Monday, November 24, 2014

Sleep Apnea - What is it? What can help? The Didgeridoo?

Each time you breath in, muscles in your throat, chest and diaphragm help you inhale; air flows from your nose and mouth into your lungs  - the breath of life.  During your waking hours your breathing is usually regular and automatic, unless you suffer from asthma or other lung diseases.  Throat muscles are important, although we are generally not aware of their action, by keeping the  airway open and stiff so inhalation is easy. When you sleep, these throat muscles may relax, narrowing your airway.  Normally, this narrowing doesn’t prevent air flow in and out of your lungs.  But if you have sleep apnea, your airway can become partially or fully blocked because of factors like these: 
*Your throat muscles and tongue relax more than normal.  Aging may play a role here.
*Your tongue and tonsils may be large compared to the opening into your windpipe.
*Overweight may cause extra fat tissue to thicken the wall of the windpipe, narrowing it and making it harder to keep open.
*The shape of your head and neck may result in a smaller airway size. 

Apnea is a word that means the suspension of breathing.  During sleep apnea, when the opening to the windpipe is narrowed or closed, people snore loudly and/or stop breathing for a time. Breathing may stop for up to a minute. Blood oxygen levels drop, triggering the brain to disturb sleep.  This helps to tighten airway muscles and open the windpipe.  Normal breathing starts again, often with a snorting sound.  When this happens repeatedly during the night, drops in oxygen levels and constant waking can result in the release of stress hormones.  A risk of high blood pressure, heart attack, stroke and irregular heartbeat is increased.  People with this condition often have excessive daytime fatigue because of sleep disturbance.  They often do not experience REM sleep and do not have dreams. 

Sleep apnea can be greatly helped by  a device called CPAP – continuous positive airway pressure, as well as by certain dental devices.  Many people with sleep apnea have used these treatments, which are important and helpful.  However, it is not easy for everyone to get used to these treatments and use them regularly. Weight loss is also helpful for some people with sleep apnea.

Since the human mind is infinitely inventive, new treatments that involve breathing techniques were bound to emerge. Instructors teaching the didgeridoo noted that their students reported reduced daytime sleepiness and less snoring after practicing the instrument for several months.  In Zurich, a group of doctors, respiratory therapists and sleep therapists decided to test the proposition that training the upper airway by digeridoo playing would reduce daytime sleepiness, due to training the muscles of the upper airways that control airway dilation and wall stiffening.  The recruited 25 patients, average age 50, who had moderate sleep apnea and were willing to learn the didgeridoo.  Half the patients became a control group, who had to wait for 4 months before taking the didg training.  The patients had weekly lessons, and were told to practice for 20 minutes 5 times a week.  They were instructed in circular breathing.  Apparently the practice was enjoyable, as compliance was excellent – the subjects practiced 6 days a week, and there were no dropouts.  The same was true of the control group, who started didg playing 4 months later.  The study found that patients had reduced daytime sleepiness and snoring – the effectiveness of didg playing was slightly less than that of regular CPAP use, but still notable.  The study was published in the British Medical Journal in 2006.

A study in Australia looked at the effectiveness of didgeridoo playing on boys with asthma.  The comparison group was singing lessons for girls.  Asthma is a problem for 15% of Austrian Aborigines, probably because of poverty and poor living conditions.  Girls are not supposed to play the didgeridoo in public for cultural reasons.  Asthma relief was more pronounced for the didg players than the singers. Playing the didg has a pronounced effect on lung capacity, relaxation and the ease of controlled breathing.  The study was published in Music and Medicine in 2013.

I have been taking classes in didgeridoo playing in Petaluma, and have found playing the instrument to be calming, mesmerizing, and helpful for my lungs. I love the sound of the low vibrations. Other people in the classes have found improvement with their sleep apnea.  The teacher, Elise Peeples, will be giving an introductory class in January as well as continuing lessons.  The classes will take place on Saturday morning in Petaluma.  I plan to post fliers about the classes and also give them to local doctors who may want to refer their patients.  Feel free to contact me if you are interested.  Full disclosure – I am crazy about wind instruments. 
Sadja Greenwood, MD, MPH  Back issues on this blog!

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