How does music aid sleep? literature review

The role of arts therapies in mitigating Sleep Initiation and Maintenance Disorders: a systematic review

Introduction

Arts therapies offer effective non-pharmacological intervention for Sleep Initiation and Maintenance Disorders (SIMDs), encompassing both passive and active modalities. This review assesses their effectiveness and ethical considerations, focusing on music therapy, meditation, and Tai Chi.

Methods

Following PRISMA guidelines, a detailed search across PubMed, the Cochrane Library, Web of Science, and CNKI identified 17 relevant RCTs. Utilizing the Joanna Briggs Institute (JBI) quality criteria and the PICO(S) framework for data extraction ensured methodological integrity.

Results

Analysis shows arts therapies significantly improve sleep quality. Music therapy and meditation yield immediate benefits, while Tai Chi and Qigong require longer commitment for significant outcomes.

Discussion

The link between SIMDs and mental health issues like anxiety, stress, and depression suggests arts therapies not only enhance sleep quality but also address underlying mental health conditions. The evidence supports a wider adoption of arts therapies in treating SIMDs due to their dual benefits.

Systematic review registration

PROSPERO, ID: CRD42024506393.

Efficacy and safety of music therapy for the treatment of anxiety and delirium in ICU patients: a meta-analysis and systematic review of randomized controlled trials

INTRODUCTION

The medical application of music therapy (MT) has received widespread attention in recent years and some researchers have attempted to apply MT to the treatment of patients with anxiety and delirium in ICU.

EVIDENCE ACQUISITION

Relevant randomized controlled trials (randomized controlled trials s) were searched in databases, such as Web of Science, PubMed, Embase, Cochrane Library, Medline, Scopus, and CINAHL. Researchers performed literature screening, data extraction, literature quality assessment, and heterogeneity analysis among RCTs.

EVIDENCE SYNTHESIS

Fourteen studies met the inclusion criteria. In general, we included RCTs with low risk of bias, and the primary outcome indicators, including the Chinese version of the State-Trait Anxiety Inventory (C-STAI), Visual Analogue Scale for Anxiety Measurement (VAS-A), and Facial Anxiety Scale (FAS), with a recommended level of evidence of "strong". The pooled results indicated that MT was effective in alleviating the anxiety state of ICU patients (95% CI, SMD=-1.09 [-1.52, -0.67], P<0.05) and could reduce mental and physical fatigue in patients with anxious delirium in ICU (95% CI, WMD=-2.35 [-3.37, -1.33], P <0.05). There were significant differences in the therapeutic effects of MT with different intervention durations. Both 15-minute and 30-minute MT were effective in reducing anxiety levels in patients with anxiety disorders in the ICU (15min: 95%CI, SMD=-1.70[-2.15, -1.24], P<0.05; 30min: 95%CI, SMD=-0.73[-1.16, - 0.29], P<0.05). However, when the duration of MT exceeded 45 min, the overtreatment of MT instead interfered with patient rest and failed to produce a positive therapeutic effect (95% CI, SMD=-1.04 [-3.06, 0.97], P=0.31). In addition, a meta-analysis of physiological outcomes found that MT was effective in maintaining the stabilization of heart rate (HR), respiratory rate (RR), and systolic blood pressure (SBP) in ICU patients with anxiety (P<0.05), but did not affect patients' oxygen saturation, mean arterial pressure and diastolic blood pressure (P>0.05). No adverse events occurred during MT treatment in the reports of included 14 studies.

CONCLUSIONS

MT can safely and effectively reduce the anxiety level of patients with anxiety and delirium in ICU and relieve their psychological and physical fatigue. And MT was able to maintain the stability of HR, RR, and SBP in ICU patients.

Multi-Sensory Stimuli Improve Relaxation and Sleep Quality in Rotating Shift Workers: A Randomized Controlled Trial

Purpose

To compare the effects of multi-sensory stimuli on relaxation and sleep quality in 2 periods.

Patients and Methods

This experimental research used a sample group of 60 individuals, divided into three groups, with each group consisting of 20 participants. The test period was divided into two equal periods of 4 days each. The collected data included measurements of relaxation (visually calibrated scale, percentage stress, and heart rate) and sleep quality (percentage sleep, total sleep duration, and duration of deep sleep). Quantitative statistics were employed to analyze the data and compare average differences.

