal to a light one, and eaten at least two hours before going to bed. Try elevating the head of your bed slightly, either by placing blocks under the bed or using a light wedge under the mattress. You should also consider a two week trial of OTC Gaviscon liquid, taken 1 tablespoon at bed time. This both neutralizes stomach acid and mechanically blocks it from coming up the esophagus.

Allergies should be considered, especially to allergens found in the bedroom. These include dust, dust mites, mold, feathers, pet dander and (sorry!) cockroaches. You can consult an allergist, or try a mild OTC antihistamine or nasal spray. These might open up both the nasal passages and reduce swelling in the upper respiratory tract. Nasal obstruction can initially be tackled with Breathe Rite nasal strips or other mechanical devices that keep the nose open. If these help, you're off to the races! And if not, you're off to your ENT doctor's office.

When you get up in the morning, hop into a hot steamy shower, to clear debris off your vocal tract. Hawking and spitting is permitted, and encouraged before your start vocalizing. Only now are you, and your vocal apparatus, ready to face the world, your morning voice hopefully behind you for another day.