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Exercises to fight apnea

Alternative therapy reduces the symptoms of respiratory sleep disturbance by 60%

wikimedia commonsDidgeridoo: a wind instrument played by Australian Aborigineswikimedia commons

An unconventional treatment may help a lot of those who suffer from the so-called syndrome of obstructive sleep apnea to sleep better: doing a series of physical exercises every day, to strengthen the throat muscles around the tongue, the soft palate (the rear portion of the roof of the mouth) and the pharynx’s lateral walls. After a three-month trial involving 31 patients from the InCor (Heart Institute) Sleep Laboratory in São Paulo, all of whom suffered from moderate apnea, the new approach reduced by about 60% the symptoms of this frequent health problem, characterized by brief interruptions of breathing during sleep, causing the person to awaken for a split second, even if he or she does not realize it. An individual’s apnea is diagnosed as moderate when the person experiences 15 to 30 breathing interruption episodes per hour of sleep. Those with light cases experience fewer than 15 episodes per hour and those with severe cases, more than 30.

The significant drop in the number of episodes experiencing lack of air is the main piece of information evidencing the alternative therapy’s benefits. Before taking part in this study, the patients, on average, experienced 22.4 breathing pauses an hour at night. By the end of the experiment, this figure was down to 13.7. Other parameters connected with the overall quality of sleep also improved.

The intensity and frequency of snoring, often linked with apnea, also diminished. Daytime sleepiness dropped. The volunteers’ average neck circumference shrank by roughly 1 cm, thus giving the air more room to go in and circulate within the respiratory system. “The exercises are probably also beneficial for people with light apnea,” explains Geraldo Lorenzi Filho, a lung specialist and the coordinator of this scientific study, the main conclusions of which were published in this year’s May issue of the American Journal of Respiratory and Critical Care Medicine. However, for the more severe cases, the alternative treatment is not expected to produce results and the patients will have to continue using the CPAP, a portable device that regulates breathing during sleep.

wikimedia commonsDidgeridoo: a wind instrument played by Australian Aborigineswikimedia commons

The idea of testing exercises for the throat region to fight apnea came from speech therapist Katia Guimarães, one of the study’s authors, whose doctoral thesis, defended at InCor last year, focused on this theme. About ten years ago, when she was working at Paulista State University (Unesp) in the town of Botucatu, she studied cadavers and found that the feeling of having a lump in the throat, as described by many apnea patients, was related with anatomical changes of the oropharynx. Subsequently it occurred to her that the constant movement of certain mouth organs might alter this area’s muscular system and be beneficial. “I thought that we might improve the tonus of the musculature of the upper airways and reduce apnea through exercises done while the patient was awake,” says the speech therapist.

Though the strategy seemed unorthodox, it gained momentum in 2005 when the British Medical Journal published a very interesting article on apnea, in which Swiss researchers showed that playing the didgeridoo, an Australian Aborigines wind instrument reminiscent of the berrante, a traditional Brazilian horn, reduced apnea symptoms. The relation between the two approaches is clear to the researchers. “This instrument seems to exercise the same muscles as the therapy tested at InCor,” comments Lorenzi Filho.

Although the initial results of the studies about mouth exercises to fight apnea are promising, the new therapy is still experimental and should not be done without a speech therapist and medical supervision, among other reasons because doing the movements wrong will not yield the results achieved in the scientific study. Moreover, there are different types of exercises that have to be done, involving the tongue, the soft palate and the cheeks, sometimes with the aid of a toothbrush or a finger.