Results

Regarding relaxation, the results from the second period test indicated that Group 2, which received both fragrance and natural sound treatment, outperformed the other groups based on the visually calibrated scale. This group also exhibited lower levels of percentage stress and heart rate as compared to Group 1 and the control group, with a confidence level of p < 0.05. In terms of sleep quality, during the second period test, Group 2 achieved more superior results compared to the other groups in terms of percentage sleep, total sleep duration, and duration of deep sleep, with a confidence level of p < 0.05.

Conclusion

It can be inferred that multi-sensory stimuli enhanced relaxation and sleep quality.

Current scenario and potential of music therapy in the management of diseases

Over the preceding years, music therapy has gained tremendous attention due to new findings of music in management of various conditions like Alzheimer's, depression, anxiety, insomnia, etc. Music is a non-invasive, patient-friendly and pleasant form of therapy with minimal or no side effects. It activates the reward pathway of brain by influencing several processes such as dopamine release, reduction in cortisol levels, increase in estrogen and testosterone levels. This review article focuses on advantages and disadvantages of music therapy, mechanism of action of music in brain and its effective applications in the management of different diseases. The article covers history of music therapy in America, Egypt, and India with practice of music therapy. The advanced effects of music therapy in autism, cancer, post-operative pain, Parkinson's disease, selective mutism, stroke, heart problems, pregnancy, eating disorders, bone fractures and obsessive compulsive disorders are discussed. Also the effect of music therapy on the quality of sleep and brain waves has been discussed. This is an established profession in western countries like America, UK, Australia, and Canada, but not in low-income countries like India where it needs to be standardized.

Sleep quality and comfort in fully automated vehicles: A comparison of two seat configurations

As autonomous driving technology advances, the possibility of using vehicles as sleeping environments becomes increasingly relevant. To investigate the feasibility of this concept, a sleep study was conducted with twelve participants who were given a 4-h opportunity window to sleep in both reclined and flat seat configurations. The evaluation involved both objective measures, including polysomnographic (PSG) data analysis, and subjective measures through questionnaires, assessing sleep quality and comfort. While the sleep quantity results were comparable between the two sleeping positions, the reclined position showed a slight advantage in sleep quantity (TST and WASO). Interestingly, a trend highlighting a possible difference was found between the seat positions regarding non-rapid eye movement stage 3 (NREM 3). NREM 3 tended to be in a higher proportion of total sleep time in the flat seat position. Sleep onset latency (SOL) also showed a trend of a shorter latency by participants in the flat position. Additionally, most participants reported a preference for the flat position over the reclined position. These findings suggest that a flat seat configuration could offer a more comfortable and restful sleep environment for passengers in autonomous vehicles.

Different nursing interventions on sleep quality among critically ill patients: A systematic review and network meta-analysis

BACKGROUND

Critically ill patients in intensive care often struggle with disrupted sleep, a prevalent issue in this population. However, the question of which non-pharmacological intervention is most effective in enhancing sleep quality remains unanswered. This study was conducted to comprehensively evaluate and compare the efficacy of various non-pharmacological interventions aimed at improving sleep quality among critically ill individuals.

METHODS

We conducted a search of PubMed, Embase, and the Cochrane Library (Cochrane Central Register of Controlled Trials) without language restrictions to identify articles published until July 15, 2023. Randomized controlled trials (RCTs) that investigated various nursing interventions designed to improve sleep quality in critically ill patients were included in this network meta-analysis. All analyses were performed using R software (version 3.4.3) with the "gemtc" package.

RESULTS

A total of 2036 patients from 31 RCTs were included in the network meta-analysis, involving 11 different nursing interventions (routine care, relaxation combined with imagery (RI), nursel, music + earplugs + eye masks, music, eye masks, earplugs + eye masks, earplugs, aromatherapy, Warm footbath combined with acupoint exercise (WFA), Virtual reality meditation (VR)). Eye masks and earplugs + eye masks were associated with improved sleep quality compared to routine care intervention (P < .05).

