Clinical Question

Does listening to music improve symptoms of insomnia or sleep problems in adults?

Evidence-Based Answer

For adults with sleep problems or insomnia, listening to music at bedtime may improve sleep quality, sleep-onset latency, sleep duration, and sleep efficiency; listening to music may improve anxiety and overall quality of life.¹ (Strength of Recommendation: B, inconsistent or limited-quality patient-oriented evidence.)

Practice Pointers

Although only approximately 10% of adults meet formal diagnostic criteria for insomnia, up to 37% of adults report that their sleep is too short, too light, or unsatisfactory; they have difficulty initiating or maintaining sleep; or they have nonrestorative sleep at least three nights per week.² Many medications approved for the treatment of insomnia are poorly tolerated due to adverse effects.³

In an update of a previous Cochrane review, the authors sought to assess how listening to music affects sleep in adults with insomnia, specifically its effect on overall sleep quality, sleep-onset latency (i.e., the amount of time it takes to fall asleep), total sleep time, sleep interruptions (i.e., the amount of wake time after sleep onset), and sleep efficiency (i.e., the percentage of time spent asleep while in bed).¹ The 13 trials (eight were new) included 1,007 participants 18 to 83 years of age. Four trials were from Taiwan, two from Iran, two from China, and one each from Singapore, Hungary, Denmark, Italy, and Austria. Two studies included participants with insomnia disorder as defined by the Diagnostic and Statistical Manual of Mental Disorders, 5th ed., or the International Classification of Sleep Disorders, and the remaining studies recruited participants whose sleep problems were not as strictly defined.

Participants listened to prerecorded music as the main intervention, although in two trials participants also received relaxation instructions. Music listening sessions ranged from 25 to 60 minutes per day (mean = 36 minutes), and trial duration ranged from three days to three months. Seven trials used researcher-selected music, and the remaining studies allowed for some degree of participant selection. Music genres included Western and Chinese classical music, Buddhist songs, new age, lullabies, traditional Persian music, Chinese five elements tone music, eclectic, ambient, popular oldies, and jazz. Seven trials compared listening to music with no treatment, whereas six trials compared listening to music with treatment as usual. Most trials instructed participants to listen to music at bedtime, and only four trials did not specify a time of day for listening to music.

Music listening improved sleep quality on the Pittsburgh Sleep Quality Index, which uses a scale of 0 to 21; higher scores indicated worse sleep quality (standardized mean difference [SMD] = −2.79; 95% CI, −3.86 to −1.72; 10 studies; 708 participants; moderate-certainty evidence). Subgroup analyses found no difference in relative outcomes between participants in studies lasting eight to 21 days compared with studies lasting 22 days or longer. There was no difference in outcomes in patients with different insomnia etiologies (e.g., age-related insomnia, insomnia caused by a medical condition, pregnancy-related insomnia, primary insomnia disorder). There was no difference in outcomes between researcher-selected and participant-selected music, and no difference between listening to music alone or combined with relaxation instructions.

In three trials of 136 participants, music listening seemed to have no effect on sleep-onset latency, total sleep time, sleep interruptions, or sleep efficiency when assessed with polysomnography. However, a meta-analysis of three trials that assessed sleep using the Pittsburgh Sleep Quality Index demonstrated that music listening improved sleep-onset latency, sleep duration, and sleep efficiency, but it did not improve sleep interruptions (197participants; low-certainty evidence).

Music listening did not seem to reduce the severity of insomnia (two trials; 63 participants) or demonstrate any effect on depression for patients with sleep problems (three studies; 173 participants). This intervention may have a small beneficial effect on anxiety (SMD = −0.52; 95% CI, −0.75 to −0.28; P < .001; three studies; 294 participants) and quality of life (SMD = 0.55; 95% CI, 0.25 to 0.85; P < .001; two studies; 177 participants) compared with no treatment or treatment as usual. No studies reported any adverse effects.

The American College of Physicians recommends using cognitive behavior therapy for insomnia as the initial treatment for chronic insomnia disorder and adding pharmacologic therapy only after considering the benefits, harms, and costs. The American College of Physicians does not recommend for or against listening to music as a treatment for insomnia.⁴