|My fine instrument -- the didgeridoo|
Who would have thought it? This week I attended the Medical Grand Rounds at CSM, the hospital where I practiced. The topic of the lecture was: Sleep Apnea: a Complete Look at Advanced Diagnosis and Treatment.The speaker, a pulmonologist who specializes in sleep medicine, sited that learning to play the didgeridoo using what is called circular breathing actually can help people with sleep apnea and can decrease the number of sleep apnea episodes. Now I haven't read this article from the British Medical Journal, but I assume this would really only help those who have fairly mild sleep apnea. It is presumed that this activity helps by strengthening the muscles that support the tissues of the throat and that surround the airway, letting those muscles work to keep the airway open better during sleep.
First perhaps I should describe briefly what sleep apnea is for those who do not know. Apnea means a pause in breathing -- that is a period of time when the patient actually does not breath. This is a problem that occurs in certain individuals with fairly well defined risk factors: obesity, advanced age, people with certain facial features such as a receding lower jaw, people with buck teeth or snorers, and diabetics. There are two components to this pause in breathing: one is in the central nervous system where breathing is just not triggered and the other component is obstructive. The tissues of the throat and the airway collapse and obstruct the flow of air even if the chest and abdominal muscles of the patient are contracting and trying to move air. If a person stops breathing for more than 10 seconds at a time during which there is no air movement at all, this is abnormal. These episodes can occur from 5 times a minute to over 30 times a minute. The significance of this is that there are some fairly concerning possible complications of moderate and severe sleep apnea. Some football fans may recall that Reggie White, a former Green Bay packer football star died during his sleep of sleep apnea. Probably in his case, the sleep apnea was severe enough that low blood oxygen led to a lethal cardiac arrhythmia. That hypoxia may not kill a person but over time it can lead the heart to enlarge and therefore increases the frequency of congestive heart failure and other cardiovascular events. Also high blood pressure and increased incidence of stroke can occur. Since the sleep apnea patient does not get restful sleep, he/she often suffers from severe daytime drowsiness which interferes with normal activities and in the case of a driver or a worker, may lead to accidents, and injury. Other effects of sleep apnea include further weight gain, edema, urinating frequently at night due to an increase of a hormone called the naturetic hormone produced by a heart that is having to work harder to circulate oxygen to the body, reduced interest in sex, and mood changes and personality changes. All of these possible complications make sleep apnea a serious condition that needs to be treated.
If you are having trouble visualizing this disorder, here is a link with a schematic video which demonstrates obstructive sleep apnea.
This type of sleep apnea is the most common. There is another type of sleep apnea called central sleep apnea. In this type there is no obstruction to airflow; the brain simply fails to trigger breathing so that there are pauses. This is a less common type of sleep apnea. And like so many disorders in medicine, there is also a combination of both obstructive and central sleep apnea. It is thought that after longstanding obstructive sleep apnes, it may progress so that each apneic episode also has a portion that is centrally caused where the brain fails to trigger the attempt to breath against the obstruction. Central sleep apneas may be more difficult to treat. Sometimes there are medications that stimulate breathing due to their affect on the acid base balance of the body. One of those medications is also used to prevent or treat altitude sicknes for the same reason -- the medication increases the frequency of breathing.
Obstructive sleep apnea is not always easy to treat. The most common treatment is to wear a tightly fitted mask over the nose or face which is connected to a machine which provides a constant or intermittent positive pressure from outside the body to keep the airway open during breathing. For some people, this mask and machine are very difficult to adjust to and fail to work. For people with milder forms of this sleep disordered breathing, mouth appliances help. For more severe forms that do not respond to the breathing machine, there are various surgical techniques that might help. Some of these are quite serious surgery however. Weight loss in the obese will usually help considerably but the presence of the sleep apnea may make it very difficult to lose weight, even more so than in the average person.
So where does this thing called a didgeridoo come in and also -- What the heck is a didgeridoo?
Well, the didgeridoo is an Australian aboriginal wind instrument made from the trunk of a small tree, quite often a eucalyptus tree, which has been hollowed out by termites. This instrument is thought to be second only to the drums as the earliest human musical instrument. When such a hollowed out tree is found by a knowledgeable member of certain aboriginal tribes, they are harvested and formed into a long tube usually about 3-4 ft long, though some are as long as 8-10 feet. The hollowing out is completed and then the instrument is often decorated on the outside, painted or varnished. Now such instruments have been made from plastics and even from PVC pipe. But the original hollowed out trees still preferred by aboriginal people are regarded as sacred instruments. Usually in these tribes, only men are allowed to play these instruments.
The technique for playing these instruments is quite different than the playing of most other wind instruments that we know about in the Western world. Air is taken in continuously through the nose in sort of a huffing motion and then circulated through the mouth, puffing out the cheeks and holding a column of air and continuing to expel it through the didgeridoo, while continuing to breath through the nose and letting air get to the lungs. This allows the player to produce a tone from the instrument which is uninterrupted and which can go one for 40 minutes or more at a time. The sound produced is a steady buzzing drone, its pitch being determined by the length and shape of the instrument. The accomplished player also throws his own voice into the instrument punctuating the drone with yells, and screeches which sound like bird or animal sounds superimposed on the drone. There are multiple examples of this music on You Tube. Here are some links so you can get an idea of what playing this instrument looks like. For those who have not learned circular breathing, it is also possible to play this instrument and use it as a rhythm instrument by simply speaking into the instrument. Even speaking its name didgeridoo, didgeridoo, etc provides a nice syncopated sound that comes from the instrument.
|The beeswax mouthpiece|
In 2005 my husband and I traveled to Australia and of course we traveled to the outback to see Ayers Rock, or Ularu, the aboriginal or Pitjintjara name. It is here that we heard a native playing this instrument. And in Alice Springs, near Ularu, there is a wonderful store which sells authentic wooden didgeridoos. We bought one for $350 and had it sent back home. It came with a CD which has some examples of authentic music and a booklet which is supposed to teach how to play it. I have tried, but not for a long time, but I have not been able to master circular breathing. So right now my didgeridoo is a decorative item standing on a stand in my front foyer. It is an attractive item, but I truly wish I could learn to play it the correct way. But though it looks to be a simple instrument, it requires much practice and perhaps a unique ability to produce the sounds that you will hear by listening on these links. Again as in many of my contacts with other societies around the world, I have gained a new respect for these unique and wonderful talents and the people who practice them around the world.
Another one which shows a slide show while listening to the didgeridoo player. http://www.youtube.com/watch?v=81vLopFB3wI&feature=related
If you really are getting into this digeridoo thing, here is a link to a 1 hour show done in Germany using the didgeridoo. You may not wish to look at the whole thing, but it certainly shows the range of sounds that can be produced with this ancient and unique instrument. Some of the speaking is in German but some is in English. Take a look throughout the hour program.
And finally, a very unique performer with the didgeridoo. This would not be regarded as authentic aboriginal playing, but it certainly is original.
And I certainly would not have thought that such a very unique talent from a very narrow corner of the world could actually be mentioned in a modern medical lecture on sleep apnea. As I often say at the end of these articles, Wow!