CONCLUSIONS

In summary, eye masks and earplugs + eye masks stand out as the most effective interventions for enhancing sleep quality in critically ill patients. Therefore, critical care nurses should consider incorporating the use of eye masks alone or combining music with eye masks into the sleep care regimen for critically ill patients.

Longitudinal associations between cyber victimization and problematic mobile phone use in adolescents: Disentangling between-person effects from within-person effects

BACKGROUND

Being the target of cyber victimization has been shown to be connected with several forms of maladjustment among adolescents. However, there is not a clear understanding of the impact of cyber victimization on Problematic Mobile Phone Use (PMPU) and the potential mechanism underlying the association. The present study tested the longitudinal association between cyber victimization and adolescents' PMPU as well as the mediating role of sleep problems in this association.

METHODS

A sample of 1835 Chinese adolescents (55.9 % boys; M_age = 12.34) completed self-report questionnaires regarding cyber victimization, sleep problems and PMPU at four time points, using 6-month intervals. Gender, age and socioeconomic status were controlled for in the analyses. We tested cross-lagged panel models (CLPMs) and random intercept cross-lagged panel models (RI-CLPMs) to separate between- and within-person effects, allowing a robust and rigorous test of relationships among variables.

RESULTS

As hypothesized, at the within-person level, cyber victimization was a predictive risk factor of later PMPU among adolescents, and sleep problems served as an explanatory mechanism by which cyber victimization predicted adolescents' PMPU over time.

CONCLUSION

These findings contribute to identifying adolescents at risk for engaging in PMPU, as well as the prevention and intervention.

Music that is used while studying and music that is used for sleep share similar musical features, genres and subgroups

Music is an integral part of daily human life, and certain types of music are often associated with certain contexts, such as specific music for sleeping or for studying. The mood-arousal hypothesis suggests that music used for studying should be uplifting to boost arousal and increase cognitive performance while previous studies suggest that music used as a sleep aid should be calm, gentle and slow to decrease arousal. In this study, we created the Study music dataset by collecting tracks from Spotify playlists with the words 'study' or 'studying' in the title or description. In comparison with a pre-existing dataset, the Sleep music dataset, we show that the music's audio features, as defined by Spotify, are highly similar. Additionally, they share most of the same genres and have similar subgroups after a k-means clustering analysis. We suggest that both sleep music and study music aim to create a pleasant but not too disturbing auditory environment, which enables one to focus on studying and to lower arousal for sleeping. Using large Spotify-based datasets, we were able to uncover similarities between music used in two different contexts one would expect to be different.

The audio features of sleep music: Universal and subgroup characteristics

Throughout history, lullabies have been used to help children sleep, and today, with the increasing accessibility of recorded music, many people report listening to music as a tool to improve sleep. Nevertheless, we know very little about this common human habit. In this study, we elucidated the characteristics of music associated with sleep by extracting audio features from a large number of tracks (N = 225,626) retrieved from sleep playlists at the global streaming platform Spotify. Compared to music in general, we found that sleep music was softer and slower; it was more often instrumental (i.e. without lyrics) and played on acoustic instruments. Yet, a large amount of variation was present in sleep music, which clustered into six distinct subgroups. Strikingly, three of the subgroups included popular tracks that were faster, louder, and more energetic than average sleep music. The findings reveal previously unknown aspects of the audio features of sleep music and highlight the individual variation in the choice of music used for sleep. By using digital traces, we were able to determine the universal and subgroup characteristics of sleep music in a unique, global dataset, advancing our understanding of how humans use music to regulate their behaviour in everyday life.

Case Report: "I got my brain back" A patient's experience with music-induced analgesia for chronic pain

Listening to music has progressively been proposed as a complementary alternative for chronic pain; understanding its properties and its neurobiological bases is urgent. We show a phenomenological investigation of a woman who has lived 20  years with chronic pain. The inquiry involved her experience of the context in which she listens to music, the intensity and quality of pain, body mapping, memories, emotions, and cognition. The participant listens to music for different reasons, such as pain and anxiety relief, motivation to exercise, and quality of sleep, but all seem to revolve around different strategies for pain management. Experiences in physiological and cognitive aspects included perceived restorative sleep that may have improved the participant's general wellbeing and improved cognitive and motor performance as well as communication skills. The music enabled the participant not only to relieve pain but also withdrawal effects after discontinuing her opioid-based treatment. These effects may encompass endogenous opioid and dopamine mechanisms involving natural analgesia associated with pleasurable experiences. Future studies could consider phenomenological case studies and therapeutic accompaniment to reorient subjective properties of pain and expand quantitative and qualitative knowledge for more comprehensive reports on music and analgesia.

