Tag: Mouth exercises

Obstructive Sleep Apnea Treatment

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Sleep Apnea, Solutions

Obstructive Sleep Apnea Treatment

If you’ve been diagnosed with obstructive sleep apnea (OSA) or think you might have the condition, you may have questions about how to treat it.

There are several treatment options; the most effective way to treat your sleep apnea depends on the severity of your condition.

Generally, mild to moderate cases can be effectively managed with the same techniques used to treat primary snoring (i.e. non-apnea). Severe cases where your AHI is over 30 are best managed with CPAP.

In extreme cases where CPAP is not tolerated and there is a clear physical obstruction, surgery can also be an option.

This article explores the various methods that can be used to manage obstructive sleep apnea.

Each category has links to other useful SnoreLab articles on the subject.

Side note: what determines sleep apnea severity?

The severity of sleep apnea is split into mild, moderate and severe. These designations are based on how many times you experience apnea or hypopnea episodes per hour – your AHI score. This is where your breathing completely stops or partially stops for 10 seconds or more.

Make sure to read our article about sleep apnea diagnosis to understand sleep studies, the AHI score and classifying the severity of obstructive sleep apnea.

Making suitable lifestyle changes

If your sleep apnea is at the milder end of the spectrum, you can treat it by making some targeted lifestyle changes.

What is most effective depends greatly on what is responsible for your sleep apnea in the first place. Generally speaking, the following lifestyle changes have the most positive impact:

1. Lose weight

Your weight has a significant influence on your likelihood of developing obstructive sleep apnea. Simply put, the heavier you are, the more likely you are to suffer from OSA.

Side note: the statistics of weight loss and sleep apnea

Some epidemiological studies indicate that 70% of patients experiencing sleep apnea are obese, and 40% of obese people are suffering from sleep apnea [1].

Promisingly, research has demonstrated that losing 10-15% of your body weight can half the severity of your sleep apnea [2], and that losing 60% of body fat can eradicate sleep apnea for around 86% of obese people [3].

There’s no shortage of advice or special diets when it comes to losing weight. It can all be a bit confusing and overwhelming. No single technique works wonders for everyone, and drastic solutions are rarely stuck at for very long.

Instead, be sure to check out SnoreLab’s SMART strategy for effective, sustainable weight loss and also have a read of our full article of the impact of weight on snoring and sleep apnea.

2. Stop smoking and reduce alcohol consumption

Smokers, and even passive smokers are more at risk of snoring and experiencing sleep disordered breathing [4][5].

Some studies have found that smokers are 2.5 times more likely to suffer from obstructive sleep apnea [6].

Quitting smoking has shown to reduce your likelihood of experiencing sleep disordered breathing [7]. This is because smoking contributes to greater inflammation and irritation in the upper airway which predisposes it to vibration and collapse [8].

Further, a nightcap is also not ideal for healthy sleep. Alcohol causes your muscles to relax – even more than they do normally when you fall asleep. It therefore increases the collapsibility of your airway and heightens the risk of experiencing apneas.

SnoreLab users amongst many others have found that reducing their alcohol consumption yields drastic reductions in their snoring and sleep apnea.

3. Alter your sleeping position

More than half of all obstructive sleep apnea cases are referred to as “position-induced” sleep apnea [9], where the severity of the condition is made worse by back-sleeping.

By sleeping on your back, your mouth has a tendency to fall open. This changes the shape of your upper airway and makes obstruction more likely.

Sleep apnea can therefore be massively reduced by switching to side-sleeping. There are many techniques you can use to make this change – be sure to check out our guide to sleeping position and snoring.

Anti-snoring mouthpieces

Whilst not recommended for severe cases of OSA, a mandibular advancement device (MAD) can be a good option for those with mild to moderate OSA, or those who do not tolerate CPAP.

MADs brings your lower jaw (mandible) forward (or advance it) to tighten the tissues in your airway that are prone to slackening and causing obstruction.

There are many different types of MAD available so finding the right one can be a bit confusing. To get the best quality we recommend getting a mouthpiece custom fitted by a dentist, though this can be quite expensive.

You can still find great quality mouthpieces without paying loads for a custom-made one. Have a read of our guide to anti-snoring mouthpieces so you know what to look out for when buying generic devices online.

If your tongue causes obstruction in your airway, a different type of mouthpiece called a “tongue retainer” can also be effective for mild to moderate OSA.

CPAP

CPAP stands for continuous positive airway pressure and is a treatment suitable for moderate to severe sleep apnea sufferers. It is the primary method for managing OSA and has a wealth of evidence to support its efficacy.

In most countries, it is only available with a prescription after confirmed diagnosis of sleep apnea.

A CPAP device uses a mask to force air into your nose and throat to keep your airways open.
CPAP does not give you more oxygen. Instead, it introduces a current of normal air that creates positive pressure; this props open your airway to stop it from collapsing.

Many people are fearful of CPAP. Users can also struggle with their devices, experiencing discomfort, claustrophobia and air leakage.

Despite its scary reputation, it’s important to know that CPAP can be a life-saving tool. There are measures you can take to get the most out of it and cope with any difficulties you may have.

 

SnoreLab’s guide to dealing with CPAP issues

Check out

Performing mouth exercises

Research has shown that exercising the muscles in your airway can have a positive impact on mild to moderate sleep apnea.

These techniques are adapted from speech and language therapy and consist of repeated movements in the tongue, cheeks, jaw and soft palate in order to increase muscular tone.

Several studies demonstrate that patients with sleep apnea can reduce their AHI scores and sleepiness by performing these exercises regularly [10] [11] [12] [13].

You can read about all of the evidence and also learn the 5 exercises we recommend.

Surgery

Surgery is usually a last resort only when other techniques to manage your sleep apnea have failed.

Whilst there is some research to show that surgery can produce positive outcomes for OSA, there isn’t enough evidence for surgery to be routinely recommended ahead of alternatives like CPAP.

Usually, to be considered for surgery, there are several requirements that will be assessed by an ENT (ear, nose and throat) specialist first:

  • A diagnosis of severe obstructive sleep apnea, confirmed by a sleep study
  • A clear physical obstruction that can be rectified by surgery
  • Failed treatment with alternative methods such as CPAP and mouthpieces
  • Evidence that the condition is severely affecting your quality of life

There are many types of surgery for snoring and not all are recommended for OSA sufferers.

To get an overview of the surgical interventions available and the important considerations when exploring surgical options, be sure to read our article on surgery for snoring and sleep apnea.

Conclusion

Obstructive sleep apnea can be managed via a number of different means. What is most effective depends on the causes of your condition and its severity.

Regardless of which treatment route you take, many countries have support groups for people with OSA.

These organisations aim to educate and provide support with all facets of OSA.

They give helpful information on living with the condition, provide practical support with CPAP and other treatments, fund and publish the latest research into sleep apnea as well as organising support meetings in person.

Mouth Exercises for Snoring

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Diet & Lifestyle, Science, Solutions

Mouth Exercises for Snoring

Anti-snoring mouth exercises can be of massive benefit to almost all snorers.

We know that getting some exercise can help us lose weight which is a great way to tackle snoring. Increasingly, we are seeing that exercise to help snoring needn’t involve running, cycling or swimming, or even breaking a sweat.

More people are turning to mouth, tongue and throat exercises to take control of their snoring and are seeing amazing results.

 

Five anti-snoring exercises that really work

Jump

How do these exercises work?

Snoring is caused by slack tissue in your airway increasing resistance to air passing through [1]. Anti-snoring exercises aim to tone up this slackened tissue, treating the root cause of snoring.

Low muscle tone causes snoring

Our tongues and muscles in the thoat naturally relax when we sleep. Snoring happens when this relaxation becomes too much and the tissues start to flap, or when the tongue falls back and its base obstructs airflow.

