by Patricia Salber
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 be 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.
Now I am a doctor and 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.
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 apneoa 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?”
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, and 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 NS, 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 interation 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 was 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.
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 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 for now I have expanded my Sleep Apnea Self-Directed Treatment list:
- 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!
Pat Salber, MD MBA is a Principal in Zolo Health and writes at The Doctor Weighs In.