Comparing the effects of music and exercise with music for older adults with insomnia

Effects of brisk walking with or without music on body composition, standing balance, cardiovascular parameters, and salivary biomarkers in older women

This study aimed to assess and compare changes in body composition, standing balance, cardiovascular parameters, and salivary biomarkers, particularly salivary antioxidant status, after brisk walking training with or without music in older women. Twenty-four subjects were randomly assigned to brisk walking groups: with music (BWM) (n=12) or without music (BW) (n=12). Eighteen subjects completed the exercise training (9 in each group), and their data were used for analysis. The research protocols were classified into three phases: pretraining phase, training phase, and posttraining phase, while the data collection was divided into four sessions: resting condition, during treadmill exercise testing, immediately posttreadmill exercise testing, and 5-min posttreadmill exercise testing defined as after the cool-down session. The results showed that 8 weeks of home-based brisk walking with or without music did not improve standing balance, blood pressure, salivary biomarkers including total protein concentration, and antioxidant status but maintained or prevented the decline of these parameters. Only the BWM group reduced fat mass relative to increasing fat-free mass (P<0.05) and improved recovery heart rate (P<0.05) by modifying cardiac autonomic control in posttreadmill exercise testing. Therefore, brisk walking with preferred music can be a tool to delay the progression of cardiovascular dysfunction in older women. A longer duration of the exercise program and larger groups of participants are needed for further investigation of brisk walking with or without music on physiological and biochemical changes.

Effect of physical activity on sleep problems in sedentary adults: a scoping systematic review

This systematic review was steered forward with the aim of analyzing how different forms of exercise could influence the objective and subjective sleep outcome among sedentary adults with sleep problems. A pre-detailed study protocol (PROSPERO ID: CRD42021229649) was used to search for RCTs through five databases. The methodological quality of the included RCTs was assessed by PEDro and studies were included if they scored > 5. Effect size of all outcome measures were calculated using Cohen's d. Of the 4154 studies, 19 studies met the inclusion criteria and underwent quality assessment using 11-point PEDRO scale. 9 studies with PEDro score > 5 were finally included in this systematic review out of which, participants of 4 studies had insomnia (nrange = 37-48, agerange = 44-60 years), 3 studies had poor sleep quality (nrange = 80-275, agerange = 52-70 years) and 2 studies had obstructive sleep apnea syndrome (nrange = 26-68, agerange = 51 years). Majority of studies revealed that physical activity seems to have greater improvement with a large effect size on subjective sleep outcomes among sedentary adults with sleep problems like insomnia, poor sleep quality and OSAS, whereas limited studies and non-significant results were observed on objective sleep outcomes. Physical activity improves sleep outcomes especially among sedentary middle-aged and older adults. More research is needed to examine the effect of physical activity programs on objective sleep outcomes especially in younger sedentary adults with different sleep problems.

Supplementary Information

The online version contains supplementary material available at 10.1007/s41105-023-00494-w.

Tailored Music Listening in Persons With Dementia: A Feasibility Randomized Clinical Trial

Introduction: This study examined the feasibility, acceptability, and preliminary efficacy of tailored music listening intervention on sleep disturbances in older adults with dementia and their caregivers. Methods: We randomly assigned 33 older adults with dementia (mean age 71.7 [SD: 7.1], 72.7% female, 81.8% African American/Black) and their caregivers (mean age 58.4 [SD: 16.7], 72.7% female, 84.8% African American/Black) to a wait-list control or intervention group (NCT04157244). Results: The music intervention was feasible as evidenced by high study measure completion and retention rates (>90%). Recruitment was stopped prematurely due to the COVID-19 pandemic. We found mixed acceptability results from the survey and qualitative interviews with the participants. Both groups improved on objective sleep outcomes of sleep latency and wake sleep after onset. We found a small effect size for sleep duration post-intervention. Discussion: The findings provide preliminary evidence for the feasibility of a tailored music intervention and identified ways to improve its acceptability.

