By Anthony Habib Rahawi

Introduction

Sleep is a dynamic process that is crucial for multidimensional health,¹ as impaired sleep increases the risk of developing cardiovascular, respiratory, gastrointestinal, and psychological disorders. Insufficient sleep affects approximately one third of adults in the US, while approximately one fifth of the US population are diagnosed with sleep disorders.² Due to the prevalence and impact of insufficient sleep and sleep disorders, there is much ongoing research focusing on the efficacy of medical and behavioral therapies and interventions on sleep quality and duration,^3–7 with music therapy being of particular interest (Figure 1).

Music is a cost-effective and accessible therapy that combats the need for a prescription or referral to a sleep clinician. Studies on the effect of music on sleep began as a result of the known outcomes of music on physiological processes.⁸ Relaxing, sedative genres such as Classical, Baroque, and New Age are known to “reduce sympathetic nervous system activity, decrease anxiety, blood pressure, and heart and respiratory rates,” especially when the pieces are at a slower tempo.^6,9 With this in mind, researchers began to study whether listening to music prior to sleeping could improve sleep.

Music Therapy and Insomnia

The prevalence of sleep disorders amongst the adult population has led to the evaluation of music as a form of sleep therapy due to its accessibility and physiological benefits. The most common sleep disorder – insomnia – leads to difficulty falling asleep, issues staying asleep, and/or struggles receiving proper sleep quality throughout the night.¹⁰ Because of the prevalence of insomnia and the accessibility of music, multiple trials have revolved around the efficacy of music therapy as an intervention for insomnia.^11,12

A recent meta-analysis (a study of studies) evaluated thirteen studies comprised of 1007 total participants, aged 19 to 83 with sleep difficulties who were instructed to listen to sedative music 25-60 minutes prior to sleeping.¹² Patients with insomnia who listened to sedative music experienced an overall decrease in the amount of time spent falling asleep and an increased total sleep time per night. However, no significant change to sleep fragmentation (the number of episodes of waking up per night) was observed. These findings suggest that, while music therapy can decrease the time it takes for individuals with insomnia to fall asleep, it is likely unable to prevent awakenings from occurring while asleep. While more needs to be evaluated regarding music therapy during awakenings, music therapy seems to be a viable treatment for patients with insomnia who have difficulties falling asleep.

Music as a Sleep Aid for Adults Without Sleep Disorders

Along with its potential use as an intervention for patients with insomnia, music therapy for healthy adults without sleep disorders has been studied to determine its use as a general sleep aid. Different genres of music have been evaluated as nighttime sleep aids to determine which genres most significantly increased subjective sleep quality.⁵ Music genres with sedative properties such as Classical and Meditative music were significantly better at improving sleep quality than music involving rhythmic, percussive instruments. Thus, relaxing music genres helped participants wake up feeling more well-rested.

While many studies have evaluated the efficacy of music therapy during nighttime sleep, its uses for naps are also being assessed. In a recent study, adult women ages 19 to 35 were asked to listen to sedative music prior to taking a 90-minute nap.⁴ This study evaluated sleep quality through a sleep report as well as through physiological measurements via electroencephalography (EEG), the measurement of cortical activity. Along with an increase in subjective sleep quality, EEG indicated that sedative music increased slow-wave activity during sleep, which is indicative of deeper stages of sleep. This supports the use of music therapy to improve sleep both throughout the night and during naps.

Audiobooks have become increasingly accessible throughout the years thanks to their inclusion in podcast services. One popular audiobook genre is bedtime stories for adults, which individuals might prefer as a sleep aid over music. To establish whether listening to music before sleeping increased sleep quality compared to audiobooks, one study evaluated the effects of these auditory sleep aids in young-adult students ages 19-28 years.⁶ The participants were placed into one of three groups: students who listened to sedative music, students who listened to audiobooks, and a control group with no auditory stimulus. Compared to both the audiobook and control groups, the students who listened to music reported greater sleep quality. Thus, music therapy shows more promise as a sleep aid than other forms of audible interventions.

Current Conclusions and the Future of Sleepy Music

An overwhelming amount of evidence supports the use of music therapy as an intervention for impaired sleep for adults. Most adults who listen to relaxing music prior to sleeping reported an increase in sleep quality independent of sleep disorders. However, most studies have relied on the influence of music therapy on subjective sleep measures, and only a few have examined the physiological effects of music therapy through the use of EEG to measure cortical activity. Future studies should evaluate the associations between music therapy and sleep EEG biomarkers to better verify whether music has positive effects on objective physiological measures of sleep. Additionally, ascertaining whether listening to music before sleep influences the development of risk factors associated with poor sleep (e.g. cardiovascular disease) would determine whether music therapy could be utilized as a preventative measure. Regardless, current evidence supports listening to relaxing music prior to going to sleep to help fall asleep faster, stay asleep longer, and feel more rested upon waking up.

TL;DR

• Music as a sleep aid is being evaluated for overall efficacy.
• Music can improve sleep quality and increase time spent asleep in adults with and without insomnia.

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Reference

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