Most conventional treatments for obstructive sleep apnea (OSA), upper airway resistance syndrome (UARS) and snoring include lifestyle modifications, CPAP therapy, and oral appliance therapy. Today, let’s explore if playing select musical instruments impact these disorders.
Snoring, Upper Airway Resistance Syndrome (UARS) and Obstructive Sleep Apnea (OSA)
Snoring, upper airway resistance syndrome (UARS) and obstructive sleep apnea are all related. These sleep breathing conditions are commonly described as a progression of increased resistance through the airway passage involving soft tissues of the throat and tongue. This increased resistance in the airway during sleep can lead to snoring, and eventually to complete collapse of the airway as in obstructive sleep apnea, a serious yet common sleep disorder.
“Can I do anything to strengthen my throat muscles and tissues to treat my condition (OSA, snoring) ?”
Patients afflicted with snoring, UARS or OSA may ask, “Can I do anything to strengthen my throat muscles and tissues to treat my condition?” Musical instrument playing and oropharyngeal therapy can be explored. In this article, we will tackle some research involving musical instruments and obstructive sleep apnea, the more severe condition in the progression of these conditions.
Most commonly, physician-recommend treatment options for snoring, UARS and OSA may include CPAP therapy, oral appliance therapy, lifestyle changes. But for those who may have a mild diagnosis and reluctant to try recommended treatments, let’s explore the research behind musical instruments as a treatment alternative. Other individuals who may be interested in enhancing the outcome of their current treatment may also be interested in playing musical instruments.
Some musical instruments may strengthen the muscles and tissues of the throat passage, decreasing OSA events or associated symptoms.
The Didgeridoo and Moderate Obstructive Sleep Apnea Study
One of the first and best-known studies in this arena involves moderate obstructive sleep apnea participants with the Aboriginal wind instrument called didgeridoo.
The study published by the British Medical Journal in 2006, tested their hypothesis that playing the didgeridoo, a wind instrument, may strengthen the throat muscles involved in snoring and OSA patients. The strengthening of the tissues and muscles would then prevent the collapse that occurs in these patients’ airway during sleep.
The study concluded that after four months of didgeridoo playing (with lessons) daytime sleepiness and sleep obstructive apnea events were reduced. The conclusion:
“Regular didgeridoo playing is an effective treatment alternative well accepted by patients with moderate obstructive sleep apnoea syndrome.”
What is a didgeridoo?
A didgeridoo is a four to five-foot-long wind instrument indigenous to Australia. The traditional didgeridoo is made from eucalyptus tree trunks, and limbs hollowed out by termites. Today didgeridoos are made from a large variety of materials and are typically 3-5 feet in length.
The didgeridoo is a drone instrument producing a single fundamental pitch. Generally the longer the length, the deeper the tone. Specific playing techniques can create an apparent shift in pitch.
Are you interested in hearing a didgeridoo?
You can listen to the sounds of a didgeridoo here: Didgeridoo Sounds
Some points for review from this didgeridoo – OSA study
- It was a relatively small study- 25 participants, mostly men
- The starting hypopnea index of participants was 15-30
- The Average apnea-hypopnea index had dropped from an average of 21 to 11.6. (Also to note: the AHI of the untreated control group decreased as well, but only to 15.4.)
- With one participant, the apnea-hypopnea index fell from 17 to 2
- Additionally, there was a marked improvement in participants’ daytime sleepiness.
- Participants in the didgeridoo group practiced an average of 5.9 days a week for 25.3 minutes
- Participants’ bed partners noted less visible sleep disturbances in their bed partners (the participants).
- Participants had an instructor with four lessons. These lessons included:
- Lip technique to produce and hold the keynote for 20-30 seconds.
- Circular breathing – a technique that enables the wind instrumentalist to maintain a sound for long periods by inhaling through the nose while maintaining airflow through the instrument, using the cheeks as bellows.
