Meta-Analysis of Music Therapy Efficacy as Intervention for Sleep Disorders

Context and Objective: Due to the high prevalence of sleep disorder in seniors, this study focuses on the effect of objective music therapy or MAT and cognitive-behavioral therapy or CBT on overall sleep quality and subscale indexes of sleep quality in seniors. Methodology: The present study is an experimental one with random selection of the subjects. The sample study is taken from 5000 senior member’s if Shiraz’s Jahandedehgan day care center. This study holds 66 subjects containing the entry and exclusion criteria. Following 7.85 percent loss, 61 seniors suffering from primary insomnia disorder and mean age of 68.15 were placed into three groups, two experimental and one control group. The experimental group one takes part in musical and cognitive-behavioral group therapy and the experimental group two takes part in cognitive-behavioral group therapy while the last group received no intervention. All patients in this study were measured for the level of disorder and before and after the treatment using the PSQI scale of insomnia disorder. The collected data were measured by statistical software SPSS 21 and were analyzed by multivariate analysis of covariance or MANCOVA and ANCOVA. Findings: The mean of overall sleep quality before the intervention in experimental groups 1&2 and control were 13/31, 12/95, and 12/7 respectively and were changed into 13.31, 9.73, and 7.59 after the intervention in post-test and finally in the 3 months follow-ups the means become 7.22, 9.32, and 13.55. The mean difference in the overall sleep quality after the intervention and the subscale indexes were significant as The result showed musical therapy and cognitive behavioral caused a significant reduction on the patients with the symptoms of insomnia disorder (P<0.001). Conclusion: The present study shows that music therapy and cognitive-behavioral therapy are more effective in developing overall sleep quality and decreasing the symptoms of insomnia disorder in seniors than the cognitive-behavioral therapy alone. Using this method by experts in the field of mental health and elderly care companions is strongly recommended. Trial registration: This study is registered in the IRCT Register, IRCT2015041521754N3. Ethical approval was gained in June 2015.

BackgroundSleep disorders are a risk factor for developing a variety of mental disorders, have a negative impact on their remission rates and increase the risk of relapse. Early identification and treatment of sleep disorders is therefore of paramount importance. Unfortunately, in mental health care sleep disorders are often poorly recognized and specific treatment frequently occurs late or not at all. This protocol-paper presents a randomized controlled trial investigating the clinical relevance of early detection and treatment of sleep disorders in mental health care. The two aims of this project are 1) to determine the prevalence of sleep disorders in different mental disorders, and 2) to investigate the contribution of early identification and adequate treatment of sleep disorders in individuals with mental disorders to their sleep, mental disorder symptoms, general functioning, and quality of life.MethodsPatients newly referred to a Dutch mental health institute for psychiatric treatment will be screened for sleep disorders with the self-assessment Holland Sleep Disorders Questionnaire (HSDQ). Patients scoring above the cut-off criteria will be invited for additional diagnostic evaluation and, treatment of the respective sleep disorder. Participants will be randomly assigned to two groups: Immediate sleep diagnostics and intervention (TAU+SI-T0), or delayed start of sleep intervention (TAU+SI-T1; 6 months after inclusion). The effect of sleep treatment as add-on to treatment as usual (TAU) will be tested with regard to sleep disorder symptoms, general functioning, and quality of life (in collaboration with a psychiatric sleep centre).DiscussionThis trial will examine the prevalence of different sleep disorders in a broad range of mental disorders, providing information on the co-occurrence of specific sleep and mental disorders. Further, this study is the first to investigate the impact of early treatment of sleep disorders on the outcome of many mental disorders. Moreover, standard sleep interventions will be tailored to specific mental disorders, to increase their efficacy. The results of this trial may contribute considerably to the improvement of mental health care.Trial registrationThis clinical trial has been retrospectively registered in the Netherlands Trial Register (NL8389; https://www.trialregister.nl/trial/8389) on February 2th, 2020.

The present study aimed at further investigating trait aspects of sleep-related cognitive arousal and general cognitive arousal and their association with both objective and subjective sleep parameters in primary insomnia patients. A clinical sample of 182 primary insomnia patients and 54 healthy controls was investigated using 2 nights of polysomnography, subjective sleep variables, and a questionnaire on sleep-related and general cognitive arousal. Compared to healthy controls, primary insomnia patients showed both more sleep-related and general cognitive arousal. Furthermore, sleep-related cognitive arousal was closely associated with measures of sleep-onset and sleep-maintenance problems, while general cognitive arousal was not. Cognitive-behavioral treatment for insomnia might benefit from dedicating more effort to psychological interventions that are able to reduce sleep-related cognitive arousal.

