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Music Displays Benefit as a Nonpharmacological Intervention for Improving Sleep in Insomnia

Disease Spotlight | <b>Disease Spotlight: Insomnia</b>

In a meta-analyses review of 10 trials, findings revealed a beneficial effect of listening to music to improve sleep quality for adults with insomnia.

In an updated review of randomized controlled trials, music showed to potentially be an effective approach for the improvement of subjective sleep quality for adults with insomnia symptoms.1 The review made it more apparent that listening to music could also be nonpharmacological intervention treatment for improving adults with insomnia as it has been currently used as a sleeping aid.

In comparison with no intervention or treatment as usual (TAU), results showed moderate-certainty evidence for improved sleep quality in those in music groups as measured by the Pittsburgh Sleep Quality Index (PSQI)2 (mean difference [MD], −2.79; 95% CI −3.86 to −1.72; studies, n= 10; participants, n = 708). In contrast, the review demonstrated very low‐certainty evidence for a difference of the effects between the groups on insomnia severity (MD, −6.96, 95% CI −15.21 to 1.28; studies, n = 2; participants, n =63).

Lead investigator Kira Jespersen, PhD, MSc, and colleagues noted that, “music probably facilitates a large improvement in the quality of sleep compared to no treatment or treatment as usual. We do not know if listening to music has an effect on the severity of insomnia (difficulty in falling or staying asleep) or the number of times a person wakes up (broken sleep) compared to no treatment or treatment as usual.”

Thirteen randomized controlled trials (participants, n = 1007) that examined the effect of listening for 25 to 60 minutes to prerecorded music daily over the course of three days to three months, were included in the meta-analysis. Eleven online databases, 2 trials registered up to December 2021, and hand searched reference lists were searched.1 Only 2 of the research authors of the review screened the studies independently for eligibility, selected the records for inclusion, withdrew data, and evaluated the risk of bias of the chosen studies.

Jespersen, assistant professor, center for music in the brain, department of clinical Medicine, Aarhus University & The Royal Academy of Music Aarhus/Aalborg, Aarhus, Denmark, and colleagues wrote, “Listening to music may improve slightly sleep‐onset latency (how quickly a person falls asleep), sleep duration (length of time a person is asleep) and sleep efficiency (amount of a time a person is asleep compared to the total time spent in bed), compared to no treatment or treatment as usual. None of the studies reported any negative effects caused by listening to music.”

The reviewers evaluated the certainty of the evidence by the studies using GRADE (Grading of Recommendations, Assessment, Development and Evaluations). As for the primary outcomes, sleep quality, insomnia severity, sleep‐onset latency, total sleep time, sleep interruption, sleep efficiency, and adverse events, were assessed. Additionally included in the meta-analyses were data on the predefined outcome measures that were reported by at least 2 homogeneous studies consistently regarding interventions, outcomes, and participants.

Additional findings in 3 studies (participants, n = 197) showed low-certainty evidence that listening to music may decrease problems with sleep‐onset latency (MD −0.60, 95% CI −0.83 to −0.37), total sleep time (MD −0.69, 95% CI −1.16 to −0.23) and sleep efficiency (MD −0.96, 95% CI −1.38 to −0.54). The studies also showed that music might not have any effect on perceived sleep interruption (MD −0.53, 95% CI −1.47 to 0.40).

Jespersen et al noted, “Our confidence in the evidence for the quality of sleep is only moderate because the people in the studies were aware of which treatment they were getting and the people scoring the data were also sometimes aware of which treatment the participants were getting, which could introduce bias. We have little confidence in the evidence for the severity of insomnia because the studies were very small and were done in different types of people who knew which treatment they were getting.”

Further study is needed on the effect of listening to music in other aspects of sleep along with the daytime consequences of insomnia, the study investigators noted. Hence, more research should focus on measures of daytime functioning as an aspect of sleep, such as mood, fatigue, concentration, and quality of life.1

REFERENCES
1. Jespersen KV, Pando-Naude V, Koenig J, Jennum P, Vuust P. Listening to music for insomnia in adults. Cochrane Database Syst Rev. 2022;8(8):CD010459. Published 2022 Aug 24. doi:10.1002/14651858.CD010459.pub3
2. Buysse DJ, Reynolds CF 3rd, Monk TH, Berman SR, Kupfer DJ. The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry Res. 1989;28(2):193-213. doi:10.1016/0165-1781(89)90047-4