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. 2022 Aug 24;8(8):CD010459.
doi: 10.1002/14651858.CD010459.pub3.

Listening to music for insomnia in adults

Kira V Jespersen  1 , Victor Pando-Naude  1 , Julian Koenig  2 , Poul Jennum  3 , Peter Vuust  1
Affiliations

Listening to music for insomnia in adults

Kira V Jespersen et al. Cochrane Database Syst Rev. .

Abstract

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and contacted authors of published studies to identify additional studies eligible for inclusion, including any unpublished or ongoing trials.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.

Trial registration: ClinicalTrials.gov NCT02376686 NCT03676491 NCT04157244 NCT04578860 NCT04585425 NCT04633395.

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Conflict of interest statement

KVJ: reports being the primary author of one study included in the reviewa; the study was supported by Trygfonden, Denmark (grant covered equipment and running costs), but the researchers retained complete control over the study design, methods, analysis, interpretation and dissemination of the results; paid to Center for Music in the Brain, Aarhus University.

VPN: reports no known conflicts of interest.

JK: works as a health professional at the University Hospital Cologne, Clinic and Polyclinic for Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Cologne Germany, where he leads the specialised outpatient clinic for treatment resistant psychiatric disorders in children and adolescents.

PJ: reports no known conflicts of interest.

PV: reports being a co‐author of a trial that is included in the reviewa; the study was supported by Trygfonden, Denmark (grant covered equipment and running costs), but the researchers retained complete control over the study design, methods, analysis, interpretation and dissemination of the results.

aKVJ and PV are authors on the Jespersen 2019 trial, therefore, two other review authors (VPN and JK), with no involvement in the study, assessed the trial.

Figures

1
1
PRISMA flow diagram
2
2
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included trials
3
3
Risk of bias summary: review authors' judgements about each risk of bias item for each included trial
4
4
Forest plot of comparison: 1 Sleep quality: listening to music versus control ‐ Pittsburgh Sleep Quality Index (PSQI) ‐ global score, outcome: 1.1 Sleep quality: Pittsburgh Sleep Quality Index (PSQI) ‐ immediately post‐treatment.
5
5
1.1
1.1. Analysis
Comparison 1: Sleep quality: listening to music versus control – Pittsburgh Sleep Quality Index (PSQI) – global score, Outcome 1: Sleep quality: Pittsburgh Sleep Quality Index (PSQI) – immediately postintervention
1.2
1.2. Analysis
Comparison 1: Sleep quality: listening to music versus control – Pittsburgh Sleep Quality Index (PSQI) – global score, Outcome 2: Subgroup (PSQI) by duration of intervention – immediately postintervention
1.3
1.3. Analysis
Comparison 1: Sleep quality: listening to music versus control – Pittsburgh Sleep Quality Index (PSQI) – global score, Outcome 3: Subgroup (PSQI) by aetiology – immediately postintervention
1.4
1.4. Analysis
Comparison 1: Sleep quality: listening to music versus control – Pittsburgh Sleep Quality Index (PSQI) – global score, Outcome 4: Subgroup (PSQI) by music selection – immediately postintervention
1.5
1.5. Analysis
Comparison 1: Sleep quality: listening to music versus control – Pittsburgh Sleep Quality Index (PSQI) – global score, Outcome 5: Subgroup (PSQI) by relaxation instructions – immediately postintervention
2.1
2.1. Analysis
Comparison 2: Insomnia severity: listening to music versus control – Insomnia Severity Index (ISI), Outcome 1: Insomnia severity: Insomnia Severity Index (ISI) – immediately postintervention
3.1
3.1. Analysis
Comparison 3: Sleep onset latency: listening to music versus control, Outcome 1: Sleep onset latency: Pittsburgh Sleep quality Index (PSQI) – immediately postintervention
4.1
4.1. Analysis
Comparison 4: Total sleep time: listening to music versus control, Outcome 1: Total sleep time: Pittsburgh Sleep Quality Index – immediately postintervention
5.1
5.1. Analysis
Comparison 5: Sleep interruption: listening to music versus control, Outcome 1: Sleep interruption: Pittsburgh Sleep Quality Index – immediately postintervention
6.1
6.1. Analysis
Comparison 6: Sleep efficiency: listening to music versus control, Outcome 1: Sleep efficiency: Pittsburgh Sleep Quality Index (component score) – immediately postintervention
7.1
7.1. Analysis
Comparison 7: Depression: listening to music versus control, Outcome 1: Depression – immediately postintervention
8.1
8.1. Analysis
Comparison 8: Anxiety: listening to music versus control, Outcome 1: Anxiety – immediately postintervention
9.1
9.1. Analysis
Comparison 9: Quality of life: listening to music versus control, Outcome 1: Quality of life – immediately postintervention
See this image and copyright information in PMC

Update of

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References to studies awaiting assessment

Miller 2002 {published and unpublished data}
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References to ongoing studies

IRCT2015051822141N1 {published data only}IRCT2015051822141N1
    1. IRCT2015051822141N1. Comparison between effect of music and relaxation on sleep [Comparison of the effects of music and muscle relaxation on sleep quality in elderly people referring to the Jahandidegan center in Shiraz 2014-2015]. www.irct.ir/trial/19172 (first received 18 May 2015).
IRCT20150519022320N10 {published data only}IRCT20150519022320N10
    1. IRCT20150519022320N10. The effect of traditional music on sleep quality in elderlies. www.irct.ir/trial/29507 (first received 9 March 2018).
NCT02376686 {published data only}
    1. NCT02376686. Music intervention in the treatment of sleep disorders for depressed patients [Musik als nicht-pharmakologische intervention zur behandlung von schlafstörungen bei patienten mit depressiven erkrankungen]. clinicaltrials.gov/ct2/show/NCT02376686 (first received 3 March 2015).
NCT03676491 {published data only}
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NCT04578860 {published data only}
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NCT04585425 {published data only}
    1. NCT04585425. Music for sleep-onset insomnia [God Nat – God Dag. A randomized controlled trial of bedtime music as early intervention for sleep-onset insomnia]. clinicaltrials.gov/ct2/show/NCT04585425 (first received 14 October 2020).
NCT04633395 {published data only}
    1. NCT04633395. Treating pregnancy related insomnia with music [Treating pregnancy related insomnia with music: a randomised control trial]. clinicaltrials.gov/ct2/show/NCT04633395 (first received 18 November 2020).

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