Exercises for Obstructive Sleep Apnea

Look better, feel better, function better, be healthier, and improve your sleep with these simple exercises to treat obstructive sleep apnea. Daytime sleepiness and snoring will also diminish. And remember, the more you put into it, the more you get out of it.

By Mark D. Harris

Obstructive Sleep Apnea (OSA) occurs when a person develops partial or complete obstruction of the upper airway during sleep, when this obstruction results in apnea (no breathing for at least ten seconds) or hypopnea (decreased breathing). The person with OSA will then partially or fully wake up and their blood oxygen will decrease. About 25% of Americans have OSA, with men, older adults, and the obese at greater risk. OSA increases a person’s risk for high blood pressure, diabetes, atrial fibrillation, heart failure, coronary heart disease, stroke, trauma from falling asleep (while driving, for example), and death. It is a big health problem in the United States, and increasingly, the world. OSA is usually treated with medications, positive airway pressure (like CPAP), and surgery.[1] OSA is worse with supine sleeping (sleeping on your back). Some patients control their symptoms with side sleeping (sometimes with a full-length body pillow). However, there are many exercises that can help decrease symptoms of OSA, improve function, and make you look and feel better.[2]

Tongue-specific exercises

The genioglossus muscle in the tongue pulls the tongue down and forward, opening the retroglossal part (back part) of the airway. Some exercises strengthen the tongue, improving control when the tongue is weak or infiltrated with fat. [3]  To strengthen the genioglossus and other tongue muscles:

1. Stick your tongue out. Place a spoon in your mouth under your tongue. Push the spoon up while holding your tongue steady in the center of your mouth for at least ten seconds. Increase the force and the duration as you get stronger. Later, actively push down the spoon with your tongue.
2. Repeat the exercise with the spoon on top of your tongue.
3. Stick your tongue out. Place a spoon in your mouth on the right side of your tongue. Push the spoon to the right while holding your tongue steady in the center of your mouth for at least five seconds. Increase the force and the duration as you get stronger. Later, actively push the spoon to the right with your tongue.
4. Repeat the exercise on your left side.
5. Brush your tongue with a toothbrush.

Lip- and facial muscle specific exercises

Singers, models, actors, wind musicians, and public speakers exercise their lips and facial muscles, but the rest of us get lazy. Here are things to do to improve your face, and your perhaps also your OSA.

1. Hold a spoon upside down between your lips with the handle pointing forward out of the mouth. Move the handle up and down at least thirty times. Your jaw will move a little but that is OK. Repeat.
2. Hold a spoon upside down gently between your lips. Suck in to bring the spoon farther into your mouth, then reduce the suction to let it go back but do not let it fall out of your mouth.
3. Use a straw sometimes for drinking water if you have no dental or medical reasons not to.
4. Smile a lot, frown a little.

Playing Musical Instruments

Brass instruments such as the trumpet, French horn, trombone, baritone, euphonium, or tuba, requires a musician to produce a buzzing sound with their lips, while coordinating tongue movements. The didgeridoo, an instrument developed by Australian aborigines, requires similar technique. Wind instruments including the clarinet, oboe, bassoon, and saxophone involve blowing across a reed, which then vibrates to produce resonating sound. Flutes and piccolos require blowing across a small hole in the instrument. All these exercise facial muscles as well as respiratory muscles.

Playing wind instruments has been associated with a lower apnea-hypopnea index (AHI) and reducing the risk of developing OSA.[4] Playing wind instruments and singing confers a positive effect on sleep disorders including snoring.[5]

Singing and Speaking exercises

1. Read at least one document (at least 300 words) out loud daily, enunciating each word slowly and distinctly, and over pronouncing every consonant.
2. Sing at least one song per day, enunciating each word distinctly and holding each tone carefully and accurately.

General Exercise

1. Aerobic exercise such as walking 60 minutes per day or running 30 minutes per day improves breath support and opens airways.
2. Resistance exercises such as weightlifting improve blood perfusion (blood supply to tissues such as muscles, kidneys, bowels, heart, and brain), mental and physical well-being, and overall health.

Conclusion

Obstructive Sleep Apnea is a serious condition with large lifestyle impacts and serious if not deadly long-term complications. A complete medical evaluation is important, and some people will require medication, CPAP, or surgery. Many people, however, will be able to control their OSA with lifestyle changes, weight loss, smoking cessation, and exercises such as those listed above. Sweet dreams!

[1] Daniel Gottlieb, Naresh Punjabi. Diagnosis and Management of Obstructive Sleep Apnea, Journal of the American Medical Association (JAMA), 14 April 2020, 1389-1400

[2] Bughin F, Desplan M, Mestejanot C, Picot MC, Roubille F, Jaffuel D, Mercier J, Jaussent I, Dauvilliers Y. Effects of an individualized exercise training program on severity markers of obstructive sleep apnea syndrome: a randomised controlled trial. Sleep Med. 2020 Feb 18;70:33-42.

[3] Tongue Exercises May Ease Sleep Apnea, https://www.webmd.com/sleep-disorders/sleep-apnea/news/20090507/tongue-exercises-may-ease-sleep-apnea

[4] de Jong JC, Maroda AJ, Camacho M, Chen PG. The Impact of Playing a Musical Instrument on Obstructive Sleep Apnea: A Systematic Review. Ann Otol Rhinol Laryngol. 2020;129(9):924-929. doi:10.1177/0003489420917407.

[5] van der Weijden FN, Lobbezoo F, Slot DE. The effect of playing a wind instrument or singing on risk of sleep apnea: a systematic review and meta-analysis. J Clin Sleep Med. 2020;16(9):1591-1601. doi:10.5664/jcsm.8628.