[Monotonous sound stimuli embedded with either binaural or monaural beats have the same effect on sleep latency: study on a large subject group]

OBJECTIVE

The aim of this study was to test on a large group of subjects the hypothesis that sleep latency (SL) does not depend on the nature of low-frequency beats embedded into monotonous sound stimulus supplied through the fall-asleep process. Specifically, it does not depend on whether those beats are monaural (MB) or binaural (BB).

MATERIAL AND METHODS

A special application for Android OS was developed and installed on the individual smartphones of 221 subjects for the purpose of the study. Three attempts were performed with each of them using 3 different kinds of monotonous sound supplied according to counterbalanced design. Three kinds of sound were identical in pitch but differed in the beat presence and type: BB, MB or sham (sound without beats).

RESULTS

Repeated measures analysis of variance (rANOVA) revealed no significant statistical effect of stimulus type on SL (p=0.21). A pairwise comparison of SL for different stimulation conditions showed the null hypothesis significance level adjusted according to multiple comparison correction to be p=1.0. Thus, in this experiment SL did not significantly depend on the monotonous sound stimulus type: MB, BB, or sham.

CONCLUSION

The software application developed is useful as universal platform to assess at home conditions the impact of various external factors on fall-asleep process.

Effects of Audio Brain Entrainment on Korean People with Mild Insomnia

Sleep health has become an important healthy lifestyle. Research has shown that almost one-fifth of the Korean adult population does not have sufficient sleep. The lack of sleep is associated with significant medical, psychological, social, and economic issues. People are not only yearning for sufficient sleep but the quality of sleep as well. Usually, the obvious choice will be the use of pharmaceuticals however, these often have various side effects, and the lasting use of these medications could become a concern. Therefore, new non-drug alternatives are sought after. Audio brain entrainment is a procedure that modules neural activities by synchronizing brainwave frequency with pulse tones. By producing frequency tones for the deep sleep stage, it promotes a good night's sleep. In this paper, we developed a pillow integrated with the audio speakers that produce alpha and theta beats that should help improve sleep. Sleep polysomnography was performed on 10 people to compare the effects of the audio stimulus. Initial results showed a positive effect on sleep onset latency, indicating that sleep induction happened. This noninvasive stimulation technique can be a promising candidate for wearable bioelectronics medicine and further neuroscience research.

Determinants of natural adult sleep: An umbrella review

BACKGROUND

Sleep has a major impact on health, which makes it a relevant topic for research and health practitioners. Research on sleep determinants, i.e. factors that positively or negatively influence sleep, is fragmented.

OBJECTIVE

The purpose of this umbrella review is to provide an overview of the current evidence on determinants of natural adult sleep.

METHODS

A comprehensive literature search was performed on determinants of sleep. Reviews and meta-analyses on natural adult sleep were included. Six electronic databases (PubMed, WoS, Embase, CINAHL, PsycInfo and Cochrane) were used for the search, last accessed September 2021. The quality of the selected articles was assessed using the AMSTAR2 tool. Results were categorized in four main categories: biological, behavioral, environmental and personal/socio-economical determinants.

RESULTS

In total 93 reviews and meta-analyses resulted in a total of 30 identified determinants. The impact of each determinant differs per individual and per situation. Each determinant was found to affect different sleep parameters and the relationship with sleep is influenced by both generic and specific moderators.

DISCUSSION

A comprehensive overview on relevant sleep determinants provides a practical and scientifically based starting point to identify relevant intervention approaches to secure or improve individual sleep quality. The difference in aggregation level of the determinants and in measurement methods are the major limitations of this umbrella review. Extending existing generic sleep hygiene rules with an overview of all types of potential determinants will enhance the awareness of the complexity and can be used to improve the effect of sleep interventions in health promotion.

