Didgeridoo sleep apnea

Ok, so it is official. I am a CPAP failure. I gave it my best effort, but I just couldn’t do it.

The first night I used the machine, I got in 4 hours before the noise woke me up and I couldn’t fall asleep again. Despite that, I felt great the next day…this sent a message to me that my sleep has been seriously disrupted by the apnea.

The next night, the CPAP nasal pillows rubbed my nostrils and drove me crazy…crazy…crazy. My sleep was fitful.

The final night of my failed trial, it was both the noise and the nostrils that took me from a beautiful pre-CPAP drowsiness to an angry, wide-awakefulness due to trying to sleep with this “therapy” on my face. After two hours, I ripped the nasal pillows off of my face and threw them to the ground. I promptly fell asleep and awoke the next day feeling pretty darn good.

 

After the CPAP failure

Now I am a doctor so I know that “silent” conditions, like sleep apnea, can shorten your life. And, of course, I plan on living forever.

OMG, in considering my options, I decided that CPAP is so unpalatable to me that I would rather lose 20 pounds and give up wine with dinner. I am highly committed to making these behavioral changes so that I can “cure” my sleep apnea. So there! That is what I am going to do.

 

The intro to the diggeridoo

Resolute on implementing my plan, I went to return the medieval torture device to the lovely people at the Kaiser San Rafael sleep center. The nurse who took care of me was explaining CPAP alternatives and, in the course of the explanation, laughingly said, “You could take up the didgeridoo.

This caught my ear. Since I got the diagnosis of sleep apnea, I have been reading the sleep apnea literature. I remember reading that the British Medical Journal published a paper, entitled, “Didgeridoo playing as alternative treatment for obstructive sleep apnea syndrome: randomized controlled trial” in February 2006.

So, the nurses’ remark about the didgeridoo made me think: “What is worse—the dreaded CPAP machine or learning to play an Australian aboriginal wind instrument?”

 

The study

So I tracked down the BMJ didgeridoo study on the Internet. Here is what the researchers did. They recruited 25 people, aged >18 years old who had an apnea-hypopnea index of 15-30 (moderate sleep apnea). The participants in the study could not be using CPAP, drugs that act on the nervous system, drink no more than 14 drinks/week, be obese, or have an active weight loss plan.

The patients were randomized into an intervention group—the didgeridoo trainees—or a control group. The didgeridoo group got individual lessons on how to play the instrument from a didgeridoo instructor. Over time they were taught circular breathing—a technique that enables the instrument player to maintain a sound for long periods by inhaling through the nose while maintaining airflow through the instrument, using the cheeks as bellows. In later lessons, they learned to “optimize the complex interaction between the lips, the vocal tract, and circular breathing so that vibrations in the upper airway are more readily transmitted to the lower airways.

The didgeridoo trainees practiced 5.9 days a week for 25.3 minutes a day. The control group people were told they were on a waiting list to start their didgeridoo training. They were not allowed to start playing the instrument during the four month training period.

 

The findings

Daytime sleepiness (as measured by the Epworth index), the primary outcome of the study, improved significantly (-3 units) in the didgeridoo group compared with the control group. The apnea-hypopnea index also improved significantly (-6.2) as did the partner rating of sleep disturbance (-2.8).

Despite these positive findings, there was no effect on the quality of sleep as measured by the Pittsburgh quality of sleep index. There was no significant effect on the SGF 36 and adjusting for severity of the condition and weight change during the study did not alter the results.

 

The conclusion

The conclusion of the study was that didgeridoo playing improved daytime sleepiness in patients with moderate snoring and obstructive sleep apnea. It also reduced sleep disturbance in their partners.

Limitations of the study are the small number of participants and the exclusion of folks with predisposing behaviors (alcohol and drug consumption). That being said, it seems like a pretty benign treatment, and if nothing else, for someone like me, there may be a placebo effect that is additive to known behavioral interventions, such as alcohol abstinence and weight loss.

 

So, what should this CPAP failure do?

For now, I have expanded my Sleep Apnea Self-Directed Treatment list to the following:

  • Lose 20 pounds
  • DC wine
  • Buy a didgeridoo
  • Find a didgeridoo trainer
  • Practice at least 5.9 days per week for 25 minutes a day

Wish me luck!


Update (09/09/15):

So I didn’t lose the 20 pounds or give up the evening Chardonnay, but I did buy a didgeridoo and took some lessons. Here was the problem. I simply couldn’t make music with the instrument. I would blow and blow and blow, but hardly ever created anything but air-sounds. It was pathetic. So, I quit. Another failure under my belt.

But, there is hope on the horizon—an new product in development called the Airing—a hoseless, maskess micro CPAP. Here’s a link to learn more. It’s my next sleep apnea dream.


