Music-based strategies may improve sleep quality in older adults

Wang C, Li G, Zheng L, et al. Effects of music intervention on sleep quality of older adults: A systematic review and meta-analysis Complement Ther Med. 2021; 59:102719.

Review question

What are the effects of music-based strategies on sleep quality in older adults, compared with control groups that exclude the use of medication and music?

Background

Some research has shown that having poor sleep quality can lead to depression, anxiety, dementia, physical impairments, heart disease, diabetes, and more in older adults. Sleep disorders, such as insomnia, result in poor sleep quality, and are primarily treated with medication. However, long-term use of medication is not recommended due to issues around tolerance, dependence, and the increased risk of illness and death. Efforts are now focusing on finding safe and effective non-medication-based treatments. Strategies that involve the use of music fall into this category and have demonstrated mixed effectiveness in the past. As such, a comprehensive evaluation of the numerical data on music-based strategies and sleep quality in older adults is needed. 

How the review was done

This is a systematic review of nine studies, the majority of which were randomized controlled trials and non-randomized controlled trials. The studies were published between 2003 and 2019, and included a total of 489 participants. Six studies were included in a meta-analysis. Key features of the studies:

• Participants were older adults (with an average age ranging between 64 and 81), some of whom had sleep difficulties or insomnia. 
• Participants engaged in active (e.g., could create music) or passive (e.g., focused on listening to music) music-based strategies, generally at home. The music content participants were exposed to consisted of one or more of the following: Ussak Maqam music, meditative music, Chinese music (e.g., classical), western music (e.g., modern jazz and classical), five-elements music, music with a slow melody, a selection of soft music, and a database of different pieces of music on its own or combined with a process of making music. Some studies had specific requirements around temperature, lighting, posture, music volume, and clothing worn (e.g., participants instructed to wear comfortable clothes).
• Generally, music was played at night/bedtime, with participants engaging in the music-based strategy between 30 minutes to 7 hours per week for a total of 1 to 12 weeks.
• Researchers measured changes in subjective sleep quality, sleep latency (i.e., time it takes to go from being fully awake to fully asleep), sleep duration, sleep efficiency (i.e., percentage of sleep time attained while in bed), sleep disturbances, use of sleep medication, and daytime dysfunction (i.e., one’s own perception of experiencing troubles with: 1) staying awake while completing daytime activities like driving, and 2) maintaining enough enthusiasm to complete tasks).
• Results were compared to people in control groups who either had an uninterrupted sleep period, received routine life care via a pension agency, maintained a sleep log, used a CD or cassette for muscular relaxation, received sleep promotion education sessions, or received a sleep hygiene education session and telephone calls. Control groups excluded the use of medication and music.

What the researchers found

The review found that music-based strategies may lead to meaningful improvements in overall sleep quality in older adults, compared to control groups. A closer look at specific components of sleep revealed that, in particular, sleep latency, sleep duration, sleep efficiency, and sleep of daytime dysfunction may be enhanced. These positive results were based on a small number of studies and therefore should be interpreted with caution. To further establish these findings, more high quality studies, which are large and less varied, are needed on this topic.    

Conclusion

In order adults, music-based strategies may help to enhance overall sleep quality and some individual components of sleep. More research is needed in the future.