One thing that sets physiotherapists apart from other forms of manual therapy is that we love giving out exercises to help the underlying issue. As a physio working in the head, neck and jaw area my exercises don’t always look like what a general musculoskeletal physio would give. So when I saw the literature regarding the use of didgeridoo to strengthen the muscles of the upper airways, I was very intrigued.
A question I ask every person who comes in with head, neck and jaw issues is “how do you sleep?”. There is 2 reasons for this; the first is poor sleep almost always affects your symptoms (read more about that here) and secondly some people report snoring which then tells me a little bit about the integrity of their upper airways.
The sound of snoring occurs when there is vibration of the lips, tongue, muscles of the throat and diaphragm. The vibration occurs due to these muscles having less tension and tone, when this occurs the tongue falls back and the throat narrows. The more relaxed these muscles get, the more vibration and the more vibration the louder the sound. If there is enough relaxation then the throat closes up and you are unable to get oxygen in which then would be classed as obstructive sleep apnoea (OSA).
When someone tells me they snore I have suspicions that they may not be getting a restful sleep each night (and neither would their partner!) and that they may need some training and strenghthening of their upper airways.
A recent randomised control study looked at 25 patients with a apnoea-hypopnea index (an index used to show the severity of sleep apnea) of 15-30 (classified as moderate sleep apnoea). They gave these individuals 4 months training of playing the Aboriginal instrument, the didgeridoo.
What the training involved was:
- Teaching the participants the lip technique to produce and hold a note for 20-30 seconds
- Circular breathing, which involves inhaling through the nose while maintaining airflow through the didgeridoo using the cheeks
- Mastering the complex of the lip and vocal tract allowing the vibrations to move from the upper airway to the lower airways
- Practising at home for 20 minutes 5 days a week
What the researchers found was that there were improvements with day time sleepiness and that the apnoea-hypopnoe index improved. So why did this happen?
Playing the diderigoo trains the muscles of the upper airways, it is these muscles that maintain airway dilation improving the stiffness of the walls. This is mainly done through the circular breathing process which uses the tip and mid portion of the tongue, cheek muscles and diaphragm. Do these muscles sound familiar? They are in fact the muscles that relax and vibrate with snoring!
Now don’t get me wrong, there are many ways to skin a cat, I mean through my speciality of treating the head, neck and jaw I focus a lot on training the muscles of the lips, tongue and cheeks using different techniques in order to strengthen the tongue and inevitably stabilise the jaw. However I love the sound of the didgeridoo and I am sure there may be many other people out there who feel the same. There is something very soothing and meditative about the drone sound it creates and I feel we need to remember that there are different strokes for different fokes and for some individuals the exercises I would normally provide to strengthen the orofacial muscles may be very boring and unmotivating and there may be some people out there who feel that playing the didgeridoo would mean practising an instrument they have always been fond of and at the same time they would be getting the upper airway strengthening they may need.
This study showed didgeridoo playing improved daytime sleepiness in people with moderate snoring and obstructive sleep apnoea but of course this doesn’t mean that if you snore that you need to go out and purchase a didgeridoo from your local music store! Like many studies, more extensive research needs to be produced, but if you already own a didgeridoo or have always wanted to learn how to play and you know you snore why not play a little more or give it a go and see what happens with your snoring.
Wuhan et al. (2005) Didgeridoo playing as alternative treatment for obstructive sleep apnoea syndrome: randomised controlled trial BMJ; 332