Consummate snorer Adam Dudding has tried many things in his quest for a silent night – from weight loss to using the expensive and unglamorous CPAP machine, but perhaps learning the ancient art of the didgeridoo is the ultimate solution?
Sometimes, says sleep doctor Otto Brändli, the way to fix someone’s snoring is really obvious. Like the time a Russian patient came to see him at his clinic in Switzerland. “He was training as an astronaut and he was snoring. They said, ‘Well this guy can’t go up there.’ So I looked at his throat and he had huge tonsils. They were almost kissing each other.
“I said, ‘Well we can solve the problem. Get your tonsils out!’”
Dr Brändli is on a video call from his home in Zurich – a 13th-century building where the thickness of the walls interferes with the wifi, so he has to move rooms halfway through our interview.
He’s 82 but retired from private practice as a pulmonary specialist only last year. He studied sleep medicine in New York in the ’70s then pioneered a sleep lab back home in Switzerland, where he prescribed all manner of interventions to deal with the curse of snoring and the associated disorder of sleep apnoea. (Apnoea or apnea– meaning literally “no breath” – is where your airway squeezes shut, leading to potentially dangerous drops in oxygen saturation.)
The fixes include surgery, like in the case of the grounded cosmonaut. Weight loss can definitely help. There are devices you can try.
Brändli says back in the day, he did some pioneering work on treatments to keep the airway open by pumping lightly pressurised air – “continuous positive air pressure” – through a facemask overnight. Sadly, he didn’t work quite fast enough. “We missed the patent. The Australians were one year ahead with their publication – otherwise perhaps I would have become a rich man.”
That was the patent filed in 1982 by Australian doctor Colin Sullivan titled “Device for treating snoring sickness”. These days, around 10 million continuous positive air pressure (CPAP) machines are sold each year worldwide, and they’re considered the gold standard for treating apnoea.
But I haven’t called Switzerland to ask Otto Brändli about his missing millions. I’ve tracked him down because I want to know more about a study he co-authored almost two decades ago – a study which suggested there was another, much lower-tech, way of getting one’s nocturnal breathing in order.
I wanted Otto to explain to me why learning the didgeridoo might change my life.
I am a snorer. Not the world’s worst snorer – I’m pretty sure that accolade goes to a guy I encountered in a Department of Conservation hut on the Routeburn Track, whose bravura impression of an orchestra of trombones mating with a jet engine at takeoff left an entire dormitory weeping with sleep deprivation the next morning – but my huffing and snorting was bad enough that last year I decided to do something about it.
I’ve bought strange devices off the internet – including a mouthguard that juts your lower jaw forwards, and a clamp that yanks your tongue halfway out your mouth. I’ve taped my lips shut. I did an at-home "sleep study" (pictured) with equipment from a sleep clinic then trialled their $2000 CPAP machine – which indeed totally eliminates the snoring but is, frankly, pretty annoying because it involves strapping a nose-mask and a big plastic tube to the front of your face all night.
So I’ve kept looking for other solutions.
First there was weight loss
I’d been advised that because I wasn’t overweight, weight loss wouldn’t make much difference to my snoring. But I was starting the year with a booze-free January anyway, so I decided to reduce my food intake too, and see what happened. It turned out the advice was wrong, because after losing 5kg the noisiness of my snoring (as measured with an iPhone app) improved dramatically.
My dieting secret, if anyone cares, was to adopt about six different approaches all at once, then drop the ones that proved too annoying. So I tried including obsessive calorie-counting on an app (quit after three weeks), eating off smaller plates (felt silly so quit after three days), plating meals rather than putting serving dishes on the table (this actually works!), reducing carbs, increasing protein, stopping snacking, and cooking many meals from Nadia Lim’s excellent Fresh Start cookbook. Also – and I think this is probably the bit that actually did it – I made peace with feeling slightly hungry much more often that I used to – and I guess there's every chance my ongoing peckishness may eventually see all the kilograms return. (NB: readers are not advised to attempt to lose weight quickly or beyond the limits of a healthy weight range.)
