Effect of music therapy on improving sleep quality in older adults: A systematic review and meta-analysis

Comparative efficacy of non-pharmacological interventions on sleep quality in old adults: A systematic review and network meta-analysis

AIMS AND OBJECTIVES

To compare the effectiveness of non-pharmacological interventions in enhancing sleep quality in older people.

BACKGROUND

Sleep problems in older adults have become increasingly prominent. Sleep problems not only affect the health and quality of life of older people, but also the range of chronic diseases caused by sleep problems also impose a huge burden on social services and health care. Non-pharmacological interventions are an effective alternative to pharmacological therapies, but it is unclear which non-pharmacological therapies are most effective in enhancing sleep quality in older adults.

DESIGN

A systematic review and network meta-analysis based on PRISMA-NMA.

METHODS

A total of seven databases were searched from the establishment of the database to March 2023. After literature screening and data extraction, the Cochrane Bias assessment tool 2.0 version of randomised controlled trials (RCTs) was used to evaluate literature quality. A network meta-analysis was performed to evaluate the relative efficacy of the non-pharmacological interventions on sleep quality.

RESULTS

A total of 71 RCTs involving nine non-pharmacological interventions were included. The results of the network meta-analysis showed that the joint intervention may be the most effective non-pharmacological intervention to enhance sleep quality in older adults.

CONCLUSION

This study confirms that non-pharmacological interventions can improve sleep quality in older adults. The use of non-pharmacological interventions can be promoted by healthcare professionals in the future to improve the quality of sleep and thus the physical and mental health of older people.

RELEVANCE TO CLINICAL PRACTICE

This evidence suggests that joint interventions may be most effective. Therefore, in the future, a combination of non-pharmacological interventions could be used to maximise their effectiveness in improving sleep quality in older people and promoting healthy aging.

NO PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution is not applicable to this study.

Effectiveness of binaural beat music combined with rhythmical photic stimulation on older people with depressive symptoms in long-term care institution: a quasi-experimental pilot study

BACKGROUND

Many older adults residing in long-term care often face issues like poor sleep, reduced vitality, and depression. Non-pharmacological approaches, specifically Binaural Beat Music (BBM) and Rhythmic Photic Stimulation (RPS), may alleviate these symptoms, yet their efficacy in this demographic has not been extensively explored.

AIMS

This study investigated the effects of combined BBM and RPS interventions on sleep quality, vitality, and depression among older residents with depressive symptoms in long-term care facilities.

METHODS

Using a quasi-experimental design, a total of 88 older adults with depressive symptoms from Taiwanese daytime care centers were divided into the BBM with RPS, and Sham groups (44 each). They underwent 20-minute daily sessions of their assigned treatment for two weeks. The BBM with RPS group listened to 10 Hz binaural beat music with 10 Hz photic stimulation glasses, and the Sham group received non-stimulating music and glasses.

RESULTS

After the intervention, participants in the BBM with RPS groups showed significant improvements in vitality and depressive mood, with a notable increase in sympathetic nervous system activity. Conversely, the Sham group exhibited significant deterioration in vitality and mental health, with a significant increase in parasympathetic activity. Additionally, compared with the Sham group, the BBM and RPS groups showed significant improvements in vitality, mental health, and depression, with a significant increase in sympathetic nervous activity.

CONCLUSION

The two-week intervention suggests that the combination of BBM and RPS, as a non-invasive intervention, can potentially improve vitality, mental health, and depressive mood among older adults in long-term care institutions.

The effect of music on menopausal symptoms, sleep quality,and depression: a randomized controlled trial

OBJECTIVE

This study aimed to determine the effect of music on menopausal symptoms, sleep quality, and depression levels in menopausal women.