When these muscles are weak, the chance of snoring is much higher. Muscle tone diminishes with age which explains why older people are more likely to snore.

Exercises vs. snoring aids

Wearing various remedies can tighten this tissue or hold things in place. But to keep snoring away, you’ll always rely on these appliances.

Anti-snoring exercises tone these tissues, stop them collapsing and prevent them from flapping.

You can train yourself into sleeping more quietly without having to wear an anti-snoring appliance ever again!

There are snoring aids on the market with very little science to back them up. The same is not true for anti-snoring exercises. There’s plenty of evidence and it all looks rather encouraging [2].

The evidence – music lessons

In 2000, researchers investigated whether you could reduce snoring with singing. A drama therapist from the University of Exeter in the UK developed a series of singing exercises for a group of twenty snorers [3].

The group sung these songs for twenty minutes a day for three months. The singing they did wasn’t your typical tune you might hum to yourself, but focused more on projecting strong vowel sounds with big exaggerated mouth movements.

It sounds more like yodeling, is rather bizarre, but it works. Comparing the participants’ snoring recordings before and after the study, the researchers saw a big drop in snoring.

In a different study six years later, twenty-five patients with moderate obstructive sleep apnea were signed up for didgeridoo lessons. Fourteen received tuition and did practice at home every day for four months. The other eleven – the control group – were put on a waiting list and carried on as normal.

Playing the didgeridoo is hard and requires strong mouth, tongue and throat muscles. At the end of the four months, the group who played the instrument showed some promising results improvements to their snoring [4]:

  • They were less sleepy throughout the day.
  • Their sleep apnea episodes reduced. Patients had a lower apnea/hypopnea index, 6.2 points fewer than the control group.
  • Their partners reported feeling less disturbed at night.

The evidence – targeted exercises

Didgeridoos and didgeridoo teachers are not easy to come by, and not everybody wants to walk around yodeling. Researchers took the concepts of these practices and created a series of exercises that target the snoring muscles of the tongue, soft palate and throat.

Guimaraes et al

In 2009, a group of scientists in Brazil performed the largest snoring exercise study to date [5]. The study design was robust, randomizing thirty-one different patients with moderate obstructive sleep apnea into two groups.

Each group was under the impression that they were receiving an amazing new anti-snoring therapy (important to ensure that any improvements are not due to the “placebo effect”), but only 16 were given the anti-snoring exercises. The other fifteen were a control group, given “sham therapy” which entailed a series of breathing exercises.

Each group attended supervised sessions for thirty minutes once a week and were told to do their exercises every day at home too.

Whilst the control group did ineffectual deep breathing, the test group followed an exercise regime involving the tongue, soft palate and walls of the throat. Exercises involved sucking, swallowing, chewing, breathing and speaking.

After three months, those doing the exercises had markedly improved their sleep apnea. They:

  • Reduced the severity of their sleep apnea. AHI on average dropped by 39% compared to no change in the control group.
  • Snored less frequently and less loudly
  • Had better sleep quality
  • Experienced less sleepiness during the daytime
  • Had improved oxygen saturation during sleep apnea episodes

Other studies

Further studies highlighted that thirty minute sessions are long and realistically people were unlikely to do this under their own steam. Merely brushing our teeth twice a day for two minutes is something that one in four of us struggle with [6]!

Researchers started to focus on shorter regimes, using similar exercises but done in short sessions several times per day. These patients still significantly decreased their snoring volume by 60%, improved their sleep quality and made their partners feel less disturbed [7].

Overall, the studies have strongly shown that [2]:

  • Anti-snoring exercise therapy reduces sleep apnea severity by 50%.
  • Exercises also reduce normal snoring, both objectively and subjectively. Snorers’ partners feel less disturbed and both the frequency and volume of snoring is decreased.
  • Sleepiness improves with consistent anti-snoring exercises.
  • Exercise regimes needn’t be long. As little as forty minutes per week can have a positive impact.

