GrannyJo4, I can ONLY swallow if my chin is level OR if I "tuck" my chin OR if I put my chin over either shoulder and "tuck" it. I CANNOT swallow like a regular person -- as in tilting my head back to take a swig of Coca-cola out of a bottle. A speech therapist taught me the swallowing "tricks". I ALWAYS use a straw to drink -- this keeps my head in the proper position. ALL straws don't work -- I can't get a "vacuum"/suction on the larger ones -- I buy VERY skinny ones which I grip with my teeth and tongue. Because I have significant Bulbar symptoms, my lips will not grip the straw. (I have the same problem with my asthma inhaler -- and had to cut/modify a plastic ketchup bottle with a hole to fit the breathing part of the inhaler, so that I can inhale through the slim spout.)

I suspect that when you are asleep, your chin in in the level or "tucked" position and THAT is why you are not having trouble swallowing.

I'm having increasing difficulty swallowing my pills. I can swallow solids OR I can swallow liquids (by using the above mentioned methods), but MIXTURES of solids and liquids are a problem. Currently, I toss my head back trying to get the pills into "position" in the back of my mouth at the opening of my throat, then level my chin to swallow. The pills "float", so I sometimes do the head "toss" half a dozen times before success. Even then, I often end up with liquid in my nose -- which I HATE because it burns. But, all of my meds do NOT come in liquid form. I usually let my Mestinon melt under my tongue -- that is the only med I take multiple times a day.