Improvements in daytime sleepiness, sleep quality, and apnea-hypopnea index observed in a new study suggest that respiratory muscle training through shankh (conch shell) blowing may emerge as a novel therapeutic option for managing symptoms of obstructive sleep apnea in the future.

Obstructive sleep apnea (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 practiced shankh blowing slept better, felt more alert during the day and had fewer breathing interruptions at night.

“Conch blowing is a simple, low-cost intervention that could help reduce symptoms without the need for medication or machines,” said Dr. Krishna Sharma, a researcher at the Eternal Heart Care Centre and Research Institute in Jaipur.

“The standard treatment for OSA is a continuous positive airway pressure machine (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 practicing 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 practice blowing through a conch shell (16 patients) or to practice 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.

They were encouraged to practice at home for a minimum of 15 minutes, five days per week. After six months, they were reassessed.

Compared to the people who practiced deep breathing, the people who practiced shankh blowing were 34% less sleepy during the daytime, they reported sleeping better and polysomnography revealed that they had four to five fewer apneas (where breathing stops during sleep) per hour on average.

They also had higher levels of oxygen in their blood during the night.

“The way the shankh is blown is quite distinctive,” Dr. Sharma said.

“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 spiraling 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.”

The study was published in the journal ERJ Open Research.

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Krishna K. Sharma et al. 2025. Efficacy of blowing shankh on moderate sleep apnea: a randomised control trial. ERJ Open Research 00258-2025; doi: 10.1183/23120541.00258-2025