• Home
  • Store
    • Newsletter Subscriptions
    • Multimedia
    • Books
    • eBooks
    • ABPN SA Courses
    • Social Work Courses
  • CME Center
  • Multimedia
    • Podcast
    • Webinars
    • Blog
    • Psychiatry News Videos
    • Medication Guide Videos
  • Newsletters
    • General Psychiatry
    • Child Psychiatry
    • Addiction Treatment
    • Hospital Psychiatry
    • Geriatric Psychiatry
    • Psychotherapy and Social Work
  • FAQs
  • Med Fact Book App
  • Log In
  • Register
  • Welcome
  • Sign Out
  • Subscribe
Home » Music for Sleep
Clinical Update

Music for Sleep

April 14, 2023
Jesse Koskey, MD.
From The Carlat Psychiatry Report
Issue Links: Editorial Information | PDF of Issue

Jesse Koskey, MD. Associate Clinical Professor, Department of Psychiatry and Behavioral Sciences, UC Davis Health, Sacramento, CA.

Dr. Koskey has no financial relationships with companies related to this material.

The first known lullaby was recorded on a cuneiform tablet in Babylonia about 4,000 years ago, and the use of music to aid sleep has continued right up through the age of Spotify. Music therapy is cheaper, easier, and safer than standard insomnia treatments, but is it a sound recommendation to make for our patients?

A look at the data

Music therapy for insomnia is not supported by the kind of large clinical trials that would pass muster at the FDA, but it does have empiric support. The best of these studies compared music to an active control, such as sleep hygiene (avoiding daytime naps), acupuncture, relaxing activity, or listening to audiobooks. A network meta-analysis compared these varied treatment arms with music therapy using data from 1,339 subjects in 20 controlled trials. Music was the most effective intervention both for the overall severity of insomnia (measured by the patient-rated Pittsburgh Sleep Quality Index [PSQI]) as well as sleep quality and initiation. Similar results were obtained from a Cochrane meta-analysis, which used a higher bar for study quality, including 13 randomized controlled trials that compared music therapy to usual care in 1,007 subjects (Jespersen KV et al, Cochrane Database Syst Rev 2022;8(8):CD010459).

Surprisingly, the effect size for music therapy was in the moderate to large range in both of those meta-analyses, which is comparable to the effect we see with z-hypnotics and benzodiazepines (Nowell PD et al, JAMA 1997;278(24):2170–2177). The caveat is that most of the studies enrolled people with only mild sleep problems. When tested in more severe insomnia, music therapy was no more effective than audiobooks or waitlist control (Jespersen KV et al, J Sleep Res 2019;28(4):e12817).

There are other problems with this research. Although most studies used blinded raters, it wasn’t possible to blind the subjects (or “deafen” them, as it were) to the intervention. The studies were also small and depended on subjective reporting. When they did include objective measures of sleep like polysomnography, the effects were usually not significant. In contrast, objective measures improve with hypnotics and cognitive behavioral therapy for insomnia (CBT-I), although these changes are usually mild.

Music can, of course, have observable physiological effects on listeners. Blood pressure, respiration, and heart rate can change tempo in response to musical cues, a phenomenon called entrainment (Bernardi L et al, Circulation 2009;119(25):3171–3180). Musical crescendos are associated with vasoconstriction, and relaxing music correlates with reduced blood pressure and vasodilation in listeners. The ambient music trio Marconi Union deliberately attempted to entrain relaxation through their composition “Weightless,” which reduced blood pressure and anxiety in a small study of healthy volunteers. The piece starts at 60 beats per minute (bpm) and gradually slows over the next eight minutes to finish at 50 bpm.

A musical protocol

There is no right way to apply music for sleep. In most studies, subjects listened to relaxing music for 30–60 minutes before bed. Headphones worked as well as speakers, and music worked regardless of whether subjects were simply instructed to listen to it or were given more complicated relaxation instructions. Sometimes the music cut off after a set time and sometimes it played through the night.

Although most studies involved relaxing music, there was no secret formula to the tunes, and the intervention worked just as well when the researchers selected the tracks as when the subjects did. Familiar tunes without lyrics were preferred, as were slow tempos, regular rhythms, bass tones, and tranquil melodies. Successful trials drew from Western, Indian, and Chinese classical; new age; Gregorian chant; Celtic; and electronic music (such as binaural beats in the 5–7 Hz theta range). One piece that rose to the top in a comparative study was “Weightless,” the ambient track by Marconi Union referenced above.

Even nonrelaxing music can be beneficial, as long as it’s enjoyable. Simply enjoying music of any sort may be helpful (Dickson GT and Schubert E, Sleep Med 2019;63:142–150). A 2020 randomized controlled trial pitted an album called The Most Relaxing Classical Music against sleep music self-selected by study subjects. A total of 95 university students with self-reported difficulty sleeping were randomized to the Most Relaxing group, the bring-your-own group, or a no-music control for four weeks. The prescribed album featured slow, calm pieces such as Pachelbel’s “Canon” and Debussy’s “Clair de Lune.” The self-selected music was not necessarily slow or relaxing. In fact, over 75% of subjects chose Western and Japanese pop, anime, and video game tunes. After a month, both music groups showed similar improvements on the PSQI, while sleep did not change in the nonmusic controls (Yamasato A et al, Tokai J Exp Clin Med 2020;45(4):207–213).