To see if weight-loss had helped the apnoea too, I repeated the full at-home sleep study, and it showed that my AHI (apnoea-hypopnea index) had fallen from 28 events per hour (30 is considered “severe”), all the way down to nine, which is ranked “mild”.
Which was great – but if I could go a little further and get my AHI below five, I technically wouldn't have apnoea at all any more, and I could be done with the effective-but-annoying CPAP.
That’s when I remembered the article I’d read about some research conducted in Zurich back in 2005. The authors’ names were at the top of the article, and when I emailed Otto Brändli, he emailed right back.
The poorly designed human throat
The fundamental problem, Brändli explains during our stuttering video call, is that the plumbing of the human throat is badly designed. The pipe to your lungs (the trachea) is at the front, and the pipe leading to your gut (the oesophagus) is at the back.
That’s back-to-front – a “misconstruction” says Brändli – because air from your nose enters the throat at the back, while food in your mouth enters at the front, so everything has to cross over, or else you’d be swallowing air, and breathing food and water.
To keep things orderly, various fleshy structures selectively open and close those pipes. Also, the walls of the throat are really stretchy, so we can swallow big chunks of food.
That’s all very well, but once you’re asleep and all these stretchy, fleshy structures relax, the movement of air in and out can start things vibrating, or even blocking completely. Hey presto, you’re snoring, or even worse, experiencing apnoea. If the apnoea’s bad enough you end up nodding off during the day and you’re at risk of serious health issues including high blood pressure, heart failure and strokes. (All this is especially likely if you’re an overweight middle-aged male, but it can happen to any sex at any age or weight.)
CPAP machines work by holding the floppy parts of the throat apart all night with lightly pressurised air, and when he was practising, Brändli routinely prescribed their use.
An unlikely cure: the didgeridoo
But one day a patient called Alex Suarez, who he was treating for moderate apnoea, came into the sleep clinic and said while he’d abandoned his CPAP mask, he had been playing the didgeridoo, and he thought he’d detected an improvement just from that.
He asked Brändli to do another overnight sleep study of his breathing.
“I wasn’t convinced that it would show a difference,” says Brändli, “but it did! He was much better!”
Alex Suarez believed this should be investigated further, and offered to teach other apnoea sufferers how to play if Brändli could find a team of researchers to measure what happened. There was no external funding to do the work, but “Alex was a convincing person,” says Brändli.
The resulting study tracked 25 people with mild to moderate apnoea for several months. Fourteen received lessons then practised daily; the other 11 were a control group and received no treatment.
The results were striking: the didgeridoo students saw dramatic reductions in daytime sleepiness, in their apnoea-hypopnea index (AHI), and in complaints about snoring from their partners, while for the control group nothing much changed.
Brändli says didgeridoo-playing evidently gave those floppy bits in the back of the throat a workout, strengthening and toning the muscles, just like a gym workout tightens other body parts.
“It’s like these arms of the women, you know – ” (Being Swiss, Brändli clearly doesn’t know the charming English terms “bingo wings” or “bat wings”, so he has to demonstrate by lifting his right arm and wobbling the tricep with his other hand.) “– when the muscles flops around.”
Regular didgeridoo playing, which includes a technique called “circular breathing”, tightened and toned the floppy muscles inside the throat, and as a result “they cannot vibrate any more because it's stable”.
The research writeup was accepted by the prestigious British Medical Journal and for a brief moment the team was famous: Brändli had a Swiss TV crew at his front door. He fielded a call in the middle of the night from Australians who were excited that the ancient Aboriginal instrument had been put to clinical use (though they also asked him why Swiss researchers hadn’t instead used the Swiss alphorn – and if you want an answer to that probably rhetorical question, I suggest you Google some photos of alphorns).