 

Detailed summary of the research into oropharyngeal exercises for snoring

Read

Five anti-snoring exercises that really work

One doctor, a massive advocate of anti-snoring exercises and the professed “patron saint of snorers” describes these exercises as yoga for your mouth with a focus on stretching and positional training [1].

The exercises favor quicker, sharp repetitions as opposed to long holds, which can instead add muscular bulk and make matters worse.

Different studies have used different techniques, but here are five of the key exercises that appear in most experiments and can really make a difference:

  1. Tongue curlers. With your mouth open, slide the tip of your tongue backwards along your hard palate as far back as it will go. Repeat 20 times.
  2. With an open mouth, press your tongue flat against the roof of your mouth and suck it upwards. Hold for 2 seconds and repeat 20 times.
  3. Force the back of your tongue against the floor of your mouth whilst the tip remains in contact with your lower front teeth. Again, you should do this with an open mouth.
  4. Pull your cheek out with your finger, use your cheek/mouth muscles to pull the finger back in.
  5. Elevate the back of your throat by sounding “aahh”. Once you get better at this exercise, you should be able to raise your uvula (the dangling part in the back of your throat) without making a sound.

You are unlikely to see instant results. These exercises are most effective when performed daily and stuck to over a period of time. Remember, you don’t need to spend ages on your routine, as little as eight minutes has shown to still be very effective [7].

To give yourself the best chance of success, set aside a time in the day to do these exercises. Also try to do them in private as you may look and feel a little strange. With some practice you will get better at the exercises and will start to notice the difference.

Oropharyngeal Exercises for Snoring – What’s the Evidence?

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Science

Oropharyngeal Exercises for Snoring – What’s the Evidence?

Introduction

Snoring occurs when the muscles in your upper airway relax, restricting airflow which in turn causes these tissues to vibrate and make sound.

Conventional snoring remedies treat the symptom, not the cause. Whilst they may stop the sound in the short term, they don’t address the root of the problem – weak muscles in the airway.

Increasing volumes of research are highlighting that snorers don’t need to be committed to a snoring remedy that they switch on or wear for the rest of their lives, but rather, they can incorporate inexpensive and effective techniques into their daily lives to stop snoring without artificial assistance.

Using techniques adapted from speech and language therapy, various research groups have employed the use of a set of oropharyngeal exercises which address weaknesses and develop muscular tone in the tongue, soft palate, throat, cheeks and jaw. This is with a view to reducing snoring, decreasing the severity of sleep apnea, mitigating disturbance of bed partners and producing better sleep and quality of life [1].

In this article, we summarise their findings.

Effects of Oropharyngeal Exercises on Patients with Moderate Obstructive Sleep Apnea Syndrome – Guimaraes et al, 2009 [2]

Overview of study

Kátia Guimaraes is a speech and language therapist from Brazil and is one of the first people to propose that oropharyngeal exercises can produce positive outcomes for obstructive sleep apnea [3].

This study uses an exercise regime that has become the basis for many subsequent experiments (though now, usually somewhat redacted). It is the first of its kind, has a robust design and is the most extensive.

Study design

Patients selected for the study met the following criteria:

  • Aged 25-65
  • BMI under 40
  • Previous diagnosis of moderate obstructive sleep apnea (AHI 15-30) via a sleep study

Guimaraes and colleagues designed a randomised-controlled trial. This means that as well as getting some patients to perform the prescribed exercises under scrutiny, another group of patients were given “sham therapy” and nasal irrigation as a control. The sham therapy consisted of simple deep breathing exercises and had to be performed with the same frequency as the study group’s exercises. This is a similar concept to a placebo in a drug trial.