TRIAL REGISTRATION

The umbrella review was registered with PROSPERO (registration ID CRD42020149648) https://www.google.com/search?client=firefox-b-d&q=CRD42020149648.

The Effectiveness of a Multi-Sensory Sleep-Promotion Program on Sleep Quality among Hospitalized Older Adults of Thailand: A Quasi-Experimental Study

BACKGROUND/OBJECTIVE

Older adults suffer from sleep disturbances, especially during hospitalization, affecting their health condition, recovery, and in-hospital mortality. Therefore, we aimed to explore the effectiveness of a multi-sensory sleep-promotion program on sleep quality among hospitalized Thai older adults.

METHODS

In a quasi-experimental study, the 52 eligible older adults in a private medical ward were equally assigned into two groups. The experimental group received a sleep quality assessment after the first night of admission, the 60-minute multi-sensory sleep-promotion program for three nights, and an outcome evaluation on the last night after the intervention. In contrast, the control group received routine care for the same period. Sleep quality was measured by the Verran and Snyder-Halpern Sleep Scale (Thai version). In addition, independent and paired samples t-tests compared the sleep quality between and within the two groups.

RESULTS

The older adults in the experimental group had better sleep quality than those who did not (p < .001). Those who participated in the multi-sensory sleep-promotion program markedly improved their sleep quality over five days (p < .001).

CONCLUSION

A multi-sensory sleep-promotion program can promote the sleep quality of older adults. The five alternative methods to promote sleep are effective without the deleterious effects of hypnotics and sedatives often experienced among older adults. Therefore, nurses and other healthcare professionals can implement this program as standard practice. In addition, they may adjust it to fit the acuity level and care dependencies of older adults in other cultures to promote sleep quality.

Progressive muscle relaxation increases slow-wave sleep during a daytime nap

Sleep is critical for health, cognition, and restorative processes, and yet, many experience chronic sleep restriction. Sleep interventions have been designed to enhance overnight sleep quality and physiology. Components of these interventions, like relaxation-based progressive muscle relaxation (PMR), have been studied in isolation and have shown direct effects on sleep architecture, including increasing time in restorative, slow-wave sleep (SWS). These relaxation methods have been understudied in naps, which are effective fatigue countermeasures that reduce deleterious effects of chronic sleep restriction. We hypothesised that PMR should boost SWS in a nap, as compared to an active control. We used a between-subject design in which healthy young adults underwent PMR training or listened to Mozart music (control) prior to a 90-min nap opportunity. We assessed changes in the amount and lateralisation of SWS, as evidence suggests left hemispheric lateralisation may be a proxy for recuperative sleep needs, and changes to state-dependent anxiety and fatigue before and after the nap to assess intervention success. We found PMR participants spent ~10 min more in SWS, equivalent to 125% more time, than the control group, and concomitantly, significantly less time in rapid eye movement sleep. PMR participants also had greater right lateralised slow-wave activity and delta activity compared to the control suggesting a more well-rested brain profile during sleep. Further, pre-sleep anxiety levels predicted nap architecture in the intervention group, suggesting benefits may be impacted by anxiety. The feasibility and accessibility of PMR prior to a nap make this an interesting research avenue to pursue with strong translational application.

Listening to music for insomnia in adults

BACKGROUND

Insomnia is a common problem in modern society. It is associated with reduced quality of life and impairments in physical and mental health. Listening to music is widely used as a sleep aid, but it remains unclear if it can actually improve insomnia in adults. This Cochrane Review is an update of a review published in 2015.

OBJECTIVES

To assess the effects of listening to music on sleep in adults with insomnia and to assess the influence of specific variables that may moderate the effect.

SEARCH METHODS

For this update, we searched CENTRAL, MEDLINE, Embase, nine other databases and two trials registers up to December 2021. In addition, we handsearched reference lists of included studies, and contacted authors of published studies to identify additional studies eligible for inclusion, including any unpublished or ongoing trials.

SELECTION CRITERIA

Randomised controlled trials comparing the effects of listening to music with no treatment or treatment as usual (TAU) in adults complaining of sleep difficulties.