Relation between Burnout and Sleep Problems in Nurses: A Systematic Review with Meta-Analysis

Burnout can affect nurses’ sleep quality. The aim of this study was to analyze the relationship between burnout syndrome and sleep problems in nurses. A systematic review with meta-analysis was performed. PubMed, CINAHL and Scopus databases were used. Some of the inclusion criteria were quantitative studies, in which the levels of burnout and sleep disorders were investigated in a sample of nurses using validated scales. A total of 12 studies were included. Sociodemographic variables did not influence the relation between burnout and sleep problems, except for being female. The environment and workplace violence, together with psychological traits and shifts, affect the probability of developing burnout and insomnia. The meta-analysis sample was n = 1127 nurses. The effect size of the correlation between burnout and sleep disorders was r = 0.39 (95% CI 0.29−0.48) with p < 0.001, indicating that the higher the level of burnout in nurses, the greater the presence of sleep disorders. The positive correlation between burnout and sleep disorders is a problem that must be addressed to improve the health of nurses. Developing turnicity strategies, using warmer lights in hospital units during night shifts and eliminating the fixed night shift could improve nurses’ working conditions.

Entrapment of Binaural Auditory Beats in Subjects with Symptoms of Insomnia

Binaural beat (BB) stimulation, which has two different frequencies for each ear, is reportedly effective in reducing anxiety and controlling mood. This study aimed to evaluate the brain wave entrainment effect of binaural beats and to propose an effective and safe supplementary therapy for relieving the symptoms of insomnia. Subjects between 20 and 59 years of age with subclinical symptoms of insomnia were recruited from the community. Quantitative electroencephalography was measured twice, before and two weeks after the BB intervention. Participants used the apparatus with or without 6 Hz BB for 30 min before going to bed for two weeks. When music with BB was played, the relative theta power increased (occipital, p = 0.009). After two weeks of intervention with music, the theta power increased when listening to music with BB (parietal, p = 0.009). After listening to music with BB for two weeks, the decrease in the beta power was more noticeable than after using music-only devices when participants listened to music in the laboratory (occipital, p = 0.035). When BB were played, the entrapment of the theta wave appeared. Therefore, exposure to music with BB is likely to reduce the hyper-arousal state and contribute to sleep induction.

Effects of music interventions on sleep in older adults: A systematic review

Sleep disruption is common among older adults. Non-pharmacological interventions involving music has emerged as a promising approach to address sleep disruption. The purpose of this systematic review was to examine the effects of music interventions on sleep outcomes among older adults (age ≥ 50). We searched five databases through May 2020 and found 16 eligible studies focused on two types of music interventions: music listening (n = 11) and multi-component (n = 5). We found mixed evidence in the efficacy of music interventions to improve sleep outcomes in older adults, which included sleep quality, objective and subjective sleep characteristics. Music listening interventions contained relaxing music with research teams personalizing music choice based on participants' preferences. Multi-component interventions included listening to music in addition to one other approach, such as massage, tai chi, and nature scenes. Future higher-quality studies should provide a detailed description of music interventions and tailor music selections to older adults' preferences.

ActiGraph and Short-term Heart Rate Variability Study Protocol: Amended for the COVID-19 Pandemic

BACKGROUND

ActiGraph accelerometry is widely used in nursing research to estimate daily physical activity. Heart rate variability (HRV), a measure of autonomic modulation, can be assessed in conjunction with the ActiGraph using a Polar H7 Bluetooth heart rate monitor. There is a paucity of nursing literature to guide nurse researchers' protocol development when using the ActiGraph to assess both physical activity and short-term HRV via its Bluetooth capabilities.

OBJECTIVES

The aim of this study was to describe a standardized research ActiGraph and HRV (ActiGraph HRV) protocol for an ongoing randomized controlled trial to measure physical activity and short-term HRV in patients with ischemic heart disease who report hopelessness.

METHODS

We outline the study protocol for the standardization of reliable and rigorous physical activity and HRV data collection using the ActiGraph wGT3X-BT and Polar H7 Bluetooth heart rate monitor, and data analysis using ActiLife and Kubios software programs.

RESULTS

Sixty-four participants enrolled in the randomized controlled trial to date, and 45 (70.3%) have completed or are actively participating in the study. Heart rate variability data have been collected on 43 of the 45 participants (96%) to date. During the first data collection time point, 42 of 44 participants (95.5%) wore the ActiGraph for a minimum of 5 valid days, followed by 28 of 31 participants (90.3%) and 25 of 26 participants (96.2%) at subsequent data collection time points. The intraclass correlation for physical activity in this study is 0.95 and 0.98 for HRV.

DISCUSSION

Revisions to the protocol were successfully implemented at the onset of the COVID-19 pandemic for data collection using social distancing. The protocol was additionally amended in response to an unanticipated problem with ActiGraph battery life using Bluetooth technology. Use of the ActiGraph HRV protocol has led to a reliable and rigorous measurement of physical activity and HRV for patients with ischemic heart disease who report hopelessness in this randomized controlled trial.

CONCLUSION

We provide an ActiGraph HRV protocol that can be adapted as a model in the development of ActiGraph HRV protocols for future nursing research in community and home-based settings while maximizing social distancing in the current and future pandemics.

Tailored music listening intervention to reduce sleep disturbances in older adults with dementia: Research protocol

Sleep disruption in older adults living with Alzheimer's disease and related dementias (ADRD) is debilitating and contributes to increased institutionalization, reduced cognitive function, and accelerated disease progression. Furthermore, sleep disruption is linked to poor health outcomes in caregivers, such as decreased quality of life and increased caregiver burden. Given the potentially harmful side effects of pharmacologic treatment, nonpharmacologic approaches, such as music, may provide a safer alternative to reducing sleep disruption in this vulnerable population. A growing body of literature suggests that calming tailored music may improve sleep quality in older adults with memory loss, but its efficacy has not been demonstrated in older adults with ADRD in the community, where most older adults with ADRD live. If shown to be feasible and acceptable, tailored music interventions can then be tested for efficacy in reducing sleep disruption. This protocol details a wait-list randomized controlled trial (NCT04157244), the purpose of which is to test the feasibility, acceptability, and examine the preliminary efficacy of a tailored music listening intervention in older adults with ADRD who report sleep disruption. Music selections will be tailored to the music genre preferences of older adults with ADRD and account for known sleep-inducing properties. The feasibility of processes that is key to the success of the subsequent study will be examined. Preliminary efficacy of the intervention will be assessed using objective (actigraphy) and subjective (proxy-reported) sleep quality measures. In addition, qualitative data will be solicited, examining the acceptability and satisfaction with the intervention by individuals with ADRD.

Schisandrin B exerts hypnotic effects in PCPA-treated rats by increasing hypothalamic 5-HT and γ-aminobutyric acid levels

Schisandrin B (SchB) is one of the primary active components of Schisandra chinensis (Turcz.) Baill., a traditional Chinese herb that has been used to treat insomnia for hundreds of years. Our previous studies revealed that SchB exerts sedative and hypnotic effects, increasing the content of γ-aminobutyric acid (GABA) and the expression of its receptors in the brain tissues of rats. 5-hydroxytryptamine (5-HT) is another important neurotransmitter involved in sleep regulation, although, to the best of our knowledge, there are no reports of its association with SchB. Therefore, the present study aimed to determine whether the hypnotic effect of SchB was partly due to alterations in the expression of 5-HT. The results indicated that SchB reduced sleep latency and increased sleep duration in parachlorophenylalanine (PCPA)-induced rats with insomnia by increasing 5-HT and 5-hydroxyindoleacetic acid, and upregulating the expression of the 5-HT receptor 1A in the hypothalamus. SchB also increased the ratio of GABA to glutamic acid and the activity of glutamic acid decarboxylase, decreased the activity of GABA transaminase, and upregulated the expression of GABA_A receptor α1 and GABA_A receptor γ2 in the rat hypothalamus. These results suggested that SchB improved PCPA-induced insomnia in rats, and its effects may be associated with the regulation of GABA and 5-HT levels in the hypothalamus.

Minimal Effects of Binaural Auditory Beats for Subclinical Insomnia: A Randomized Double-Blind Controlled Study

BACKGROUND

Auditory binaural beat (BB) stimulation is known to modulate electroencephalographic activity by brain entrainment, but few studies have established whether BB can affect the sleep state. We examined the effect of θ BB in improving sleep disturbances and daytime alertness.

METHODS

We conducted double-blind and sham-controlled randomized trial. Subjects with subclinical insomnia were randomly assigned and listened to music for 2 weeks with or without θ BB for 30 minutes before going to sleep.

RESULTS

There were 43 participants (32 female; mean age, 34.3 ± 10.4 years) who finished the trial. The insomnia severity decreased at 2 weeks in both groups without significant differences in Insomnia Severity Index score (4.41 ± 4.32 vs 2.71 ± 4.66, P = 0.656), although the effect was much stronger for the music with the BB group than for the music-only group (Cohen d = 1.02 vs 0.58). In awake electroencephalographic analysis, the relative β power after 2 weeks was higher in the music with the BB group than in the music-only group (0.2 ± 7.02 vs -3.91 ± 6.97, P = 0.041).

CONCLUSIONS

Auditory θ BB with music does not induce evident improvement of sleep disturbances more than does pure music, but could alter brain activity toward increasing daytime alertness in subclinical insomnia, which needs to be corroborated in a clinical population.

Insomnia in Older Adults

Purpose of Review

To evaluate and summarize recent research articles pertaining to insomnia in older adults that can guide healthcare providers on factors to consider when assessing and managing insomnia.

Recent Findings

Up to 75% of older adults experience symptoms of insomnia. Insomnia is associated with socioeconomic status, racial and ethnic classification, family relationships, medical and mental health disorders, cognitive function, and dementia. Although one-fifth of older adults are still prescribed sleep medications, cognitive behavioral therapy for insomnia is the first line treatment for insomnia, resulting in short-term and long-term benefits.

Summary

To manage insomnia safely and effectively, healthcare providers need to consistently assess for insomnia during baseline and annual assessments, evaluate medical and social factors associated with insomnia, minimize the use of sleep medications, and provide referrals to and/or collaborate with providers who perform cognitive behavioral therapy for insomnia. Insomnia screening is important as it facilitates early intervention with behavioral management, reduces the potential for pharmacological management, which increases fall risk in older adults, and enables further assessment and early identification of outcomes such as cognitive impairment.

Can music improve sleep quality in adults with primary insomnia? A systematic review and network meta-analysis

BACKGROUND

Primary insomnia is one of the most common issues for adults. However, whether to use music intervention as a non-pharmacological method of treatment, as well as which treatment should be preferred, is still a matter of controversy. Therefore, we aimed to compare and rank music interventions and no-music controls for primary insomnia patients.

METHODS

A network meta-analysis was used to identify evidence from relevant clinical trials. We searched PubMed, Embase, the Cochrane Library, and the China National Knowledge Infrastructure Library for publications up to May 2017, pertaining to music intervention for primary insomnia patients. The prespecified primary outcome was sleep quality (scored by the PSQI and overall), and the secondary outcomes were sleep onset latency and sleep efficiency. We did pairwise meta-analyses using the random-effects model, later completing the random-effects network meta-analyses. The study was registered with PROSPERO, number CRD42017064750.

RESULTS

We deemed 20 trials to be eligible, involving 1339 patients and 12 intervention arms. For PSQI scores, all intervention arms were statistically more effective than the usual care, with patients ranking listening to music as the best means of intervention (SMD: -0.61, 95%CrI: -1.01 to -0.20). For overall sleep quality, only music-associated relaxation was statistically more effective than the patients' usual care (-0.28, -0.48 to -0.08). In terms of sleep onset latency, music-associated relaxation and listening to music had significant advantages (-0.26, -0.64 to -0.09, and -0.28, -0.53 to -0.02); listening to music and music with exercise displayed a tendency to improve sleep efficiency.

CONCLUSIONS

When considering the efficacy, music intervention seemed to offer clear advantages for adults with primary insomnia. Listening to music and music-associated relaxation are probably the best options to consider in the application of music intervention.

Differences Between Sleep Logs and Actigraphy Combined With Electroencephalography in Adults With Sleep Disturbances

BACKGROUND

Actigraphy plus single-channel electroencephalography (EEG) has a high agreement with polysomnography and is considered a simple method for monitoring sleep at home. No studies, however, have evaluated its agreement with sleep logs.

PURPOSE

A sleep log was compared to a single-channel EEG in adults with sleep disturbances. The determinants of the agreement between the two recording methods were explored.

METHOD

This prospective comparison substudy included 71 participants aged 22-67 years sampled from a previous study of nonpharmacological therapy for sleep disturbances. The participants concurrently used a sleep log and a single-channel EEG machine for 6 days to measure their sleep at home. Total sleep time (TST) and sleep onset latency (SOL) were compared.

RESULTS

Correlations between measurements were .43 for TST ( p < .001) and .30 ( p < .01) for SOL. Bland-Altman analysis revealed that the mean bias between methods was 81.54 min (standard deviation [ SD] = 66.72 min) for TST and 5.58 min ( SD = 25.38 min) for SOL. SDs for both TST and SOL were higher for the sleep log than for EEG. A multivariate linear regression model demonstrated that age (standardized coefficient β = .42, p = .001) was a significant predictor of the mean difference in SOL measurements, accounting for 13.7% of the total variance in the mean difference.

CONCLUSION

Sleep log and single-channel EEG sleep measures are distinct from one another, and age predicts the mean level of disagreement between the two measures in adults with sleep disturbances.