Useful Actionable Update: Got Sleep Apnea? Try a Didgeridoo

I know, I know.

For the last few years, my sleep hasn’t felt especially refreshing. While there are many reasons for this, I felt I had pretty much dialed in every possible parameter from bedtime routines, consistency, sleep hygiene, diet, meal timing, morning light exposure, etc. And yet I was stuck!

Several years ago I listened to this podcast all about nighttime breathing issues and it inspired me to get an at-home sleep study, which I later wrote about here.

Initially my early sleep studies revealed that I had something called UARS, or Upper Airway Resistance Syndrome. It’s not quite sleep apnea in that UARS doesn’t cause a drop in blood oxygen saturation, but because you are working harder to breathe at night due to some kind of upper airway issue, the symptoms are often the same as apnea.

Were I sitting around on the couch eating Cheetos all day I don’t know that I would have wanted to attack this problem with such vigor, but given my training and racing and general values around health, this was not acceptable.

I tried various myofunctional therapy exercises (basically: PT for the face and airway muscles) and I cut out dairy (which inflamed my airways a bit) and began using things like Breathe Right Strips and the fancier version called Intake and while I felt better or worse some days, I could tell the problem wasn’t solved.

A year or so later my sleep still wasn’t improving and so I did another at home sleep study, and this time it showed mild apnea, with an AHI of 6.5. AHI stands for Apnea Hypoxia Index and it measures how many apnea events you have on average in a given night. Anything under 5 is considered "not apnea” (though it could still be UARS, which means you have an AHI of <5 but an RDI, or respiratory distress index, above 5). Given how important my health is to me, having apnea represented a real gaping hole in my plan to stay healthy and perform well at the things I enjoy. (Also, not sleeping well just feels bad, so even outside of racing and training and all-day golf events, who wants to feel less than chippy?)

My dentist in LA makes oral appliances called mandibular advancement devices to help with nighttime breathing issues, and these work by basically pushing the lower jaw forward to create more space in the back of the throat. But these (A) aren’t usually covered by insurance (B) aren’t always effective depending on why you’re having nighttime breathing issues and (C) can cause jaw pain and even TMJ. Further, while they may treat symptoms, they don’t treat underlying causes, which is always my preferred route.

I then investigated going to The Breathe Institute, just down the street in Westwood. They focus exclusively on breathing issues, especially nighttime breathing issues, and diagnose your situation via something called a DISE, or a Drug Induced Sleep Endoscopy, where they give you a sedative to put you and your airway muscles in a very relaxed state, which gives the doctors an idea of what’s happening to your airways when you sleep (REM sleep is when most apnea-like events occur because it is the sleep stage where your muscles are the most relaxed). This was also rather expensive and many of their interventions seem to involve various surgical procedures, which I wasn’t willing to have.

A friend of mine had been given a BiPAP machine by his insurance company (like CPAP, only with two different pressure settings for inhales and exhales) and he hated it, so he gave it to me to try. While CPAP/BiPAP is considered the gold standard for apnea treatment, it only has a 50% compliance rate because many people find it challenging to get used to. And once again, it doesn’t treat underlying causes, so if my airway muscles were collapsing at night due to weakness (my best guess as to my underlying cause), they would only continue to get weaker and weaker as time went on, requiring greater and greater CPAP pressure. Also, maintaining a CPAP machine is rather involved in terms of cleaning and replacing the various components regularly to avoid blowing mold and bacteria straight into your sinuses. Still, I was open to trying it as I know many people whose lives have been changed by it. In the end (admittedly, only a week or two), while I didn’t find the nasal pillows uncomfortable, I did find the whole thing distracting enough that I often failed to even fall asleep with it on.

While scrolling around on the Apnea sub-reddit, I came across several posts like this one, citing didgeridoo playing as a curative for apnea. I initially wrote this off as internet quackery but after coming across a few legitimate journal articles citing didgeridoo as an actual alternative treatment for apnea, I was convinced to give it a try. Especially because the patient cohort in the study was made up of people with moderate apnea, which is far more severe than my mild apnea (mild is an AHI of 5-15 while moderate is 15-30!).

I found a cheap didgeridoo on Amazon, watched a few YouTube tutorials, and was off to the races. The protocol in the journal article I linked to mentioned 30 minutes a day, so I committed to that. In general, I found it very easy to begin making the appropriate sounds with a didgeridoo, though continue to find the notion of circular breathing difficult. It’s not a hard concept to practice when, say, blowing through a straw, but I find it very challenging to do when actually playing “the didge.” After reading more though, it seems circular breathing isn’t really where the benefit comes from, so I don’t worry about this. The basic benefit seems to mostly come from the embouchure and tongue/throat involvement, similar enough to many myofunctional exercises out there.

I began playing daily in October and I would say by sometimes in late November or early December, my sleep began to feel much more refreshing. My main symptom was a slight vertiginous feeling most days. Never on the level of vertigo, but I would put it at a 0.5 out of 10 in terms of dizziness. This has pretty much entirely gone away, which is a huge relief. In fact, the only time I feel the way I used to is when I fall asleep on my back, which makes nighttime breathing worse for obvious reasons. And while I haven’t done a repeat sleep study to check my AHI, my serum CO2 has improved dramatically. For the last several years it was well above the standard range (to say nothing of the optimal range) at 30 or 32, and after my most recent blood draw, my CO2 had come down to 23. This would indicate that I have less CO2 building up in my blood due to improved nighttime breathing, as nothing else has changed in my breathing mechanics.

I continue to play my didgeridoo for 30 minutes a day. Usually I pop headphones on and watch a movie while I just drone away on the ol’ didge. I have no interest in joining a drum circle anytime soon, and I’m not interested in becoming a virtuosic player, but for my purposes, I am delighted to recommend this as a possible intervention if you’re struggling with your own nighttime breathing issues.