METHODS

This randomized controlled study was carried out between August and December 2022. The study sample consisted of 61 menopausal women (intervention: 30 and control: 31). The intervention group listened to music twice a day for 5 weeks, with a total of 70 sessions. The control group received only routine care. Menopause symptoms, depression levels, and sleep quality were evaluated at the beginning and the end of the study using the Menopausal Symptoms Rating Scale, Beck Depression Inventory, and Pittsburg Sleep Quality Index.

RESULTS

The post-test Menopausal Symptoms Rating Scale, Beck Depression Inventory, and Pittsburg Sleep Quality Index scores of the menopausal women were found to be lower in the intervention group than in the control group (p=0.011, p=0.001, and p=0.006, respectively). When the pre-test and post-test mean scores were compared, the mean menopausal symptoms and depression levels decreased, and sleep quality increased significantly in the intervention group. No significant difference was observed in the control group.

CONCLUSION

This study shows that music may have an effect on reducing the level of menopausal symptoms and depression levels and also increasing the sleep quality of menopausal women.

Non-pharmacological interventions for improving sleep outcomes among patients with a diagnosis of coronary artery disease: a systematic review and meta-analysis

AIMS

To determine the effectiveness of non-pharmacological interventions on sleep outcomes among patients with coronary artery disease and recognize pertinent characteristics that potentially affect the effectiveness of such interventions.

METHODS AND RESULTS

Relevant studies conducted before 27 April 2022 were identified through four core electronic databases using terms related to coronary artery disease, sleep outcomes, and randomized controlled trials. Two authors independently conducted study selection, data extraction, and risk-of-bias assessment. Meta-analysis, sub-group analysis, publication bias analysis, and sensitivity analysis were conducted using R version 4.2.2. Of the 4755 retrieved articles, 42 studies were selected for systematic review and 30 studies were included in the meta-analysis. The findings of this study revealed that non-pharmacological interventions significantly improved self-reported sleep quality (standardized mean difference = -0.85, 95% confidence interval -1.08, -0.63), but had no effects on objectively measured sleep efficiency and duration. Regarding the types of interventions involved, environmental control was the most effective in improving self-reported sleep quality, followed by relaxation, self-care behaviour management, and relaxation and cognitive/psychological complex interventions. Through subgroup analysis, we did not find any covariates that were significantly related to self-reported sleep quality.

CONCLUSION

Non-pharmacological interventions have been shown to play beneficial roles in improving self-reported sleep quality among patients with coronary artery disease. Additional studies are required to elucidate the effect of non-pharmacological interventions on objectively measured sleep outcomes and to characterize their optimal frequencies and durations.

REGISTRATION

PROSPERO CRD42022366851.

Treatments and regulatory mechanisms of acoustic stimuli on mood disorders and neurological diseases

Acoustic stimuli such as music or ambient noise can significantly affect physiological and psychological health in humans. We here summarize positive effects of music therapy in premature infant distress regulation, performance enhancement, sleep quality control, and treatment of mental disorders. Specifically, music therapy exhibits promising effects on treatment of neurological disorders such as Alzheimer's disease (AD) and Parkinson's disease (PD). We also highlight regulatory mechanisms by which auditory intervention affects an organism, encompassing modulation of immune responses, gene expression, neurotransmitter regulation and neural circuitry. As a safe, cost-effective and non-invasive intervention, music therapy offers substantial potential in treating a variety of neurological conditions.

The effects of therapeutic touch and music on sleep quality, menopausal symptoms, and quality of life in menopausal women

OBJECTIVES

This study aimed to examine the effects of therapeutic touch (TT) and music on sleep quality, menopausal symptoms, and quality of life in menopausal women.

METHODS

This study was carried out in an experimental model with a pretest, a posttest, and a control group. The study was completed with a total of 108 menopausal women in the TT, music, and control groups. Data were collected using a Participant Information Form, the Pittsburgh Sleep Quality Index, the Menopause Rating Scale, and the Menopause-Specific Quality of Life Scale. TT was applied in the TT group once a week for 4 weeks, and the music group was asked to listen to music for 30 minutes before bedtime every day for 4 weeks. Posttest data were collected in all groups 4 weeks after the pretest. The χ 2 , analysis of covariance, post hoc tests, and partial η2 methods were used to analyze the collected data.

RESULTS

When the effect of the pretest scores was adjusted, compared with the control group, there were statistically significant differences in the posttest scores of the participants in both the TT and music groups in the Pittsburgh Sleep Quality Index dimensions of subjective sleep quality ( P < 0.001), sleep latency ( P ≤ 0.001), and sleep disturbances ( P < 0.05). When the effect of the pretest scores was adjusted, compared with the control group, there were statistically significant differences in the posttest scores of the participants in both the TT and music groups in the Menopause Rating Scale and Menopause-Specific Quality of Life Scale ( P < 0.001).

CONCLUSIONS

It was concluded that TT and music increased sleep quality (subjective sleep quality, sleep latency, and sleep disturbances) and quality of life and reduced menopausal symptoms.

The European Insomnia Guideline: An update on the diagnosis and treatment of insomnia 2023

Progress in the field of insomnia since 2017 necessitated this update of the European Insomnia Guideline. Recommendations for the diagnostic procedure for insomnia and its comorbidities are: clinical interview (encompassing sleep and medical history); the use of sleep questionnaires and diaries (and physical examination and additional measures where indicated) (A). Actigraphy is not recommended for the routine evaluation of insomnia (C), but may be useful for differential-diagnostic purposes (A). Polysomnography should be used to evaluate other sleep disorders if suspected (i.e. periodic limb movement disorder, sleep-related breathing disorders, etc.), treatment-resistant insomnia (A) and for other indications (B). Cognitive-behavioural therapy for insomnia is recommended as the first-line treatment for chronic insomnia in adults of any age (including patients with comorbidities), either applied in-person or digitally (A). When cognitive-behavioural therapy for insomnia is not sufficiently effective, a pharmacological intervention can be offered (A). Benzodiazepines (A), benzodiazepine receptor agonists (A), daridorexant (A) and low-dose sedating antidepressants (B) can be used for the short-term treatment of insomnia (≤ 4 weeks). Longer-term treatment with these substances may be initiated in some cases, considering advantages and disadvantages (B). Orexin receptor antagonists can be used for periods of up to 3 months or longer in some cases (A). Prolonged-release melatonin can be used for up to 3 months in patients ≥ 55 years (B). Antihistaminergic drugs, antipsychotics, fast-release melatonin, ramelteon and phytotherapeutics are not recommended for insomnia treatment (A). Light therapy and exercise interventions may be useful as adjunct therapies to cognitive-behavioural therapy for insomnia (B).

Music Intervention for older adults: Evidence Map of Systematic Reviews

BACKGROUND

With the increasing aging population, the health problems of the elderly have received increasing attention. As a non-pharmacological interventions, music intervention has been widely used in clinical practice to improve the physical and mental health of the elderly. This article aims to provide a comprehensive review of existing systematic reviews on the health effects of music interventions for older adults in clinical practice.

METHODS

The study utilized the evidence map methodology, which involved identifying all relevant systematic reviews, meta-analysis from 7 electronic databases from their inception to November 2022. The studies were analyzed using AMSTAR 2.

RESULTS

The researchers identified 67 studies, with the majority published in the past 5 years. The effects of music interventions were categorized into 4 groups of health outcomes: positive (58 results), potentially positive (4 results), inconclusive (2 results), and no effect (3 results). The health outcomes were further classified into 5 groups: psychological well-being, cognitive functioning, physiological responses, quality of life, and overall well-being.

CONCLUSIONS

The study revealed that music interventions for older adults can have positive or potentially positive effects on health outcomes, encompassing psychological well-being, cognitive functioning, physiological responses, quality of life, and overall well-being. However, some studies yielded inconclusive or no effect. The study offers valuable insights for healthcare professionals and serves as a visual resource to access evidence-based information on the use of music interventions in promoting health and addressing various conditions in older adults.

Effect of sleep ambient music on sleep quality and mental health in college students: a self-controlled study

To verify the effect of sleep ambient music intervention (SAMI) on sleep quality and mental status of college students, and to further explore the minimum effective duration of SAMI, this study was designed as a pre-and post-intervention self-controlled exploratory study. Participants were subjected to a one-week no-intervention test, then 4 weeks of music intervention followed. Subjective sleep quality data were collected using the Pittsburgh Sleep Quality Index (PSQI); objective sleep quality data were collected with Actigraphy; and mental status data were collected using the State-Trait Anxiety Inventory (STAI) and the Beck Depression Inventory-II (BDI-II). Data were analyzed and processed using mixed-effects models and repeated measures. The results showed that compared with the no-intervention week, college students' subjective sleep quality, objective sleep onset latency (SOL), trait anxiety, and depression symptom were reduced at week 1; week 2; week 3; week 4 under SAMI; state anxiety of college students at week 3 and week 4 under SAMI were also reduced. And there were differences in sleep quality among college students of different genders too. Compared with females, males had worse sleep efficiency (SE), shorter total sleep time (TST), and more awaking times (AT). In addition, 3 days was the minimum effective length for SAMI to shorten objective SOL, and 2 days was the minimum effective length to shorten the subjective SOL of college students. The findings of this study suggest that SAMI can improve subjective sleep quality, shorten objective SOL, and reduce anxiety and depression in college students. Interventions for more than 3 days had a significant effect on shortening SOL and long-term effects seemed to emerge after 3 weeks.

Depression, anxiety and insomnia in Chinese older adults and their family caregivers during the COVID-19 pandemic: an actor-partner interdependence model approach

Aims

This study aimed to explore the dyadic effects of depression and anxiety on insomnia symptoms in Chinese older adults and their caregivers living in a community setting.

Methods

Data were collected from 1,507 pairs of older adults and their caregivers who were in the Guangdong Mental Health Survey in China. The 9-item Patient Health Questionnaire (PHQ-9), Generalized Anxiety Disorder module 7 (GAD-7), and Insomnia Severity Index (ISI) were used to measure depression, anxiety, and insomnia symptoms. Actor-Partner Interdependence Models (APIM) were used to determine whether anxiety or depression symptoms predicted individual or dyadic insomnia.

Results

Older adults' and caregivers' depression and anxiety had significant positive correlations with their own and their caregivers' insomnia symptoms (all P < 0.001). Actor effects were found between depression and insomnia symptoms in both older adults and caregivers (B = 0.695, P < 0.001; B = 0.547, P < 0.001, respectively), with one significant partner effects (B = 0.080, P = 0.007). Actor effects were also found between anxiety and insomnia symptoms in both older adults and caregivers (B = 0.825, P < 0.001; B = 0.751, P < 0.001, respectively), with one significant partner effects (B = 0.097, P = 0.004). However, the caregivers' depression and anxiety were not associated with older adults' insomnia symptoms in the APIM analyses.

Conclusions

Older adults and their caregivers had an interrelationship between psychological distress and insomnia. Consequently, healthcare providers might consider involving dyads when designing programs to reduce insomnia and improve psychological distress for family caregivers.

Solfeggio-frequency music exposure reverses cognitive and endocrine deficits evoked by a 24-h light exposure in adult zebrafish

Music therapy has long been used as a non-pharmacological intervention to improve cognitive function and mood in humans. Mounting rodent evidence also supports beneficial impact of music exposure on animal cognitive performance. The zebrafish (Danio rerio) is an important emerging aquatic animal model in translational biomedical and neuroscience research. Here, we evaluate the effects of intermittent (2-h or 6-h twice daily) and continuous (24-h) solfeggio-frequency music exposure on behavioral, cognitive and endocrine parameters in adult zebrafish whose circadian rhythm was disturbed by a 24-h light exposure. Overall, while a 24-h light exposure evokes overt cognitive deficits and elevates zebrafish whole-body cortisol levels, these effects were reversed by solfeggio-frequency music exposure for 2 or 6h twice daily, and by continuous 24-h exposure). Collectively, these findings suggest a positive modulation of cognitive and endocrine responses in adult zebrafish by environmental enrichment via the long-term exposure to music, and reinforces zebrafish as a robust, sensitive model organism for neurocognitive and neuroendocrine research.

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.

Sleep Deficiency in the Elderly

With aging, there are normative changes to sleep physiology and circadian rhythmicity that may predispose older adults to sleep deficiency, whereas many health-related and psychosocial/behavioral factors may precipitate sleep deficiency. In this article, we describe age-related changes to sleep and describe how the health-related and psychosocial/behavioral factors typical of aging may converge in older adults to increase the risk for sleep deficiency. Next, we review the consequences of sleep deficiency in older adults, focusing specifically on important age-related outcomes, including mortality, cognition, depression, and physical function. Finally, we review treatments for sleep deficiency, highlighting safe and effective nonpharmacologic interventions.

Music therapy for elderly sleeping quality

Elderly people have sleeping disorder problems which can be occurred frequently. This is a significant public health issue because sleeping disorder leads to cause depression, diabetes, cardiovascular, Alzheimer’s disease. Currently, music therapy might be a good choice instead of western medicines for the treatment of a sleeping disorder. This short communication describes the background of sleeping disorder, music therapy, and its research progress as well as the future development. A simple systematic search of publications in PubMed, Embase, Cochrane Library, and google search without language restriction is performed. Because of the little finding on the music therapy for sleep disorders in present literature, therefore, there is a short communication written by some literature reviews before starting a novel study of sleeping disorders for elderly people.

Feasibility and Effectiveness of a Novel Smartphone Music Application on Anxiety and Sleep in Elite Soccer Coaches

A considerable body of research has examined stress and wellbeing in athletes (e.g., Arnold et al., 2017). In contrast, similar experiences in sports coaches have received considerably less attention although these are widely exposed to numerous stressors which can potentially influence their well-being and performance. In 2017, a meta-analysis (Norris et al., 2017) highlighted various stressors influencing the performance of coaches. These include external scrutiny from the public and media, the need to constantly maintain high standards during training and competition and organizational stressors relating to administration, finances, overload, and environment. Regarding the elite football setting specifically, coaches must regularly deal with stressors such as job insecurity (Bentzen et al., 2020) and cope with the stress and adversity associated to a highly pressurized workplace environment (Knights and Ruddock-Hudson, 2016). These stressors can cause anxiety, in addition to sleep disturbance, thus there is a clear need to help coaches find ways to deal with such difficulties. In clinical health settings, music-based therapeutic interventions are systematically shown to help improve sleep quality (Chen et al., 2021) and anxiety levels (Umbrello et al., 2019). In sports settings, listening to music demonstrated a positive effect in reducing pre-competition anxiety levels in a cohort of elite shooters (John, Verma, Khanna, 2012) and amateur athletes (Elliott et al., 2014) respectively. Yet to our knowledge no study has investigated the potential benefits of music in sports coaches. In this preliminary study, we investigated 1) the feasibility of implementing a novel smartphone music application in a cohort of elite soccer coaches, and 2) its effectiveness in helping them fall asleep and reducing anxiety levels. A total of 10 elite French soccer coaches (age 28.4 ± 3.9 years, working in clubs belonging to the 4 highest standards of football in France: Ligue 1: n=1, Ligue 2: n=3, Division 3: n=1 and Division 4: n=5) were invited to participate in the present study which was also proposed as part of their personal development plan during a year-long elite coach development course. Prior to their inclusion, participants were informed about the implementation of the study by means of an information document and oral presentation by the research team and were asked to sign an informed consent form to participate. The participants were asked to download the music application (Music Care©, Paris, France) on their personal smartphone/tablet and provided with a headphone set. This music application is typically used in health care settings (see www.music-care.com/en/clinical-evidence.html for list of related research works) and offers personalized music listening according to the patient’s therapeutic need (pain, anxiety, sleep) and musical preferences (e.g., classic, jazz, traditional…). The music sequences (each 20min duration) aim to progressively bring the user into a state of relaxation, and naturally treat pain, anxiety, and sleep disorders. Each participant was instructed to use the application at home in the morning on waking up (choice of anxiety or awakening session) and in the evening prior to falling asleep (sleep session) over a 1-month period. They were asked to record the date, time and duration of each session in a personal diary. Following the sleep session, participants were also requested to respond to the question: did the session help you to fall asleep: yes, no or I don’t know? Finally, immediately before and at the end of each anxiety/awakening session, participants used a Likert scale to rate their current anxiety level (0=no anxiety to 10=maximal anxiety). Data are presented as means, standard deviations and range values unless stated. Owing to the non-normality of the dataset collected for the pre-post session anxiety score ratings, Wilcoxon’s signed-rank non-parametric test was used to compare mean data (significance level, p<0.05). Cohen’s Effect Sizes were also calculated and classified as trivial (<0.2), small (>0.2–0.6), moderate (>0.6–1.2), large (>1.2–2.0) and very large (>2.0–4.0). The BiostaTGV (INSERM, France) package was used for all statistical calculations. Results showed that out of the 10 participants, two did not choose to download the application while among the remaining 8, 2 did not record any information on their music sessions. Regarding the 6 remaining participants, half completed at least one session per day over the 30-day period while an average of 25 sessions were completed per participant (range: 18 to 29). In total, 150 sessions were completed by the participants of which 64% (n=96) were used to aid sleep, 19% (n=28) anxiety and 17% (n=26) wake-up respectively. Each music session was completed in its entirety (20mins duration) on 99.3% occasions. Of the 96 sleep-related sessions completed, 62.5% (n=60) were considered by the participants to have aided them in falling asleep (Figure 1). The comparison of anxiety levels demonstrated a significant reduction in mean values for the pre- versus post-session scores: 6.0±1.0 vs. 4.3±1.5, -28%, p < 0.0001, effect size=1.2 (large). To the best of our knowledge, this investigation is the first to report the feasibility of implementing a novel therapeutic music smartphone application in a group of elite soccer coaches and determine its effects on their current anxiety levels and helping them fall asleep. Altogether, 40% of coaches (4 out of 10) chose not to use the application which is greater than the 20% drop-out rates frequently reported in randomised controlled studies. However, half of the 6 remaining participants completed at least one music session per day over the 30-day period while an average of 25 sessions (with nearly all listened to in their entirety) were completed per participant demonstrating in our opinion a satisfactory level of feasibility. The coaches most often chose sleep sessions (64% of the total) of which nearly two thirds were considered to have helped them to fall asleep. Anxiety sessions were less frequently utilised but nevertheless helped to significantly reduce the coaches’ current anxiety levels (-28% reduction). These positive results follow those observed in clinical health settings (Chen et al., 2021; Umbrello et al., 2019) and athletes (Elliot et al., 2014, John et al., 2012). As such, we suggest that music can be used by elite soccer coaches as a tool to aid anxiety and falling asleep. Further research is nevertheless required to determine why not all the coaches used the application or tended to use it for sleep rather than anxiety purposes. Similarly, a stronger experimental approach employing a longitudinal randomized controlled study design, a larger sample size to increase statistical power in addition to inclusion of qualitative (e.g., questionnaires) and quantitative (e.g., physiological responses) metrics is necessary. We estimate that to achieve a statistical power level of 90%, a sample size of 62 participants (accounting for a 20% drop out rate) would be necessary for a future randomized controlled study.