DATA COLLECTION AND ANALYSIS

Two review authors independently screened records for eligibility, selected studies for inclusion, extracted data and assessed risk of bias of the included studies. We assessed the certainty of the evidence using GRADE. The primary outcomes were sleep quality, insomnia severity, sleep-onset latency, total sleep time, sleep interruption, sleep efficiency and adverse events. Data on the predefined outcome measures were included in meta-analyses when consistently reported by at least two studies that were homogeneous in terms of participants, interventions and outcomes. We undertook meta-analyses using random-effects models.

MAIN RESULTS

We included 13 studies (eight studies new to this update) comprising 1007 participants. The studies examined the effect of listening to prerecorded music daily, for 25 to 60 minutes, for a period of three days to three months. The risk of bias within the studies varied, with all studies being at high risk of performance bias, because of limited possibilities to blind participants to the music intervention. Some studies were at high risk of detection bias or other bias. Four studies reported funding from national research councils, three studies reported financial support from university sources and one study reported a grant from a private foundation. Five studies did not report any financial support. At the end of the intervention, we found moderate-certainty evidence for improved sleep quality measured with the Pittsburgh Sleep Quality Index (PSQI) in themusic groups compared to no intervention or TAU (mean difference (MD) -2.79, 95% confidence interval (CI) -3.86 to -1.72; 10 studies, 708 participants). The PSQI scale ranges from 0 to 21 with higher scores indicating poorer sleep. The size of the effect indicates an increase in sleep quality of the size of about one standard deviation in favour of the intervention. We found no clear evidence of a difference in the effects of listening to music compared to no treatment or TAU on insomnia severity (MD -6.96, 95% CI -15.21 to 1.28; 2 studies, 63 participants; very low-certainty evidence). We found low-certainty evidence that, compared to no treatment or TAU, listening to music may reduce problems with sleep-onset latency (MD -0.60, 95% CI -0.83 to -0.37; 3 studies, 197 participants), total sleep time (MD -0.69, 95% CI -1.16 to -0.23; 3 studies, 197 participants) and sleep efficiency (MD -0.96, 95% CI -1.38 to -0.54; 3 studies, 197 participants), but may have no effect on perceived sleep interruption (MD -0.53, 95% CI -1.47 to 0.40; 3 studies, 197 participants). In addition, three studies (136 participants) included objective measures of sleep-onset latency, total sleep time, sleep efficiency and sleep interruption and showed that listening to music may not improve these outcomes compared to no treatment or TAU. None of the included studies reported any adverse events.

AUTHORS' CONCLUSIONS

The findings of this review provide evidence that music may be effective for improving subjective sleep quality in adults with symptoms of insomnia. More research is needed to establish the effect of listening to music on other aspects of sleep as well as the daytime consequences of insomnia.

External Auditory Stimulation as a Non-Pharmacological Sleep Aid

The increased demand for well-being has fueled interest in sleep. Research in technology for monitoring sleep ranges from sleep efficiency and sleep stage analysis to sleep disorder detection, centering on wearable devices such as fitness bands, and some techniques have been commercialized and are available to consumers. Recently, as interest in digital therapeutics has increased, the field of sleep engineering demands a technology that helps people obtain quality sleep that goes beyond the level of monitoring. In particular, interest in sleep aids for people with or without insomnia but who cannot fall asleep easily at night is increasing. In this review, we discuss experiments that have tested the sleep-inducing effects of various auditory stimuli currently used for sleep-inducing purposes. The auditory stimulations were divided into (1) colored noises such as white noise and pink noise, (2) autonomous sensory meridian response sounds such as natural sounds such as rain and firewood burning, sounds of whispers, or rubbing various objects with a brush, and (3) classical music or a preferred type of music. For now, the current clinical method of receiving drugs or cognitive behavioral therapy to induce sleep is expected to dominate. However, it is anticipated that devices or applications with proven ability to induce sleep clinically will begin to appear outside the hospital environment in everyday life.

Systematic review: auditory stimulation and sleep

STUDY OBJECTIVES

Auditory stimulation devices (white and pink noise) are used to mask sounds and facilitate relaxation and sleep; however, the effectiveness of this intervention is not well established. This systematic review examined the scientific literature for the effect of specific types of auditory stimulation on sleep outcomes in adults.

