BACKGROUND
About one-third of the adult population is estimated to experience insomnia, which can have a detrimental effect on the quality of life of those affected. Insomnia is characterized by difficulty in initiating and/or maintaining sleep or experiencing nonrestorative sleep, which can lead to increased risk of accidents, higher work absenteeism, and the development of other conditions such as depression and anxiety.
Currently, management of insomnia includes the use of pharmacological, psychological, and behavioral interventions as well as a range of complementary and alternative therapies. Pharmacotherapy, although commonly used, is often accompanied with unwanted physiological and psychological side effects, such as daytime sleepiness, which can affect the ability of individuals to perform daily activities. Alternatives to pharmacological interventions include, for example, education in sleep hygiene, cognitive behavioral therapy, neurofeedback brain training, and bright light therapy.
Music is frequently used by individuals as a self-help strategy for the management of insomnia. It is thought that listening to slow relaxing music has an effect on the neuroendocrine and sympathetic nervous systems that leads to a reduction in heart rate, blood pressure, and respiratory rate, therefore inducing a state of relaxation. Music has also been linked to a reduction in circulating noradrenaline, which is involved in the onset of sleep.
OBJECTIVES
The aim of this study is assess the effects of listening to music on insomnia in adults and to assess the influence of specific variables that may moderate the effect.
INTERVENTIONS/METHODS
This review included randomized control trials (RCTs) and quasi-RCTs that compared the effects on sleep improvement in adults with insomnia of listening to prerecorded music (with or without relaxation instructions) with no treatment or treatment as usual. The intervention could either be self-administered or administered by research or clinical personnel.1
Participants were required to have insomnia as documented using a variety of measures including the Pittsburgh Sleep Quality Index (PSQI), polysonography or actigraphy, participant reports/diaries, or a diagnosis of insomnia disorder as assessed by standard diagnostic criteria such as the International Classification of Diseases.
The primary outcomes measured included sleep quality, sleep onset latency, total sleep time, sleep interruption (number of awakenings and waking after sleep onset), sleep efficiency (percentage of time in bed spent asleep), and adverse events (as reported by researchers; eg, discomfort or hearing loss).
RESULTS
A total of 74 potentially relevant publications were selected for full text reviewing after screening of titles and abstracts, of which only 6 were eligible for inclusion in the review, 5 of which reported on RCTs and 1 on a quasi-RCT. The 6 included trials involved a total of 314 participants and were conducted across a variety of settings (participant's own home, 4; sleep laboratory, 1; and inpatient rehabilitation facility, 1). In addition, the studies were based in 5 countries, including Taiwan (2), Singapore (1), Hungary (1), Denmark (1), and Austria (1). Sample sizes ranged from 15 to 65 participants between the ages of 19 and 83 years, with most being women (70%).
All trials used scores of greater than 5 on the PSQI, with mean scores ranging from 6.8 to 16.0 at baseline. All included trials used listening to prerecorded music as the main intervention, with 4 trials using music only and 2 trials using music with relaxation instructions. A range of music was used, including Western and Chinese classical music, new age, electric, popular oldies, and jazz for a duration of 25 to 60 minutes once a day over 3 to 35 days.
Meta-analysis of 5 of the included studies (N = 264; moderate-quality evidence) reporting on sleep quality as assessed by the PSQI revealed an effect in favor of music listening (mean difference, -2.80; 95% confidence interval, -3.42 to -2.17; Z = 8.77, P < .00001) when compared with no treatment or treatment as usual. The remaining study (N = 50; low-quality evidence), reporting on sleep onset latency, total sleep time, sleep interruption, and sleep efficiency, found no evidence to suggest that the intervention benefited these outcomes. None of the included studies reported any adverse events.
CONCLUSIONS
The findings of this review suggest that listening to music may improve sleep quality in different populations experiencing insomnia symptoms. However, the authors conclude that it is not possible to draw any conclusions as to the effect of music on specific insomnia subtypes such as sleep initiation or maintenance difficulties or nonrestorative sleep. Also, it is difficult to evaluate which style of music (eg, classical, new age, and jazz) is more effective than others because of the nature of the included studies.
IMPLICATIONS FOR PRACTICE
Nurses often care for patients with a range of health conditions who seek advice and support for sleeping difficulties. Music may prove to be an important addition to the current range of nonpharmacological interventions that can easily and relatively safely be implemented across a variety of settings without incurring additional costs. In addition, the patient can choose the music to listen to, play it in a place, and at a time that suits their specific needs, thereby promoting self-efficacy.
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