Tuesday, August 31, 2010

Mouth and Throat Exercises For Sleep Apnea

The most effective treatment for obstructive sleep apnea (OSA) is a continuous positive airway pressure (CPAP) machine. It maintains blood oxygen levels by keeping airways open via pressure. Airways narrow when muscles relax naturally during sleep, which may lead to pauses in breathing in some people.

CPAP virtually eliminates episodes of apnea (cessation of breathing) and hypopnea (low or shallow breathing) as well as associated snoring. As a result, sleep quality improves and daytime sleepiness is significantly lessened, even after just one use.

There are alternatives to CPAP however. One is mouth and throat exercises. The following study found that oropharyngeal exercises significantly reduced the severity of sleep apnea, leading to improved sleep quality and reductions in snoring and daytime sleepiness:

Effects of Oropharyngeal Exercises on Patients with Moderate Obstructive Sleep Apnea Syndrome, American Journal of Respiratory and Critical Care Medicine, 2009

Thirty one patients were assigned to either sham therapy (deep breathing and nasal lavage) or treatment (throat exercises).

After 3 months, those in the treatment group had a significant decrease in:
  • Neck circumference (39.6 vs. 38.5 cm)
  • Snoring frequency
  • Snoring intensity
  • Daytime sleepiness
  • Sleep quality score (a decrease in this score indicated improvement)
  • Obstructive sleep apnea severity measured by an apnea-hypopnea index (AHI)
The authors made this comparison:
"The reduction in the AHI observed in patients with moderate OSAS was remarkable and in the same order of magnitude as that previously reported by a review of randomized studies that used a mandibular advancement appliance for OSAS."
Study subjects performed the exercises throughout the day for about 30 minutes total. Here's a summary of the exercises from the study:

Soft Palate
  • Pronounce an oral vowel intermittently (isotonic exercise) and continuously (isometric exercise). Repeat daily for 3 minutes.
  • Brush the top and sides of the tongue while the tongue is sitting on the floor of the mouth. Five times each movement, 3 times a day.
  • Place the tip of the tongue against the front of the palate (against back of upper front teeth) and slide the tongue backward. A total of 3 min throughout the day.
  • Forced tongue sucking upward against the palate, pressing the entire tongue against the palate. A total of 3 min throughout the day.
  • Force the back of the tongue against the floor of the mouth while keeping the tip of the tongue in contact with the inferior incisive teeth (back of lower front teeth). A total of 3 min throughout the day.
  • Orbicularis oris muscle pressure with mouth closed. (This may mean pursing your lips, but your interpretation is welcome.)
  • Suction movements.
  • Recruitment of the buccinator muscle (cheek muscle) against the finger that is introduced in the oral cavity, pressing the buccinator muscle outward. (I think this means placing a finger in your mouth and pushing your cheek outwards. It's shown in the video below.)
  • Breathing and Speech: Forced nasal inspiration and oral expiration in conjunction with phonation of open vowels, while sitting. (Breathe in through nose and out through mouth while pronouncing the vowels.)
  • Swallowing and Chewing: Alternate bilateral chewing and deglutition (swallowing), using the tongue in the palate, closed teeth, without perioral contraction, whenever feeding. Use this chewing and swallowing form whenever eating.
The article was accompanied by this short video which demonstrates some of the exercises: