Music & Insomnia

J Music Ther. 2008 Fall;45(3):360-80

• Ziv N, Rotem T, Arnon Z, Haimov I.
• The Max Stern Academic College of Emek Yizre'el

A large percentage of older people suffer from chronic insomnia, affecting many aspects of life quality and well-being. Although insomnia is most often treated with medication, a growing number of studies demonstrate the efficiency of various relaxation techniques. The present study had three aims: first, to compare two relaxation techniques--music relaxation and progressive muscular relaxation--on various objective and subjective measures of sleep quality; second, to examine the effect of these techniques on anxiety and depression; and finally, to explore possible relationships between the efficiency of both techniques and personality variables. Fifteen older adults took part in the study. Following one week of base-line measurements of sleep quality, participants followed one week of music relaxation and one week of progressive muscular relaxation before going to sleep. Order of relaxation techniques was controlled. Results show music relaxation was more efficient in improving sleep. Sleep efficiency was higher after music relaxation than after progressive muscular relaxation. Moreover, anxiety was lower after music relaxation. Progressive muscular relaxation was related to deterioration of sleep quality on subjective measures. Beyond differences between the relaxation techniques, extraverts seemed to benefit more from both music and progressive muscular relaxation. The advantage of non-pharmacological means to treat insomnia, and the importance of taking individual differences into account are discussed.

J Adv Nurs. 2008 May;62(3):327-35

• Harmat L, Takács J, Bódizs R.
• Semmelweis University, Institute of Behavioural Sciences, Budapest, Hungary

AIM: This paper is a report of a study to investigate the effects of music on sleep quality in young participants with poor sleep. BACKGROUND: Sleep disorders may result in fatigue, tiredness, depression and problems in daytime functioning. Music can reduce sympathetic nervous system activity, decrease anxiety, blood pressure, heart and respiratory rate and may have positive effects on sleep via muscle relaxation and distraction from thoughts. Control groups have not been used in most previous studies. METHODS: We used a three-group repeated measures design. Ninety-four students (aged between 19 and 28 years) with sleep complaints were studied in 2006. Participants listened for 45 minutes either to relaxing classical music (Group 1) or an audiobook (Group 2) at bedtime for 3 weeks. The control group (Group 3) received no intervention. Sleep quality was measured using the Pittsburg Sleep Quality Index before the study and weekly during the intervention. Depressive symptoms in experimental group participants were measured using the Beck Depression Inventory. RESULTS: Repeated measures anova revealed a main effect of TIME (P < 0.0001) and an interaction between TIME and GROUPS (P < 0.0001). Post hoc tests with Bonferroni correction showed that music statistically significantly improved sleep quality (P < 0.0001). Sleep quality did not improve statistically significantly in the audiobook and the control group. Depressive symptoms decreased statistically significantly in the music group (P < 0.0001), but not in the group listening to audiobooks. CONCLUSION: Relaxing classical music is an effective intervention in reducing sleeping problems. Nurses could use this safe, cheap and easy to learn method to treat insomnia.

J Adv Nurs. 2005 Feb;49(3):234-44

• Lai HL, Good M.
• Community Health Center, Buddhist Tzu-Chi General Hospital, Hualien, Taiwan, ROC

