Key takeaways:

• A six-month randomized controlled trial in India found that regular shankh (conch shell) blowing reduced objective and subjective symptoms in people with moderate OSA.
• Participants in the intervention group had a 34% drop in Epworth Sleepiness Scale scores and significant reductions in apnea-hypopnea index compared to controls.
• Improvements included better sleep quality, higher nocturnal oxygen saturation, and possible upper airway remodeling, as suggested by reduced neck circumference.
• Researchers are planning a larger, multi-hospital trial to compare shankh blowing with CPAP and to test its effects in more severe OSA cases.

People who practiced blowing through a conch shell regularly for six months experienced a reduction in objective and subjective symptoms of obstructive sleep apnea (OSA), finds a small randomized controlled trial conducted in India and published in ERJ Open Research.

Blowing the conch shell, or shankh blowing, has been part of Indian culture for thousands of years. The researchers, led by Krishna K. Sharma, MD, from the Eternal Heart Care Centre and Research Institute in Jaipur, tested the hypothesis that engaging in respiratory muscle exercises through shankh blowing would result in reduced daytime sleepiness and other improved sleep-related outcomes for individuals with moderate OSA. 

“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,” Sharma says in a release. “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.”

In fact, the study found that people with moderate OSA who practiced shankh blowing slept better, felt more alert during the day, and had fewer breathing interruptions at night.

How the Conch Shell Study Was Done

The study included 30 people with moderate OSA, aged between 19 and 65, who were assessed between May 2022 and January 2024. They were tested with in-lab polysomnography, the Epworth Sleepiness Scale, and the Pittsburgh Sleep Quality Index (PSQI).

Those randomized to the intervention group (16 people) were encouraged to practice blowing shankh at home for a minimum of 15 minutes, five days per week. Participants who failed to return for two consecutive months or failed to blow the shankh regularly (performing less than 80%) at home were excluded. The control group (14 people) practiced a deep breathing exercise at home instead.

After six months, the patients were reassessed.

Lower AHI in Conch-Blowing Group

Participants in the intervention group experienced a significant improvement in subjective sleepiness (primary outcome), as measured by the Epworth Sleepiness Scale (ESS). At baseline, the mean ESS score was 14.6 points, which reduced to 9.6 points at the intervention end point, a 34% reduction. No considerable changes in subjective sleepiness were observed in the control group at the intervention end point (change in ESS score, -0.31 points). 

Similar results were observed for the secondary outcomes. The participants in the intervention group exhibited significant improvements in the PSQI score (change, -1.8 points) and apnea-hypopnea index (AHI) (change, -4.4 events/h) compared to the control group, which showed marginal changes in PSQI score (change, 0.3 points) and AHI (change, 1.2 events/h).

Intra-group analysis of proportional AHI changes revealed that, at six months, the intervention group experienced a significant reduction in overall AHI, whereas the control group showed a non-significant change. 

It also showed clinically meaningful percentage reductions across both NREM and REM sleep. In the paper, the authors note, “These reductions exceed the minimal clinically important difference commonly cited in the literature (approximately 20% reduction in AHI), suggesting that the intervention has a meaningful impact on disease severity.”

A significant improvement in the lowest nocturnal oxygen saturation was also observed in the intervention group. “Although this was not a predefined outcome and was not explored in depth, it may have important clinical implications,” the authors state.

Interestingly, a shrinking of neck circumference and body mass index was also observed within the intervention group, implying that blowing the shankh might induce upper airway remodeling.

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

Larger Trial Planned

 “This is a small study, but we are now planning a larger trial involving several hospitals,” Sharma continues. “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.”

Sophia Schiza, MD, PhD, head of the ERS group on sleep disordered breathing, who was not involved in the research, says in a release, 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.”

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