The music of the night

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(This article appeared in the Winter 2008-2009 issue of NYU Physician.)

To cure sleep apnea, an ancient instrument may be best medicine of all.

Puff-cheeked and red-faced, with beads of sweat across his forehead, Kazim Yildiz, 42, is steadily vibrating his lips, much like a baby blowing bubbles. He is playing a didgeridoo, believed to be the world’s oldest wind instrument. Traditionally crafted from a branch of a eucalyptus tree, the cylindrical wooden tube is indigenous to Australia, where it’s been used in traditional Aboriginal ceremonies for thousands of years.

Now, modern medicine has found a new use for this ancient artifact. With practice, the didgeridoo produces an eerie, reverberating bellow. But to those afflicted with sleep apnea—a potentially serious sleep disorder in which breathing repeatedly stops and starts—the sound is music to their ears.

“In people with sleep apnea, the airway intermittently collapses during sleep,” explains Dennis Hwang, M.D., a researcher in the Division of Pulmonary and Sleep Medicine. “We believe that learning to play the instrument strengthens the muscles of the upper airway and reduces the airway collapsibility during sleep.”

Yildiz, an information technology expert at Merrill Lynch, is part of a 10-person study being conducted at NYU to determine whether playing the didgeridoo regularly can help to cure their disorder. Sleep apnea (Greek for “without breath”) affects as many as one in five middle-age adults, who literally stop breathing for moments while they are asleep. These stoppages cause the brain to wake up, which allows breathing to resume, but the pattern may leave him sleepy and irritable during the day. Loud snoring is a common symptom of sleep apnea, although not everyone who snores has the disorder.

“Lately, I started feeling very drowsy and tired during the day and waking up many, many times during the night,” says Yildiz.“I couldn’t stay awake, and I thought, something is wrong.”

Recent studies suggest that sleep apnea increases the risk of high blood pressure, diabetes, heart attack, and stroke. Traditional therapy uses continuous positive airway pressure (CPAP), delivered through a cumbersome mask and tubing, to keep the airways open. But CPAP is not for everyone.

Playing the didgeridoo is likely to be a much more pleasant option.

In 2005, researchers in Switzerland reported in the British Medical Journal that playing the didgeridoo decreased daytime sleepiness, and the severity of sleep apnea, in people with the condition. In the NYU study, researchers will measure the patients’ airway collapsibility before and after lessons to document how much the instrument strengthens the muscles. The key, says Dr. Hwang, is probably the peculiar “circular breathing” technique, which allows the player to sustain a note almost indefinitely without pausing to inhale.

Instructor Giten Tonkov of the Energy of Breath Institute has been playing the didgeridoo for eight years. He still remembers the first time he heard its distinctive sound. “It was mysterious and mystical,” he says, “and the power of the vibration it gives out is very different. It struck a chord with me.”

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