AIM: The aim of this paper is to report an investigation of the effects of soft music on sleep quality in older community-dwelling men and women in Taiwan. BACKGROUND: Sleep is a complex rhythmic state that may be affected by the ageing process. Few studies have focused on the effects of music, a non-pharmacological method of improving the quality of sleep in older adults. METHOD: A randomized controlled trial was used with a two-group repeated measures design. Sixty people aged 60-83 years with difficulty in sleeping were recruited through community leaders and screened using the Pittsburgh Sleep Quality Index (PSQI) and Epworth Sleepiness Scale. Those reporting depression, cognitive impairment, medical or environmental problems that might interfere with sleep; and those who used sleeping medications, meditation, or caffeine at bedtime were excluded. Participants listened to their choice among six 45-minute sedative music tapes at bedtime for 3 weeks. There were five types of Western and one of Chinese music. Sleep quality was measured with the PSQI before the study and at three weekly post-tests. Groups were comparable on demographic variables, anxiety, depressive symptoms, physical activity, bedtime routine, herbal tea use, napping, pain, and pretest overall sleep quality. RESULTS: Music resulted in significantly better sleep quality in the experimental group, as well as significantly better components of sleep quality: better perceived sleep quality, longer sleep duration, greater sleep efficiency, shorter sleep latency, less sleep disturbance and less daytime dysfunction (P = 0.04-0.001). Sleep improved weekly, indicating a cumulative dose effect. CONCLUSION: The findings provide evidence for the use of soothing music as an empirically-based intervention for sleep in older people.

J Music Ther. 2004 Summer;41(2):128-50

• Tan LP.

The purpose of this randomized controlled trial was to examine the effects of background music on quality of sleep in elementary school children. Convenience sampling was used to recruit a total of 86 fifth graders (43 boys and 43 girls) from an elementary school in a city in Taiwan. Subjects were randomly assigned to the experimental groups (n = 45) and the control group (n = 41). Subjects in the experimental group were given a 45-minute CD of music at naptime everyday and bedtime each night for 3 consecutive weeks. Sleep quality was measured using the Pittsburgh Sleep Quality Index (PSQI) at pretest and 3 weekly posttests. Repeated measures MANOVA was used to examine group differences across time. Results showed that subjects who received background music at naptime everyday and bedtime each night for 3 consecutive weeks had significant improvement in global sleep quality over time. Improvements were also observed in all 6 components of the PSQI although significant improvements were only observed in sleep duration and sleep efficiency. Some shortcomings of this study include the use of convenience sample, possibility of a Hawthorne effect, lack of objective measurements, and the use of non subject's preferred music.

Can J Clin Pharmacol. 2003 Summer;10(2):89-92

• Azad N, Byszewski A, Sarazin FF, McLean W, Koziarz P.
• Geriatric Assessment Unit, The Ottawa Hospital, General Campus, Ottawa, Canada

BACKGROUND: Insomnia is common in hospitalized patients, who become significantly vulnerable to the adverse effects of the benzodiazepines (BZDs) used to treat this condition. Consequently, there has been a logical search for non-drug alternatives (NDAs) for the treatment of insomnia. Method: Inpatient insomnia cases were surveyed over the Summer of 1999. Our hypotheses were that an attitudinal difference exists between acute and chronic users of BZDs towards NDAs; and that inpatients who were prescribed BZDs have also received proper information about alternative therapies. Results: One hundred insomnia cases met the inclusion criteria. Fifty-one per cent were younger than age 65. Short acting BZDs were used in 88% of the cases. Fourty per cent of patients had started experiencing insomnia while in the hospital. Only 11% of patients received information about NDA therapy for insomnia. Eighty-two patients felt that NDAs were healthier, and the majority (n=67) responded that if an NDA were offered in the hospital, they would be willing to accept it. Female participants were more willing to consider NDAs (P<0.01). First time users of BZDs were by far more receptive to NDA remedies than were chronic users of BZDs (P<0.002). A significant number of participants who were receiving short-acting BZDs were willing to try an NDA (P<0.001). Participants interested in NDA therapies expressed preferences for for massage therapy, sleep hygiene, music and relaxation techniques (P<0.001). Conclusion: Significant attitudinal differences are seen in several domains of patient characteristics. First time female users of BZDs and those taking short acting BZD were more willing to try an NDA. Educational programs are needed for appropriate evidence-based management protocols for insomnia.