- Optimizing the complex interaction between the lips, the vocal tract, and circular breathing so that the vibrations in the upper airway are more readily transmitted to the lower airway.
- Repetition of the basics listed above with corrections by the instructor.
Can musical instruments other than the didgeridoo help prevent or treat snoring and OSA?
So if the didgeridoo can strengthen air passage muscles and tissues, the next question may be: “ Can other musical instruments help treat or prevent OSA?
Let’s explore some research on several other musical instruments and OSA risk.
A more recent study in 2015 demonstrated that double-reed woodwind musicians (e.g., oboe, bassoon, English horn) were found to have a significantly lower risk of OSA than non-wind instrumentalists such as with string, percussion, and keyboard instruments.
Study conclusion: Playing double reed instruments may lower the risk of obstructive sleep apnea. It is unknown as to why this occurs. It was speculated that it might be due to the physiological requirements of playing these instruments, or simply the lifestyle of the musicians in the study.
More on the double reed study participants:
The double reed participant group was the only group consisting of primarily female musicians.
According to the study, “Double reed instrumentalists at low risk for OSA played on average 16.5 ± 1.2 h (mean ± SEM) per week, while those at high risk played on average 9.1 ± 2.7 h per week.”
What are double reed instruments?
Double reed instruments have two reeds vibrating against each other. In contrast, a single reed instrument has a reed that vibrates against a mouthpiece that is made of metal, hardened rubber, or resin. The oboe, bassoon, and English horn are examples of double reed instruments that may help strengthen and reduce the collapsibility of airway tissues involved is obstructive sleep apnea.
Listen to the sounds of the Oboe, Bassoon, English Horn and Didgeridoos:
The sounds of the Oboe, Bassoon, and English Horn are very different than the Didgeridoo sounds. Here are a few seconds of clips of what these double reed instruments sound like when playing Ode to Joy:
Here are some additional resources on didgeridoo:
- For lessons and general didgeridoo information
- How to make a PVC Didgeridoo in 30 Seconds
- Make your own Didgeridoo
- For an interesting Ted Talk on didgeridoos
The bottom line on playing musical instruments in treating snoring and OSA
Different musical instruments involve various muscle activations. Although there is relatively limited research in the area of musical instruments in the treatment of OSA and snoring, several instruments have been researched and may be helpful.
The following instruments may help treat obstructive sleep apnea, and associated symptoms: the didgeridoo and double-reed woodwind instruments like the Oboe, Bassoon, and English Horn.
It may be likely, although unverified, that these musical instruments may help reduce benign snoring and upper airway resistance syndrome (UARS) symptoms since both of these conditions involve partial obstructions of the muscles and tissues of the upper airway as in obstructive sleep apnea.
- Puhan, M. A., Suarez, A., Cascio, C. L., Zahn, A., Heitz, M., & Braendli, O. (2006). Didgeridoo playing as alternative treatment for obstructive sleep apnoea syndrome: randomised controlled trial. BMJ, 332(7536), 266-270. doi: 10.1136/bmj.38705.470590.55
- Ward, C. P., York, K. M., & McCoy, J. G. (2012). Risk of obstructive sleep apnea lower in double reed wind musicians. Journal of Clinical Sleep Medicine, 8(03), 251-255. doi: 10.5664/jcsm.1906 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3365082/
- Brown, D. L., Zahuranec, D. B., Majersik, J. J., Wren, P. A., Gruis, K. L., Zupancic, M., & Lisabeth, L. D. (2009). Risk of sleep apnea in orchestra members. Sleep medicine, 10(6), 657-660. https://doi.org/10.1016/j.sleep.2008.05.013
- Ward, C. P., York, K. M., & McCoy, J. G. (2012). Risk of obstructive sleep apnea lower in double reed wind musicians. Journal of Clinical Sleep Medicine, 8(03), 251-255. https://aasm.org/playing-a-high-resistance-wind-instrument-may-reduce-risk-for-obstructive-sleep-apnea-in-musicians/