The study group

The study group of sixteen patients were given a set of exercises designed to work out a variety of muscles. These exercises included:

  • Tongue brushing
  • Sliding tip of the tongue back along hard palate
  • Sucking tongue against roof of the mouth
  • Forcing tongue down into the floor of the mouth whilst the tip stays in contact with the lower front teeth
  • Pursing lips
  • Sucking movements with the cheek
  • Using cheek muscles to pull against a finger
  • Elevation of soft palate

These exercises were repeated daily including a once weekly supervised session with a speech pathologist. The duration of the study was three months.

In addition to the exercises themselves, patients also supplemented their therapy with bilateral chewing (using both sides of the mouth to chew) with a focus on correct tongue, teeth and lip positioning.

Patients in both groups underwent a sleep study before starting their treatment and again after the three months. Polysomnography was conducted by professionals blind to the group allocation of the patients.

The patients in both groups also used the Epworth Sleepiness Scale (0-24) and answered questions about perceived snoring frequency and intensity (0-4).

Results

The findings from PSG comparisons before and after are as follows:

  • There were significant decreases in the severity of sleep apnea in the study group.
  • Average AHI in the study group significantly decreased from 22.4 to 13.7 – a 39% reduction.
  • Average AHI in the control group showed a non-significant increase from 22.4 to 25.9.
  • 62.5% of study group patients shifted their severity classification from moderate obstructive sleep apnea to mild or none.
  • The lowest recorded oxygen saturations improved for the study group: 83% at baseline, 85% after 3 months.
  • The lowest recorded oxygen saturations worsened for the control group: 82% at baseline, 80% after 3 months.

In addition to the objective, quantifiable findings from PSG analysis, patients and their partners also answered a series of questionnaires about snoring frequency and intensity, and sleepiness:

  • In the study group, snoring frequency and intensity significantly decreased from 4 to 3 and 3 to 1 respectively (in the control group, there was no change in snoring frequency and intensity).
  • In the study group, the Epworth Sleepiness Scale score significantly decreased from 14±5 to 8±6 (in the control group, there was no change in sleepiness).

Effects of Oropharyngeal Exercises on Snoring – Ieto et al, 2015 [4]

Overview of study

This study looked at the influence of exercises on primary snoring as opposed to obstructive sleep apnea. The subjects were described as being “a population poorly evaluated by the scientific community […] composed of middle-aged and overweight patients who were disturbed by snoring, were on average not sleepy and did not present severe OSA”. In short, unlike much of the research into sleep-disordered breathing, this research assesses the “normal snorers”.

There are fewer exercises in this study than used by Guimaraes et al [2], and the 5 exercises used in this study form the basis of subsequent work. Importantly, this study shows that big workout sessions weren’t necessary to have a positive effect. 3 short sets of exercises every day for 3 months was shown to reduce snoring.

Study design

Patients selected for the study met the following criteria:

  • Aged 33-59
  • BMI under 40
  • Complaints of primary snoring with recent diagnosis confirming such, or of mild-moderate obstructive sleep apnea (AHI 5-30)

Ieto and her team used a control group (20 subjects) as well as a therapy group (19 subjects). Each group was randomly allocated. The study duration was 3 months.

The patients underwent polysomnography at baseline and after the 3 months to objectively measure snoring. This was done by creating a “snore index” which assessed the number of times per hour the patient broke a threshold of 38 db.

Subjects also answered questions on sleepiness using the Epworth Sleepiness Scale and sleep quality using the Pittsburgh Sleep Quality Index before and after the study.

A set of 5 exercises were performed three times a day, each session taking roughly 8 minutes):

  • Push the tip of the tongue against the hard palate and slide backwards – repeat 20 times.
  • Suck the tongue upward against the hard palate and press – repeat 20 times.
  • Force the bottom of the tongue against the floor of the mouth whilst the tip maintains contact with the lower incisors – repeat 20 times.
  • Elevate soft palate and uvula whilst saying “ah” – repeat 20 times.
  • Use cheek muscles to pull against finger – repeat 10 times on each side.

In addition to these exercises, when eating, subjects were told to alternate bilateral chewing and swallowing pushing the tongue into the hard palate.