J Community Health Nurs. 2003 Spring;20(1):27-35

• Johnson JE.
• Orvis School of Nursing, University of Nevada, Reno 89557, USA

Fifty-two women over the age of 70 participated in a study to investigate the use of an individualized music protocol to promote sleep onset and maintenance. They were recruited from the practices of physicians and nurse practitioners, and met the inclusion and exclusion criteria of the International Classification of Sleep Disorders (1990), and the Diagnostic and Statistical Manual of Mental Disorders (1994). Results indicated that the use of music decreased time to sleep onset and the number of nighttime awakenings. Consequently, it increased satisfaction with sleep. Nurses may wish to recommend the use of music at bedtime to older women with insomnia.

Neurosci Behav Physiol. 1998 May-Jun;28(3):330-5

• Levin YaI.
• Department of Nervous Diseases, Faculty of Postgraduate Professional Education, I. M. Sechenov Moscow Medical Academy

The effects of a new nonpharmacological method of treating insomnia-"brain music"-were studied. The method is based on the transformation of the EEG into music using a special algorithm developed by the authors. Sleep polygrams were recorded and analyzed, and EEG segments corresponding to different sleep phases were identified using standard criteria, and were transformed into music. Patients listened to the resulting audio cassettes before going to sleep. Clinical, questionnaire, psychological, and electrophysiological (polysomnographic, electroencephalographic) methods were used before and after 15-day treatment courses in 58 patients with insomnia, who were divided into two groups: group 1 (44 patients) formed the experimental group, and group 2 (14 patients) formed the "placebo" group (in whom the "brain music" of a different patient was used). "Brain music" was found to have positive effects in more than 80% of the insomniac patients both from the point of view of subjective sensations and in terms of objective studies, i.e. neuropsychological and neurophysiological investigations. The high efficacy of "brain music" in patients with insomnia was combined with an absence of side effects and complications.

Crit Care Nurs Clin North Am. 2003 Sep;15(3):329-40

• Richards K, Nagel C, Markie M, Elwell J, Barone C.
• Central Arkansas Veterans Healthcare System, 2200 Fort Roots Drive, 3J/NLRVA, North Little Rock, AR 72114, USA

The efficacy of complementary and alternative therapies for sleep promotion in critically ill patients is largely unexamined. We found only seven studies (three on environmental interventions and one each on massage, music therapy, therapeutic touch, and, melatonin) that examined the effect of complementary and alternative therapies. A number of studies, however, have shown that massage, music therapy. and therapeutic touch promote relaxation and comfort in critically ill patients, which likely leads to improved sleep. Massage, music therapy, and therapeutic touch are safe for critically ill patients and should be routinely applied by ICU nurses who have received training on how to administer these specialized interventions. Environmental interventions, such as reducing noise, playing white noise such as ocean sounds, and decreasing interruptions to sleep for care, also are safe and logical interventions that ICU nurses should use to help patients sleep. Progressive muscle relaxation has been extensively studied and shown to be efficacious for improving sleep in persons with insomnia; however, progressive muscle relaxation requires that patients consciously attend to relaxing specific muscle groups and practice these techniques, which may be difficult for critically 11 patients. We do not currently recommend aromatherapy and alternative sedatives, such as valerian and melatonin, for sleep promotion in critically ill patients because the safety of these substances is unclear. In summary, we recommend that ICU nurses implement music therapy, environmental interventions, therapeutic touch, and relaxing massage to promote sleep in critically ill patients. These interventions are safe and may improve patient sleep, although randomized controlled trials are needed to test their efficacy. Aromatherapy and alternative sedatives require further investigation to determine their safety and efficacy.

Am J Electroneurodiagnostic Technol. 2006 Dec;46(4):343-55

• Loewy J, Hallan C, Friedman E, Martinez C.
• Louis Armstrong Center for Music and Medicine, Beth Israel Medical Center, New York, New York 10003, USA

This study included a total of 60 pediatric patients ranging from 1 month through 5 years of age. The effects of chloral hydrate and music therapy were evaluated and compared as means of safe and effective ways to achieve sleep/sedation in infants and toddlers undergoing EEG testing. The results of the study indicate that music therapy may be a cost-effective, risk-free alternative to pharmacological sedation.