METHODS

The PRISMA Statement guided this review. Searches were conducted in nine databases for intervention studies that could easily be employed in clinical practice. We excluded other types of auditory stimulation (music alone, binaural tones, and synchronization). Two reviewers screened abstracts and full-text articles for eligibility, with conflicts resolved by a third reviewer, and extracted data. Risk of bias was assessed with the Effective Public Health Practice Project Quality Assessment Tool for Quantitative Studies.

RESULTS

34 studies reported results of 1,103 persons participating in three categories of interventions: white noise (18), pink noise (11), and six multi-audio (some combination of white, pink, music, or silence). Nineteen studies had positive findings in terms of improving sleep outcomes: 6 white noise (33%), 9 pink noise (81.9%), and 4 multi-audio (66.7%). Multi-audio had the lowest (better) risk of bias (mean/SD: 1.67/0.82) compared to white (2.38/0.69) and pink noise (2.36/0.81).

CONCLUSIONS

Although there was no strong evidence to support use of auditory stimulation, none of the studies reported any adverse effects with short-term application of auditory stimulation during sleep. Future research needs to include confounding factors that can affect outcomes, including one's noise sensitivity, personality, and other conditions or medications that may affect sleep.

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.

[The effect of music embedded with binaural beats on heart rate parameters during nap]

OBJECTIVE

To test hypothesis that music embedded with binaural beats can boost activity of parasympathetic part of autonomic nervous system (PPANS) with the development of nap.

MATERIAL AND METHODS

The power of high-frequency component of heart rate variability spectrum computed on successive 2-minute intervals during 20-minute nap was a comparison criterion. The criterion was compared during nap accompanied by music with embedded binaural beats (stimulus condition) and nap in silence (control condition).

RESULTS AND CONCLUSION

Statistical comparison revealed the increase of PPANS activity during nap in stimulus condition vs. control condition. It is consistent with conclusions of other papers about positive effect of sound stimuli embedded with binaural beats on PPANS.

Music intervention for sleep quality in critically ill and surgical patients: a meta-analysis

OBJECTIVE

Sleep disruption occurs frequently in hospitalised patients. Given the potential of music intervention as a non-pharmacological measure to improve sleep quality, we aimed to assess and quantify current literature on the effect of recorded music interventions on sleep quality and quantity in the adult critical care and surgical populations.

DESIGN

Systematic review and meta-analysis.

DATA SOURCES

Embase, MEDLINE Ovid, Cochrane Central, Web of Science and Google Scholar.

ELIGIBILITY CRITERIA FOR STUDIES

Randomised controlled trials assessing the effect of music on sleep quality in critically ill and surgical patients.

METHODS

The electronic databases were systematically searched from 1 January 1981 to 27 January 2020. Data were screened, extracted and appraised by two independent reviewers. Primary outcomes were sleep quality and quantity, assessed with validated tools. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. Random effects meta-analysis was performed, and pooled standardised mean differences (SMDs) with 95% CIs were reported.

RESULTS

Five studies (259 patients) were included in qualitative (risk of bias) and quantitative analysis (meta-analysis). Pooled data showed a significant effect of recorded music on subjective sleep quality in the critical care and surgical population (SMD=1.21 (95% CI 0.50 to 1.91), p<0.01, excluding one non-English study; SMD=0.87 (95% CI 0.45 to 1.29), p<0.01). The SMD of 1.21 corresponded to a 27.1% (95% CI 11.2 to 42.8) increase in subjective sleep quality using validated questionnaires. A significant increase in subjective sleep quantity of 36 min was found in one study. Objective measurements of sleep assessed in one study using polysomnography showed significant increase in deeper sleep stage in the music group.

CONCLUSIONS

Recorded music showed a significant improvement in subjective sleep quality in some critical care and surgical populations. Therefore, its use may be relevant to improve sleep, but given the moderate potential for bias, further research is needed.

PROSPERO REGISTRATION NUMBER

CRD42020167783.

Effects of music intervention on sleep quality of older adults: A systematic review and meta-analysis

BACKGROUND

Music interventions have several benefits for sleep quality. However, the effects of music interventions on sleep quality in older adults are controversial.

OBJECTIVE

To summarize and evaluate the efficacy of music interventions on sleep quality in older adults.