The control group performed a “sham therapy” of deep-breathing exercises as well as wearing nasal strips during sleep and performing nasal irrigation 3 times per day.

Results

Objectively measured snoring using the snoring index did not change for the control group but showed a significant decrease in the treatment group:

  • Frequency of snoring reduced by 36%
  • Total power of snoring reduced by 59%
  • The objective snoring reduction was corroborated by a significant subjective decrease in the perception of snoring by bed partners.

Whilst not the primary focus of this study, a decrease in average AHI was also observed for the small subset of snorers (8 subjects) recently diagnosed with moderate OSA from an average AHI of 25.4 to 18.1 (a reduction of 29%).

Oropharyngeal exercises in the treatment of obstructive sleep apnoea – Verma et al, 2016 [5]

Overview of study

Another study with its primary focus on obstructive sleep apnea, this study stands out due to the findings beyond snoring, particularly on sleepiness and sleep quality.

The types of exercise in this study are more extensive and require a greater investment of time and effort.

Study design

As a case report, this study has a less robust design as it is missing a control group who don’t receive the intervention under investigation.

20 patients with mild to moderate obstructive sleep apnea (AHI 5-30) were given a rigorous set of oropharyngeal exercises. These exercises were split into 3 grades of difficulty, with patients stepping up a grade for every month of the 3 month study. Each exercise had to be repeated for 10 reps, 5 times per day.

The Epworth Sleepiness Scale, subjective snoring questionnaires and full PSG were performed at baseline and after 3 months.

Results

After the three month trial, the researchers found the following:

  • 85% of patients in the study showed a significant reduction in sleepiness.
  • Patients spent on 1.6 hours in deep sleep, compared to 0.97 at baseline – a 65% increase.
  • The average snoring as measured on the snoring intensity scale (0-4, lowest to highest) decreased significantly from 2.8 to 1.7.
  • Significantly less time was spent at oxygen saturations below 90%.

The effects of oropharyngeal-lingual exercises in patients with primary snoring – Nemati et al, 2015 [6]

Overview of study

Similar to the study conducted by Ieto et al, this study addressed the effect of exercises on primary snoring – not obstructive sleep apnea.

In addition to their explorations of the impact on snoring intensity and frequency, Nemati and colleagues also took the interesting step to look at the psychological and emotional impacts of snoring – assessing the relationship between changes in snoring intensities and conflicts had with roommates.

Study design

Interestingly, all measurements from this study were obtained from roommates of the snorer. 53 snorers were assessed before and after 3 months of soft palate, tongue and facial exercises totalling 30 minutes per day, at least 5 times per week. This was done by asking their roommates to report on the severity their snoring using a sliding scale of 0 (no snoring) to 10 (unbearable snoring).

In part due to the lack of a control group, this study describes itself as “semi-experimental”. That said, a sample size of 53 is good.

Results

Before versus after the exercise intervention:

  • Average snoring severity significantly decreased from 7.01 to 3.09 – a 56% reduction.
  • This reduction in the severity of snoring had a significant relationship the number of conflicts with roommates.

The role of oral myofunctional therapy in managing patients with mild to moderate obstructive sleep apnea – Baz et al, 2012 [7]

This prospective study evaluated the effect of oropharyngeal exercises on 30 patients with mild to moderate obstructive sleep apnea.

The exercises – similar to those outlined by Guimaraes et al [2] – were conducted in twice weekly supervised sessions plus at home for 3-5 times a day for at least 10 minutes at a time.

After the three months of therapy, patients showed some very positive, statistically significant changes:

  • 47% of patients reported not snoring any more.
  • Only 40% (compared to 100% at baseline) reported still experiencing excessive daytime sleepiness. This was reflected on the Epworth Sleepiness Scale with an average decrease from 16.4 to 9.27.
  • Average AHI reduced from 22.27 to 11.53.
  • Time spent at an oxygen saturation below 90% was halved.