J Music Ther. 2005 Summer;42(2):140-58

• Hernández-Ruiz E.
• The University of Kansas, Kansas, USA

The purpose of this study was to explore the effect of a music therapy procedure (music listening paired with progressive muscle relaxation) on the reduction of anxiety and improvement of sleep patterns in abused women in shelters. Twenty-eight women residing in 2 domestic violence shelters in a Midwestern city met with the researcher on 5 consecutive days for half-hour sessions. A pretest-posttest design with control and experimental groups was used. The dependent variables included: stait anxiety measured by the STAI (Spielberger et al., 1983) before and after each music stimulus, sleep quality as measured by the PSQI (Buysse et al., 1989) on the first and last sessions, and levels of fatigue as measured by the Fatigue Scale (Lee, 1992) at waking time. The independent variable was a 20-minute recording of participant-selected music with a Progressive Muscle Relaxation script. Results indicated that music therapy constituted an effective method for reducing anxiety levels. Results also indicated a significant effect on sleep quality for the experimental group, but not for the control group. No significant relationships were found between anxiety levels and sleep quality, nor fatigue levels and sleep quality. These results seem promising in the light of domestic violence research, which has found that a greater amount of personal resources is a crucial aspect of abused women's recovery process. Reduction of anxiety and improvement of sleep quality can be considered as increased personal resources, and seem feasible through the use of music therapy.

Zh Nevrol Psikhiatr Im S S Korsakova. 1997;97(4):39-43

• Levin IaI.

The effects of "Music of the Brain" which is the new nonpharmacological method of treatment of insomnia were studied. The method is based upon the transformation of EEG signals into the music by using a special algorithm developed by the author. Sleep polygramme was registered and analysed. EEG sites of sleep stages and phases which most satisfied usual criteria were selected and transformed into music. The patient listened to the recorded audio cassette just before sleep. 58 patients with insomnia were divided into 2 groups according clinical, formal, psychological and electrophysiological (polysomnography, EEG) methods which were applied before and after 15-day course of treatment. 1st group (44 individuals) was the main group and the 2nd group (14 patients) was the "placebo" group ("Music of the Brain" of other individual was used in this case). The positive effects of "Music of the Brain" were evaluated in patients with insomnia in more than 80% cases. These effects were marked on the basis of both subjective feeling and objective (psychological and neurophysiological) results. The high effectivity of "Music of the Brain" for patients with insomnia combines with the lack of side effects and complications.

ch Inq Nurs Pract. 1996 Summer;10(2):153-70; discussion 171-4

• Zimmerman L, Nieveen J, Barnason S, Schmaderer M.
• UNMC College of Nursing, USA

The purpose of this experimental study was to determine the effects of second and third day postoperative music interventions (music, music video) on pain and sleep in 96 postoperative patients having CABG surgery. The Verbal Rating Scale scores obtained before and after each 30-minute session showed that pain decreased over time for all three groups with no difference across groups. The McGill Pain Questionnaire (MPQ) was administered before session 1 and after session 2, and results indicated that Sensory, Affective, and Present Pain Intensity subscales showed no group difference for pain; however, pain decreased from Day 2 to Day 3 for all three groups. For the evaluative component of pain, those in the music group had significantly (F[2,93] = 4.74, p < .05) lower scores on postoperative Day 2 than the rest period control group. Effects of the intervention on sleep as measured by the Richard Sleep Questionnaire indicated that the video group had significantly (F[2, 92] = 3.18, p < .05) better sleep scores than the control group on the third morning. These findings lend some support for selected music interventions.

J Holist Nurs. 1995 Sep;13(3):248-54

• Mornhinweg GC, Voignier RR

Twenty-five elderly, community-based subjects with self-perceived sleep disturbances participated in this descriptive pilot study. Subjects listened to classical and New Age music before bedtime when a sleep disturbance was identified. Daily logs were kept by each participant to evaluate the effectiveness of the intervention. Twenty-four (96%) of the subjects reported improved sleep using this self-administered intervention.