Obstructive sleep apnea (OSA) is essentially a plumbing problem. Apneas, or pauses in breathing, are caused by the collapse of soft tissues in the throat and behind the tongue, leading to (literally) the airway pancaking down on itself. Because obstructive sleep apnea therefore is a pure plumbing problem, there are no medications that treat it. All of the different treatments for sleep apnea involve various mechanical attempts to keep the airway open and to prevent the apneas or breathing pauses.
CPAP use air pressure to literally splint open the airway. The example I give my patients is that of inflating a balloon. When you blow air into a balloon it expands as it fills with air. CPAP is doing the exact same thing to your throat- your throat and upper airway are being filled up and expanded, just like a balloon, with the air pressure generated by the CPAP machine. This positive air pressure keeps the airway inflated open. (CPAP actually stands for Continuous Positive Airway Pressure.)
Surgical treatments for OSA involve changing anatomy in order to move, modify, or reduce structures size in order to keep the airway from closing down.
Oral or dental appliances for sleep apnea work by attempting to move the jaw or tongue or both forward and off the back of the throat- again a mechanical attempt to keep the airway open.
These three treatment approaches, CPAP, surgery, and dental devices, represent the majority of treatments recommended in most doctors’ offices for the treatment of obstructive sleep apnea.
One of the most common questions I get from patients though, after running through these options is, “are there any exercises I can do to strengthen my throat muscles and to prevent sleep apnea?”
The answer is yes, but it’s not easy and is certainly not for everyone. On the other hand, for individuals who are determined, committed, and fitness minded there are exercise alternatives (or complements) to the traditional treatments- exercises that strengthen the muscles of throat and that effectively prevent or reduce the occurrence of obstructive sleep apnea.
For those of you who are more medical or scientific minded, two interesting medical journal references are located at the end of this blog. They will provide you with detailed information on the medical studies that examined the question of treating obstructive sleep apnea with exercise.
In the first article cited below, “Effects of oropharyngeal exercises on patients with moderate obstructive sleep apnea syndrome”, the authors took a group of individuals with moderate obstructive sleep apnea, and divided them into two groups. One was assigned to perform 30 minutes of daily sham (or placebo) exercise, and the other was assigned to perform 30 minutes of exercises actually designed to strengthen the muscles of the throat wall. The results were quite impressive. The group performing the sham exercises had no improvement in any of the study variables. The throat exercise group had significant improvements in neck size, snoring, daytime sleepiness, and, most importantly, in the Apnea-Hypopnea Index (the unit of measure of sleep apnea severity). The authors concluded that throat exercise could significantly improve sleep apnea severity in individuals suffering from moderate obstructive sleep apnea.
In addition to traditional exercises, there’s also been quite a bit written about the didgeridoo, a traditional wind instrument developed by Indigenous Australians over 1500 years ago. The second article below examines the use of playing the didgeridoo as a tool to strengthen the muscles of the throat. In addition, entering the terms “didgeridoo and sleep apnea” into your favorite search engine will pull up plenty of information on the subject.
There is no question that individuals with moderate or severe obstructive sleep apnea should pursue aggressive treatment of this condition in order to treat their symptoms and to prevent medical complications. Nevertheless, there is no reason why those traditional medical treatments cannot be supplemented with these types of throat exercises. For folks with mild sleep apnea, or those with more significant disease who can’t tolerate CPAP or the other treatments, throat exercise remain a viable treatment option.
Throat exercises to treat sleep apnea definitely isn’t for everyone, but for those looked for an out-of-the-box approach it shouldn’t be overlooked.
Guimaraes KC, Drager LF, et al. Effects of oropharyngeal exercises on patients with moderate obstructive sleep apnea syndrome. Am J Respir Crit Care Med. 2009;179:962-966.
Puhan MA, Suarez A, et al. Didgeridoo playing as alternative treatment for obstructive sleep apnea syndrome: randomized controlled trial. BMJ 2005;332:266-270.
As always, if you have any questions or concerns about your health you should speak to your physician.
Roy Artal, M.D., F.C.C.P.
Medical Director, Tower Sleep Medicine
Diplomate, American Board of Sleep Medicine
Los Angeles, California