Featured photo credit: “Didgeridoo (Imagicity 1070)” | by Graham Crumb/Imagicity.com | via Wikipedia | CC BY-SA 3.0

9 COMMENTS

  1. I ‘ve sleep apnea ,too.( OSA )

    I tried many solutions to cure it. (surgeries,using cpap etc )

    I got septoplasty and uppp surgeries and tried using cpap.(I couldn’t tolerate it)

    Also the surgeries didn’t work at all.

    Now, ı ‘ve started learning play didgerideoo.

    I am not sure that ı can follow this website and these posts.

    But ıf you can ask me via e-mail for the results,

    ı will try to reply.

    Kindly regards.

    Umut EJDER

  2. The original Didgeridoo study for Sleep Apnea at the University of Zurich did not involve circular breathing in the protocol. They decided that it would delay the study to be sure that every participant was adequate at the technique. This is great news if the idea of learning circular breathing has held you back from giving didgeridoo therapy a go.

    Patricia, it’s been nearly a year since this article was published. How are you doing with your didgeridoo therapy?

    • Barry, thanks for this nudge. I never could get the hand of the circular breathing. Life got busy and the didge took up residence in a corner of my living room. You have motivated me to take it up again.

  3. Hi Patricia,

    I too am a sleep apnea sufferer (in Marin County, too). For a couple of years I tried CPAP–many, many machines, masks, settings, hoses, chin straps, etc, etc, etc–and finally gave up. I ended up having two operations: a septoplasty/turbinate reduction to allow CPAP to be more effective (it didn’t work for that) and then, four months ago, maxillomandibular advancement (MMA). Both surgeries were performed by one of the very best surgeons for sleep apnea–but, unfortunately, though MMA has a success rate of 90%, I appear to be in the 10% for whom it is ineffective. Neither my subjective daytime experience nor my objective sleep apnea numbers have improved at all. Though there are yet further surgeries to reduce the soft tissue, my surgeon want me to try CPAP again, and is all in favor of me trying anything else that I might think would be effective, including didgeridoo playing, before any other surgeries are put on the agenda. I have such unpleasant memories of CPAP that, although I have my old CPAP out, I have yet to fire it up. One thing that may help is to use a sleeping pill that doesn’t disrupt sleep architecture too much, like Ambien or Lunesta, to be able to sleep through the disruptions of the CPAP that would otherwise wake you up.

    So, like you, I have been trying alternatives, and didgeridoo is on the list. I’ve been playing for just a few days, I find it pretty easy and fun, and circular breathing does not seem as difficult for me as some people report, but obviously I have a long way to go before I’ll know if it produces any significant results.

    Other possible treatments that that you and your readers might consider are:

    Positional therapy: I found that simply sleeping on my side reduces my AHI by over 75% (as shown in a sleep study). I found I need an aid to keep me off my back, the best I’ve found so far is the Rematee (I actually use two of these, with one I can still manage to get on to my back)

    Tongue and mouth exercises: A Brazilian study a few years ago found these to be effective. Probably overlaps somewhat with didgeridoo playing, but if there are any mechanisms by which it works that aren’t part of the didgeridoo mechanisms, you can hope for an additive effect with the didg. There is a teacher in the Bay Area who teaches tongue exercises that, according to an accompanying article to the Brazilian article, are probably what are the most effective exercises of those described int he paper.

    Reduce lower extremity edema: There was a study recently that found that those with lower extremity venous valve insufficiency, which leads to edema, and who also had sleep apnea, found improvement in their apnea if they wore compression stockings during the day to decrease the edema–the idea being that the fluid accumulating in the lower extremity during the day redistributes to, among other places, the neck, worsening the constriction, so if you decrease the lower extremity edema during the day you decrease the apnea at night. Since I have varicose veins in my calves, I started wearing compression stockings religiously. Can’t say I’ve seen any noticeable improvement, but it may be a small enough change that it’s hidden in the noise–and I’ll take small changes if they add up to a significant improvement in the apnea.

    So I think the solution may be a bunch of different changes that add up to a big effect. And, who knows, maybe I’ll try the CPAP again and this time it will do the trick.

    Good luck to you!

    Eric

    • Thanks Eric, your comment is full of great advice. I think you might be right, if you really can’t tolerate the CPAP, then optimizing everything else has to be better than doing nothing. I am heading to Amazon.com to buy a Rematee now. Pat

  4. I’m a producer with the Discovery Channel and am putting together a segment on this very topic. It appears to work for many sleep apnea patients and is a low cost alternative for those who can’t afford the diagnosis and CPAP machine. Would love to include you if possible – please let me know!

    Good luck with the treatment.

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