Sleep Apnea: Mandibular Advancement Device, Didgeridoo Practise, Vocal Training, Nose Cones and Throat & Neck Exercises

I’ve been using a combination of a Mandibular Advancement Device (MAD), Vocal Training and Didgeridoo practice to treat my severe sleep apnea for about 4 months now and I thought it was time for an update.

I wear the MAD all night every night, and most of the times that I have the occasional afternoon nap. During this time I have gradually adjusted it out by 6mm, when I hit the point where my temporomandibular joint (on which the lower jaw pivots) started to ache too much. I don’t find the MAD particularly uncomfortable to wear during the night.

It took about a week or so to adjust to sleeping with a chunk of plastic in my mouth but after that I didn’t really mind. I use the repositioner that came with my Somnomed device each morning to reposition my jaw. I notice some pain in my teeth eating crunchy foods particularly in the morning, but figure it will be worth it if it restores my health.

I’m definitely never getting laid again.

About 6 days each week for the last 5 months I’ve also been doing around 20 minutes of didgeridoo playing, which has been shown to be effective as an alternative treatment for obstructive sleep apnea. It’s a little hard to do in one hit since I get quite exhausted, so I tend to spread it out during the day and measure the time by the number of favourite songs that I play along to. I doubt I’m ever going to play didge on stage, but I did use it on a solo for an experimental song I was working on at college.

I’ve also been doing 30 minutes of singing practice using Yousician every day that I’m not at college; I’m studying music so on the days I don’t practise at home, I would often clock up half an hour in class anyway. I reckon I’ve been averaging 30 minutes a day, 6 days a week.

After having the MAD for 6 weeks I recently did a second sleep study, half with the MAD in place and half without to compare the impact of the didgeridoo and vocal practise. The results showed my AHI (which measures the severity of the condition) had dropped from 49 to 39 without the MAD and 31 with it in place. My sleep went from severely fragmented to moderately fragmented.

It’s an improvement, but I’m still a long way from <5, which is normal. The sleep specialist concluded that “The mandibular advancement dental splint is ineffective in controlling OSA”; which isn’t entirely surprising given that my sleep apnea is severe and an MAD is only recommended for mild to moderate cases.

On the positive side, my AHI without the MAD did drop 20% which I can only attribute to the vocal training and didgeridoo practice. Also, I no longer feel like falling asleep on the train to college in the mornings and I haven’t had a headache so debilitating that I’ve needed to take painkillers for a couple of months now.

I still have a mild headache, runny nose and feel run down all the time though. Nasal congestion can worsen sleep apnea, and I have a constant post-nasal drip. Something must be causing that. My sleep specialist really wanted me to use a CPAP machine, but to me that’s not really getting to the bottom of why I have sleep apnea in the first place. When I asked what caused my sleep apnea, he said it’s was just genetics; but with no family history of it I’m a little sceptical.

So what might have caused my sleep apnea, and what I could do to better treat it?

I had braces for about four years from age 14 to 17 or so, and had four teeth extracted to alleviate overcrowding. A few days ago I came across a website that suggested that these teeth may be important in putting pressure on the upper jaw to expand and grow, widening the hard palate and the nasal cavity immediately above it. During puberty the bones of the hard palate fuse together, and I had my extractions before puberty. Without a full complement of adult teeth it’s possible that my adolescent jaw didn’t expand as much as it should have and when my upper palate bones fused it left my mouth and nasal cavity too small.

The scientific literature on orthodontic extractions and sleep apnea doesn’t appear to support this view but I wonder if there isn’t a little denial going on given how lucrative adolescent orthodontic work is. Most of the studies exploring the possible link seem to look at relatively short-term impact rather than exploring the effect of pre-pubescent extractions on developing sleep apnea much later in adult life.

While it would be nice to know if this theory is true, I suspect it’s too late to do anything about my upper palate now, even if the orthodontic extractions were a contributing factor.

I also have no idea at what point I developed sleep apnea; I may well have had it as a child or adolescent. Certainly I was never capable of developing a high level of fitness when I was young: vigorous exercise would always leave me with a migraine-like headache. In a video of a talk by Dr Stashia Gominak on the relationship between Vitamin D and sleep apnea, she noted that her daytime headache patients often turned out to have undiagnosed sleep apnea. I know I used to snore even when I was young because my sisters complained about it when I was in the next room. When I stayed in hostels, I was the guy keeping everyone else in the room awake. But as to when it started, I have no idea.

I went down to the local pool & sauna for a sauna and swim 3 times a week during my holidays, in the hope of clearing up my post nasal drip. In a lecture about sleep apnea by Dr David M. Rapoport, he says “If you can clear up the nose in a sleep apnic who has allergies or nasal polyps or something like that, you can sometimes produce a very dramatic improvement”.

In another lecture about sleep apnea I watched on YouTube about sleep apnea,  saw a doctor make a passing reference to Max Air Nose Cones, so I’m now wearing them during the night to try and improve airflow through my nose.

Until a couple of weeks ago, I was also actively doing the ANS Rewire program which I’ve been on for 11 months now. I started it before I was diagnosed with sleep apnea, and it initially appeared to be helping reduce the severity of my headaches. I stuck with it until I had the results of my latest sleep study; as my sleep specialist said to me, “There may be more than one thing going on”. After 11 months I’ve watched all the videos at least twice, implemented all the diet and lifestyle recommendations, meditated for an hour almost every day and done a stack of R.E.W.I.R.E-ing.

More recently though I’ve become convinced that sleep apnea really is the cause of my chronic fatigue, which technically means I never really had CFS/ME in the first place. My sleep apnea had been missed early in the piece due to a false negative from an overnight pulse oximetry test I did at home years ago when I first got ill. While researching sleep apnea I came across a webinar by Ear, Nose & Throat surgeon Dr Michael Byrd stating that “AASM (American Academy of Sleep Medicine) does not endorse Type 4 monitoring”, which refers to pulse oximetry only. In other words, it shouldn’t be used to rule out a sleep apnea diagnosis; which is what happened to me. I’m mightily pissed off about that but at least now I know what I’m dealing with.

Physically, I feel a little better than I did before I started using the MAD, but I was disappointed with the result of the second sleep study. I still have severe sleep apnea which is potentially life-threatening and moderately fragmented sleep. I suspect that my physical symptoms are the result of being so run down due to chronic deep sleep deprivation.

I had pursued Didgeridoo practise and vocal training because they were in line with my music studies anyway, and I thought the tongue, neck & throat exercises that research has shown to be effective (also known as “Oropharyngeal exercises” or Myofunctional Therapy) looked kind of boring. However, since I’m not getting the results I need so far I’ve decided to step things up and practise the tongue, throat and neck exercises in this video:

The exercises are also available as printable slides if you want to try them yourself.

The research suggests it may take a year or more to get the full effect, but I’ll see in a couple of months how I’m progressing. Hopefully a combination of these exercises, the MAD and more vocal training at college will help. If that doesn’t work, my next step is to visit an Ear Nose and Throat surgeon (ENT) to see if they can work out what is causing the nasal congesting and post-nasal drip. Surgery is also another option, but the more I research that, the less I like the idea of going under the knife… which gives me a lot of motivation to do the exercises!

It now appears that I had undiagnosed sleep apnea all along rather than Chronic Fatigue Syndrome. Looks like I will need to rename this blog, but I think I’ll wait until I’ve found a solution and fully recovered.