In addition to acting through relaxation, entrainment, and enjoyment, music may also benefit sleepers by masking unwanted environmental sounds, the way white noise does (Dickson and Schubert, 2019). Music can provide a helpful source of distraction for patients who struggle with depressive rumination or posttraumatic anxiety at night, and it is much better than watching TV in the bedroom with its sleep-disrupting blue light.

Distraction may become discordant for some, however. One paper reported that listening to music regularly was associated with “involuntary musical imagery,” aka earworms, as well as a 54% worsening of PSQI when the earworms occurred at night. Female sex and instrumental music were more associated with earworms (Scullin MK et al, Psychol Science 2021;32(7):985–997).

The heterogeneity of subjects, methods, and mechanisms linking bedtime music and improved sleep indicate that music is a flexible and helpful intervention for patients with mild to moderate insomnia. For most, slow, relaxing music produces the best effects. Today’s digital music players have sleep timers that can turn the music off after a set time period. Based on the results above, patients could start by setting a timer for 45 minutes, but those who struggle with middle-of-the-night awakenings may want to keep music accessible from bed. Patients who don’t respond to music or have more severe insomnia may need CBT-I or hypnotics.

CARLAT VERDICT 

Music improves subjective complaints of insomnia. It is safer than sleep medication, and a healthy alternative to sleeping with the TV on.

General Psychiatry Clinical Update
KEYWORDS insomnia music therapy psychosomatics sleep disorders
    Jesse Koskey, MD.

    Powering Up the Brain: tDCS for ADHD?

    More from this author
    www.thecarlatreport.com
    Issue Date: April 14, 2023
    SUBSCRIBE NOW
    Table Of Contents
    Learning Objectives, Psychocardiology, TCPR, April/May 2023
    When Shorter Is Better
    Cardiovascular Psychiatry: Part 1
    Cardiovascular Psychiatry: Part 2
    Music for Sleep
    Do Antidepressants Have Any Role in Acute Bipolar Depression?
    L-Methylfolate May Offer Modest Boost to Antidepressants
    Can Abstaining From Social Media Help People Feel Better?
    Marginal Results for Levetiracetam in Mania
    A New Intervention for Shift-Work Disorder
    An End to YAVIS Syndrome?
    The Center Cannot Hold: My Journey Through Madness
    CME Post-Test, Psychocardiology, TCPR, April/May 2023
    DOWNLOAD NOW
    Featured Book
    • MFB7e_Print_App_Access.png

      Medication Fact Book for Psychiatric Practice, Seventh Edition (2024) - Regular Bound Book

      The updated 2024 reference guide covering the most commonly prescribed medications in psychiatry.
      READ MORE
    Featured Video
    • KarXT (Cobenfy)_ The Breakthrough Antipsychotic That Could Change Everything.jpg
      General Psychiatry

      KarXT (Cobenfy): The Breakthrough Antipsychotic That Could Change Everything

      Read More
    Featured Podcast
    • shutterstock_2603816031.jpg
      General Psychiatry

      A Scam for Every Woman, Child, and Man: Part 2

      1 in 3 Americans were victims of online scams in the past year. Even when you know your patient is being scammed, it is hard to pull them out. We speak with Cathy Wilson about...
      Listen now
    Recommended
    • Join Our Writing Team

      July 18, 2024
      WriteForUs.png
    • Insights About a Rare Transmissible Form of Alzheimer's Disease

      February 9, 2024
      shutterstock_2417738561_PeopleImages.com_Yuri A.png
    • How to Fulfill the DEA's One Time, 8-Hour Training Requirement for Registered Practitioners

      May 24, 2024
      DEA_Checkbox.png
    • Join Our Writing Team

      July 18, 2024
      WriteForUs.png
    • Insights About a Rare Transmissible Form of Alzheimer's Disease

      February 9, 2024
      shutterstock_2417738561_PeopleImages.com_Yuri A.png
    • How to Fulfill the DEA's One Time, 8-Hour Training Requirement for Registered Practitioners

      May 24, 2024
      DEA_Checkbox.png
    • Join Our Writing Team

      July 18, 2024
      WriteForUs.png
    • Insights About a Rare Transmissible Form of Alzheimer's Disease

      February 9, 2024
      shutterstock_2417738561_PeopleImages.com_Yuri A.png
    • How to Fulfill the DEA's One Time, 8-Hour Training Requirement for Registered Practitioners

      May 24, 2024
      DEA_Checkbox.png

    About

    • About Us
    • CME Center
    • FAQ
    • Contact Us

    Shop Online

    • Newsletters
    • Multimedia Subscriptions
    • Books
    • eBooks
    • ABPN Self-Assessment Courses

    Newsletters

    • The Carlat Psychiatry Report
    • The Carlat Child Psychiatry Report
    • The Carlat Addiction Treatment Report
    • The Carlat Hospital Psychiatry Report
    • The Carlat Geriatric Psychiatry Report
    • The Carlat Psychotherapy Report

    Contact

    carlat@thecarlatreport.com

    866-348-9279

    PO Box 626, Newburyport MA 01950

    Follow Us

    Please see our Terms and Conditions, Privacy Policy, Subscription Agreement, Use of Cookies, and Hardware/Software Requirements to view our website.

    © 2025 Carlat Publishing, LLC and Affiliates, All Rights Reserved.