METHODS

The Cochrane Library, Embase, PubMed, Web of Science and Chinese National Knowledge Infrastructure (CNKI) were systematically retrieved until June 2020, updated on March 13, 2021. Both experimental and quasi-experimental studies were included if they evaluated the efficacy of music interventions on sleep outcomes in older adults. The methodological quality was assessed by the Cochrane RoB 2.0 and ROBINS-I Tool. The random effects models and effect measure (MD) were adopted, and sensitivity analysis by omitting each study was conducted to explore the source of heterogeneity.

RESULTS

A total of 489 participants from 9 studies met the inclusion criteria. 6 studies were included in meta-analysis and sensitivity analysis, and 3 studies were included in the qualitative analysis. Main concerns about risk of bias were lack of blinding participants and investigators, and confounding factors might exist in non-RCTs. The Post-hoc meta-analysis indicated that music interventions might have a positive effect on sleep quality [MD = -2.64, 95 % CI (-3.76, -1.53), p <  0.001; I² = 75.0 %]. Only one study evaluated adverse events and reported zero discomfort.

CONCLUSIONS

The results indicated that music interventions might be beneficial for improving sleep quality, especially in sleep latency, sleep duration, sleep efficiency and sleep of daytime dysfunction in elderly individuals.

Job-related factors associated with changes in sleep quality among healthcare workers screening for 2019 novel coronavirus infection: a longitudinal study

BACKGROUND

Sleep disorders may exacerbate many physical and mental health conditions, causing difficulty function in a healthcare setting. Workers screening for the 2019 novel coronavirus (2019-nCoV) infection have a high risk of not only occupational exposure to the virus but also sleep disorders. However, the job-related factors associated with reduced sleep quality remain unclear.

METHODS

All healthcare workers temporarily scheduled to screen the 2019-nCoV patients were asked to complete a self-administered questionnaire that included questions on demographics, job-related factors, and sleep quality as assessed using the Pittsburgh Sleep Quality Index (PSQI). Sleep quality was assessed over a one-month follow-up period.

RESULTS

A total of 116 doctors and 99 nurses were recruited for this study. The total scheduled work time was 14.78 ± 6.69 days during follow-up. Some job-related factors, such as number of work days, years of work experience, and subjective psychological stress, were associated with changes in the PSQI score. During the study, some workers tried out cognitive behavioral therapy (CBT) for sleep disorders using methods that were available online and easily accessible. Adopting online CBT was shown to be associated with scores of components of sleep quality, sleep latency, and sleep disturbance (β = -0.152, P = 0.01; β = -0.175, P = 0.008; and β = -0.158, P = 0.011, respectively).

CONCLUSIONS

Healthcare workers involved in screening for 2019-nCoV experienced reduced sleep quality, and a reasonable work schedule may help with maintaining sleep quality. In addition, interventions for healthcare workers should target self-help sleep assistance.

Music on Prescription to Aid Sleep Quality: A Literature Review

Research on the efficacy of music for improving sleep quality has produced mixed results. We investigated whether the number of music dosages could be a reason for the lack of clarity. Six longitudinal music sleep studies using the Pittsburgh Sleep Quality Index (PSQI) over 3 weeks were identified. Music when compared to active (audiobooks or medication) or passive controls significantly improved (improvement is reflected by a lower score) PSQI within the first or second week of prescription. The improvement was an average mean difference of −1.15 (SD = 0.53) for each week. Music dosages continued to be associated with improved PSQI over a study that had a 3-month music intervention. One study with a low initial PSQI score resulted in poor sleepers (PSQI > 5) achieving healthy sleep (PSQI < 5) within 3 weeks of regular music intervention. For future studies, “prescribing” music beyond 3 weeks may lead to more instances of healthy sleep, particularly for those who have mild sleep problems. To explain the findings, we proposed that the relationship between weeks of music listening and improved PSQI are attributed to the truncation of poor bedtime habits linked to ruminative tendencies and consequent hyperarousal prior to the music intervention. Music listening at bedtime replaces those bad habits, we argue, by forming a new psychological link between bedtime and sleep through evaluative conditioning. The findings of the present study provide disarming evidence of the potential for prescription of music for treating mild sleep disorder.