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Didgeridoo, Snoring and Obstructive Sleep Apnea

The natives of Australia, the Aborigines, trust this sacred instrument to converse with the spirits of the departed. The didgeridoo instrument is made from cutting a 1-2 meter section of a eucalyptus tree that has been hollowed out by hungry termites. Its performance consists of vibrating the lips while employing a circular breathingtechnique so that the inside of the performer’s mouth as well as the inside of the instrument are caused to resonate. This dual sound is incredibly mysterious, making one feel that theground is vibrating from the very deeps of the earth. As for the instrument’s name, the leading theory is that white settlers named it  “didgeridoo” because they thought they heard this word among the instrument’s sounds. There are many names given to the instrument, however, depending on each aboriginal tribe.

Snoring and obstructive sleep apnoea syndrome are two highly prevalent sleep disorders caused by collapse of the upper airways, and are associated with substantial morbidity and mortality and rising costs. Continuous positive airways pressure therapy can reduce daytime sleepiness, but compliance with this treatment is often poor. Training or electrostimulation of the muscles of the upper airway might reduce collapsibility of the upper airways during sleep.

The most effective intervention for these disorders is continuous positive airway pressure therapy, which reduces daytime sleepiness and the risk of cardiovascular morbidity and mortality in the most severely affected patients (apnoea-hypopnoea index (measured as episodes per hour) > 30).  For moderately affected patients (apnoea-hypopnoea index 15-30) who complain about snoring and daytime sleepiness, however, continuous positive airway pressure therapy may not be suitable and other effective interventions are needed.
Regular playing of a didgeridoo reduces daytime sleepiness and snoring in people with moderate obstructive sleep apnoea syndrome and also improves the sleep quality of partners Severity of disease, expressed by the apnoea-hypopnoea index, is also substantially reduced after four months of didgeridoo playing.
A didgeridoo instructor, reported that he and some of his students experienced reduced daytime sleepiness and snoring after practising with this instrument for several months. In one person, the apnoea-hypopnoea index decreased from 17 to 2. This might be due to training of the muscles of the upper airways, which control airway dilation and wall stiffening.
To test the hypothesis that training of the upper airways by didgeridoo playing reduces daytime sleepiness in moderately affected patients and the effectiveness of  Didgeridoo playing as alternative treatment for obstructive sleep apnoea syndrome, a randomised controlled trial was done by Milo A Puhan, research fellow,  Alex Suarez, didgeridoo instructor, Christian Lo Cascio, resident in internal medicine,  Alfred Zahn, sleep laboratory technician,  Markus Heitz, specialist in respiratory and sleep medicine, and Otto Braendli, specialist in respiratory and sleep medicine

Abstract of the study and its findings:
Objective To assess the effects of didgeridoo playing on daytime sleepiness and other outcomes related to sleep by reducing collapsibility of the upper airways in patients with moderate obstructive sleep apnoea syndrome and snoring.
Design Randomised controlled trial.
Setting Private practice of a didgeridoo instructor and a single centre for sleep medicine.
Participants 25 patients aged > 18 years with an apnoea-hypopnoea index between 15 and 30 and who complained about snoring.
Interventions Didgeridoo lessons and daily practice at home with standardised instruments for four months. Participants in the control group remained on the waiting list for lessons.
Main outcome measure Daytime sleepiness (Epworth scale from 0 (no daytime sleepiness) to 24), sleep quality (Pittsburgh quality of sleep index from 0 (excellent sleep quality) to 21), partner rating of sleep disturbance (visual analogue scale from 0 (not disturbed) to 10), apnoea-hypopnoea index, and health related quality of life (SF-36).
Results Participants in the didgeridoo group practised an average of 5.9 days a week (SD 0.86) for 25.3 minutes (SD 3.4). Compared with the control group in the didgeridoo group daytime sleepiness (difference -3.0, 95% confidence interval -5.7 to -0.3, P = 0.03) and apnoea-hypopnoea index (difference -6.2, -12.3 to -0.1, P = 0.05) improved significantly and partners reported less sleep disturbance (difference -2.8, -4.7 to -0.9, P < 0.01). There was no effect on the quality of sleep (difference -0.7, -2.1 to 0.6, P = 0.27). The combined analysis of sleep related outcomes showed a moderate to large effect of didgeridoo playing (difference between summary z scores -0.78 SD units, -1.27 to -0.28, P < 0.01). Changes in health related quality of life did not differ between groups.
Conclusion Regular didgeridoo playing is an effective treatment alternative well accepted by patients with moderate obstructive sleep apnoea syndrome.
The full article can be accessed at:
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