Review question
This review assessed the effects of listening to music on insomnia (sleep problems) in adults and the impact of factors that may influence the effect.
Key messages
We found a beneficial effect of music on sleep quality. For all the other outcomes, we did not find enough good-quality evidence as there were too few participants and the people doing the scoring of the data were aware of the treatment.
What is insomnia?
Worldwide, millions of people experience insomnia. People can have difficulties getting to sleep, staying asleep or may experience poor sleep quality.
Poor sleep affects people's physical and mental health. The consequences of poor sleep are costly, for both individuals and society. Many people listen to music to improve their sleep, but the effect of listening to music is unclear.
What did we do?
We searched electronic databases to identify relevant studies. We included 13 studies with 1007 participants. The studies compared the effect of listening to music to treatment as usual or no treatment. Treatment as usual could be sleep hygiene education (learning a set of rituals to help with sleep) or standard care for participants with insomnia related to chronic medical conditions. The studies examined the effect of listening to prerecorded music daily, for 25 to 50 minutes, for three days to three months. Seven of the included studies reported funding from national research councils or university sources, and one study reported funding from a private foundation. Five studies did not report any funding sources.
What did we find?
Ten studies measured sleep quality, and the results showed that music probably facilitates a large improvement in the quality of sleep compared to no treatment or treatment as usual. We do not know if listening to music has an effect on the severity of insomnia (difficulty in falling or staying asleep) or the number of times a person wakes up (broken sleep) compared to no treatment or treatment as usual. Listening to music may improve slightly sleep-onset latency (how quickly a person falls asleep), sleep duration (length of time a person is asleep) and sleep efficiency (amount of a time a person is asleep compared to the total time spent in bed), compared to no treatment or treatment as usual. None of the studies reported any negative effects caused by listening to music.
What are the limitations of the evidence?
The quality of evidence from the 10 studies that examined sleep quality was moderate. Our confidence in the evidence for the quality of sleep is only moderate because the people in the studies were aware of which treatment they were getting and the people scoring the data were also sometimes aware of which treatment the participants were getting, which could introduce bias. We have little confidence in the evidence for the severity of insomnia because the studies were very small and were done in different types of people who knew which treatment they were getting. Our confidence in the evidence on sleep-onset latency, sleep duration and sleep efficiency is low because the studies used very different methods to measure these outcomes, and the people in the studies were aware of the nature of the treatment. We have little confidence in the evidence on sleep interruption because the studies used different methods and showed different results. Furthermore, the participants in the studies knew which treatment they were getting.
Future studies should assess other aspects of sleep as well as measures of daytime functioning, such as mood, fatigue, concentration, and quality of life.
How up to date is this evidence?
The evidence is current to 31 December 2021.
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.
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.
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.
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.
Randomised controlled trials comparing the effects of listening to music with no treatment or treatment as usual (TAU) in adults complaining of sleep difficulties.
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.
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.