Effect of speech therapy as adjunct treatment to continuous positive airway pressure on the quality of life of patients with obstructive sleep apnea – Diaferia et al, 2013 [8]

Speech and language therapy techniques underpin anti-snoring exercises. This study looked at the effectiveness of speech therapy in addition to the more conventional treatment of CPAP for obstructive sleep apnea.

In a nicely robust study design, there were four groups of similar sample sizes:

  • Speech therapy alone (n = 27)
  • Sham therapy alone (n = 24)
  • CPAP alone (n = 27)
  • Combination of CPAP with speech therapy (n = 22).

Speech therapy alone was shown to drastically reduce the average AHI for these patients (28.0 to 13.9). When supplemented with CPAP, the average reduction was even more marked, dropping from 30.4 (just over the “severe” threshold) to 3.4 (below the “mild” threshold).

In terms of sleepiness, speech therapy alone showed comparable results to using CPAP alone. The sham therapy control showed no difference in either sleepiness or AHI.

Other studies

The aforementioned studies have shown that a clearly defined set of exercises, repeated over time can produce very positive outcomes in terms of snoring reduction and reduction of sleep apnea severity amongst other facets like sleep quality and partner disturbance.

We believe this structured approach is ideal for working into your daily routine. However, the evidence extends beyond these sets of exercises.

Research groups have shown that you can work out your snoring muscles via other means. It could even be said that these earlier studies inspired the research into oropharyngeal exercises fo snoring. These techniques combat snoring via the same mechanisms as the prescribed exercises, so their findings are certainly worth a mention.

Can Signing Exercises Reduce Snoring? – Ojay and Ernst, 2000 [9]

Alise Ojay, a choir director, singer, composer and research fellow at the University of Exeter in the UK developed a series of singing exercises for a group of 20 snorers.

The group sung these songs for 20 minutes a day for three months. These songs weren’t the typical tunes you might hum to yourself, but were instead focussed on projecting strong vowel sounds with exaggerated mouth movements.

Ojay’s team saw significant improvements in the snoring of those who consistently sung. More in-depth studies have since confirmed Ojay’s findings, showing improvements in sleepiness, frequency and volume of snoring for a larger group of 93 patients in a recent randomised controlled trial [10].

Ojay continues to advocate singing as a therapy for snoring with her “Singing for Snorers” CDs.

Didgeridoo playing as an alternative treatment for obstructive sleep apnea syndrome – Puhan et al, 2006 [11]

In this small but well-known study, 25 patients with moderate obstructive sleep apnea (AHI 15-30) were randomised to 2 groups. The study group of 14 patients were given didgeridoo lessons for four months and told to practice regularly at home. The remaining 11 were left on a waiting list as a control.

Playing the didgeridoo is hard and requires strong mouth, tongue and throat muscles. A different and fun activity, adherence to the “treatment” was high, patients averaging 5.9 days a week of practice for 25.3 minutes per day.

Compared to the control group, the didgeridoo group showed on average less sleepiness (3 points less on the Epworth Sleepiness Scale), reduced OSA severity (reduced AHI score by 6.2) and disturbed the sleep of partners less.

Conclusion

The studies mentioned are the best examples of using oropharyngeal exercises to combat snoring and sleep apnea, but are non-exhaustive. There have been plenty of other case reports that have produced positive outcomes [1].

The studies in this article used the same time span of three months, and subtly varied the types of exercise and the time spent doing them. Despite this heterogeneity, the results are consistent and can be summarised as follows:

  • Oropharyngeal exercises reduce snoring both objectively and subjectively.
  • Exercises reduce the severity of obstructive sleep apnea, often changing the classification from moderate to mild or even none.
  • Subjective feelings of tiredness significantly reduce after consistently performing these exercises, with some studies objectively measuring greater time spent in deep sleep.
  • Partners report feeling less disturbed and conflicts arising from snoring reduce.

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