Yet if the study was such a success why, two decades on, are people still walking out of sleep clinics with a $2000 CPAP machine, rather than a nice bamboo didgeridoo that you can pick up online for under $100? Yes – here and there on Youtube you’ll find someone recommending a didgeridoo cure for snoring, but frankly, it hasn’t taken off.
Brändli says that’s partly because there hasn’t been much follow-up research into didgeridoo therapy. But also: “It’s the money to be made! CPAP is a big business.”
He’s not suggesting for a moment that CPAP doesn’t work. For severe cases of apnoea especially, it can be life-changing and life-saving. But for milder cases, a lot of people use it for a machine for a little while then get sick of it, and then “it hangs around in the closet, and dust settles on it. It’s sad.”
It scared the dog – but did it work?
This chat with a charming Swiss sleep doctor leaves me determined to give the didgeridoo a go.
Finding a teacher is easier than I expect. Mark “Chewy” Wilson runs drumming workshops, plays in a handpan duo with his partner and teaches didgeridoo on the side. He also happens to live just round the corner.
Chewy, 49, has been drumming for decades but first picked up the didgeridoo only 15 years ago. He’s never heard about its clinical value; what drew him in was “the melody and harmony and flow”.
During the first hour-long lesson, Chewy patiently teaches me how to make a sound. Or rather, he demonstrates a pulsing sonorous drone rich with harmonics which goes on for about 30 seconds on a single breath, then I produce a dull farty parp that lasts about half a second.
He demonstrates how to play a much longer continuous note by using “circular breathing”, where from time to time you block your throat with your tongue and snatch a little top-up breath through your nose, but simultaneously keep the air flowing past your lips by using your cheeks as bellows and squeezing out some of the air in your mouth.
Get this right and you can theoretically play a note forever, though the longest real-world note I’ve found was this chap who didgeridooed one note for two hours, two minutes and 22 seconds. My own efforts to breathe circularly are total failures, but Chewy reassures me that it took him three weeks to get it.
I do make some progress. By the end of the hour, my dull farty parps are reaching 15 seconds. The deep breathing leaves me lightheaded, and my lips are buzzing from all the parping, but honestly – it’s been fun.
Chewy lends me one of his three didgeridoos to practise on, and says if I’m not yet ready to splash out on an authentic Aboriginal instrument hollowed out by termites, I can make do with a metre of PVC pipe from a hardware store, and he’ll help make me a mouthpiece out of beeswax when I come back for lesson two.
That was a week ago. I’ve practised every day since. I still can’t breathe circularly, but my dull farty parps are now up to 28 seconds on a single breath. Every now and then I get a couple of seconds of a twangy, resonant tone, and I tell myself it almost sounds like a proper didgeridoo.
Critics are divided. Maggie the dog hid under the table at first sight of the instrument, and when I started playing she sprinted for the dog flap. Mabel the cat was more open-minded: after retreating to the safety of a doorway she listened for a good minute before turning tail and stalking down the hall.
On day five I asked for more detailed feedback from my wife. She listened for three minutes before suddenly remembering something quite important she needed to do. Before she left, though, she adjudged the sound neither thrilling nor offensive. She said it slightly reminded her of a distant foghorn, and that was vaguely comforting like vegetable soup in winter, or a woolly jumper, so I am considering this as a rave review. My second lesson is tomorrow, and I’m hoping Chewy won’t be too disappointed in me.
As for the snoring and apnoea?
The snorers in Otto Brändli’s Swiss study practised half an hour a day, five days a week, for four months before their follow-up measurements, so it’s way too soon to say if a didgeridoo will be my silver bullet.
Even if it is, Dr Brändli warned that this therapy is like a gym workout. Even if the internal bingo wings in my throat end up nicely firm and toned, I’ll need to keep playing the didgeridoo to keep them that way.
Maybe that’s a good thing. Maybe I’ll accidentally become so good that I’ll be able to start busking on weekends. As I have noted elsewhere, this is a great time for journalists to diversify their skillset.
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