Ancient practice of blowing through a conch shell could help to treat dangerous snoring condition

People who practised blowing through a conch shell regularly for six months experienced a reduction in their symptoms of obstructive sleep apnoea (OSA), according to a small randomised controlled trial published today (Monday) in ERJ Open Research [1].

OSA is a common sleep disorder where breathing repeatedly stops during the night due to a blocked airway. It leads to loud snoring, restless sleep and daytime sleepiness. It also increases the risk of high blood pressure, heart disease, and stroke.

Blowing the conch shell, or shankh blowing, has been part of Indian culture for thousands of years. The new research showed that people with moderate OSA who practised shankh blowing slept better, felt more alert during the day and had fewer breathing interruptions at night. The researchers say conch blowing is a simple, low-cost intervention that could help reduce symptoms without the need for medication or machines.

The study was led by Dr Krishna K Sharma from the Eternal Heart Care Centre and Research Institute in Jaipur, India. He said: “The standard treatment for OSA is a continuous positive airway pressure machine, or CPAP, which keeps the patient’s airway open by blowing air through a facemask throughout the night. While effective, many patients find it uncomfortable and struggle to use it consistently.

“In my clinical practice, several patients reported feeling more rested and experiencing fewer symptoms after regularly practising shankh blowing – a traditional yogic breathing exercise involving exhaling through a conch shell. These observations led us to design a scientific study to rigorously test whether this simple, ancient practice could serve as a meaningful therapy for people with OSA.”

The study included 30 people with moderate OSA, aged between 19 and 65, who were assessed at the Eternal Heart Care Centre and Research Institute between May 2022 and January 2024. They were tested with polysomnography, meaning they are monitored throughout a night’s sleep, and asked questions about the quality of their sleep and how sleepy they feel during the day.

They were randomly assigned to either be trained to practise blowing through a conch shell (16 patients) or to practise a deep breathing exercise (14 patients). Participants were provided with a traditional shankh used in yogic practices. They were trained in person at the clinic by a study team member before beginning home-based practice. Participants were encouraged to practise at home for a minimum of 15 minutes, five days per week. After six months, the patients were reassessed.

Compared to the people who practised deep breathing, the people who practised shankh blowing were 34% less sleepy during the daytime, they reported sleeping better and polysomnography revealed that they had four to five fewer apnoeas (where breathing stops during sleep) per hour on average. They also had higher levels of oxygen in their blood during the night.

Dr Sharma said: “The way the shankh is blown is quite distinctive. It involves a deep inhalation followed by a forceful, sustained exhalation through tightly pursed lips. This action creates strong vibrations and airflow resistance, which likely strengthens the muscles of the upper airway, including the throat and soft palate – areas that often collapse during sleep in people with OSA. The shankh's unique spiralling structure may also contribute to specific acoustic and mechanical effects that further stimulate and tone these muscles.

“For people living with OSA, especially those who find CPAP uncomfortable, unaffordable, or inaccessible, our findings offer a promising alternative. Shankh blowing is a simple low-cost, breathing technique that could help improve sleep and reduce symptoms without the need for machines or medication.

“This is a small study, but we are now planning a larger trial involving several hospitals. This next phase will allow us to validate and expand on our findings in a broader, more diverse population and assess how shankh blowing performs over longer periods. We also want to study how this practice affects airway muscle tone, oxygen levels and sleep in greater detail. We’re particularly interested in comparing shankh blowing with standard treatments like CPAP, and in examining its potential help in more severe forms of OSA.”

Professor Sophia Schiza, Head of the ERS group on sleep disordered breathing, based at the University of Crete, Greece, who was not involved in the research said: “Obstructive sleep apnoea is a common disease around the world. We know that OSA patients have poor quality of sleep, and higher risks of high blood pressure, strokes and heart disease. A proportion of patients experience sleepiness during the day. While CPAP and other treatments are available based on careful diagnosis of disease severity, there is still need for new treatments.

"This is an intriguing study that shows the ancient practice of shankh blowing could potentially offer an OSA treatment for selected patients by targeting muscles training. A larger study will help provide more evidence for this intervention which could be of benefit as a treatment option or in combination with other treatments in selected OSA patients."