Disturbed sleep is a hallmark feature of posttraumatic stress disorder (PTSD). However, few studies have examined sleep objectively in individuals with PTSD compared to trauma-exposed controls. This study used wrist actigraphy to measure and compare sleep patterns in trauma-exposed Australian Vietnam veterans (VV) with and without PTSD. Trauma-exposed Australian VV with and without PTSD were recruited from the PTSD Initiative. VV wore wrist accelerometers over 14 days and completed daily sleep diaries. Sleep parameters were compared between groups including sleep latency (SL), time in bed (TIB), total sleep time (TST), wake after sleep onset (WASO), and movement index (MI). Night-to-night and overall within-individual variability were assessed by root mean squared successive differences and comparison of individual standard deviations. Correlations between sleep diary (self-reported) and wrist actigraphy (objective) variables were also assessed. A total of 40 male VV (20 with PTSD) participated in the study. We found no difference in sleep patterns determined by wrist actigraphy between groups with the exception of reduced SL in VV with PTSD (3.9 ± 0.9 versus 4.9 ± 1.4 minutes, P < .05). Overall within-individual variability was significantly greater in VV with PTSD for TIB, TST, WASO, and MI. Self-reported and objective TST and WASO were more strongly correlated in VV without PTSD than those with PTSD. Although there were no significant differences in sleep parameters, VV with PTSD had increased within-individual overall sleep variability and reduced correlation between self-reported and objective sleep parameters compared to trauma-exposed controls. Further evaluation of extended sleep patterns by actigraphy in VV with PTSD is warranted.

Sleep Disorders in Neurorehabilitation

BackgroundGlobally, the demographic shift towards an aging population leads to significant challenges in healthcare systems, specifically due to an increasing incidence of multimorbidity resulting in polypharmacy among the elderly. Simultaneously, sleep disorders are a common complaint for elderly people. A treatment with pharmacological therapies often leads to side effects causing a high potential for dependency. Within this context, there is a high need to explore non-pharmacological therapeutic approaches. The purpose of this study is to evaluate the effectiveness of acupuncture and music therapy, both individually and combined as a multimodal therapy, in the treatment of sleep disorders in individuals aged 70 years and older.MethodsWe conduct a confirmatory randomized controlled trial using a two-factorial study design. A total of n = 100 elderly people receive evidence-based standard care information for age-related sleep disorders. Beyond that, patients are randomly assigned into four groups of n = 25 each to receive acupuncture, receptive music therapy with a monochord, multimodal therapy with both acupuncture and music therapy, or no further therapy. The study’s primary outcome measurement is the improvement in sleep quality as assessed by the Pittsburgh Sleep Quality Index (PSQI) (global score), at the end of intervention. Additionally, depression scores (Geriatric Depression Scale), health-related quality of life (Short-Form-Health Survey-12), neurovegetative activity measured via heart rate variability, and safety data are collected as secondary outcomes. Using a mixed-methods approach, a qualitative process evaluation will be conducted to complement the quantitative data.DiscussionThe study is ongoing and the last patient in is expected to be enrolled in April 2024. The results can provide valuable insights into the effectiveness of non-pharmacological interventions for sleep disorders among the elderly, contributing to a more personalized and holistic approach in geriatric healthcare.Trial registrationGerman Clinical Trials Register (DRKS00031886).

This review aims to systematically examine the relationship between sleep quality and its impact on physical and mental health, and to assess the effectiveness of psychotherapeutic interventions for the treatment of sleep disorders. A comprehensive literature search was conducted using major databases including PubMed, MEDLINE, and Google Scholar, focusing on articles published between 2001 and 2023. The review synthesized information from 52 studies using methods of analysis, synthesis, comparison, and generalization to assess indicators of sleep quality, their impact on health, and the effectiveness of different psychotherapeutic treatments. The review found that optimal sleep quality, characterized by adequate duration, continuity, and depth, is crucial for maintaining both physical and mental health. Poor sleep quality was found to contribute significantly to the development and exacerbation of many health problems, including metabolic disorders, cardiovascular disease, depression, and anxiety. Cognitive behavioral therapy was identified as an effective psychotherapeutic approach for improving sleep quality and managing sleep disorders, while hypnotherapy is not recommended. The findings highlight the critical role of sleep in maintaining health and the potential of targeted psychotherapeutic interventions to improve sleep quality. Given the reciprocal relationship between sleep and health, healthcare providers should prioritize the assessment and treatment of sleep disorders. Further research should focus on long-term clinical trials to establish causal relationships and the sustainability of treatment effects, promoting wider application of these findings in clinical practice.

Objective To observe the effect of music therapy on sleep quality of elderly patients with blood disease and sleep disorders.Methods Totals of 40 elderly patients with blood disease and sleep disorders received four weeks of music therapy.The sleep quality was evaluated by Pitts Paul Sleep Index (PSQI) before and after music therapy.Results After the music therapy,the PSQI score of patients was significantly lower than that before intervention [(5.23 ± 3.01) vs (10.04 ± 6.58) ; t =4.853,P ＜ 0.05)].And patients'subjective sleep quality improved,the time to fall asleep shortened,sleep disorders alleviated,sleep medication reduced after music therapy,and the differences was statistically significant (P ＜ 0.05).Conclusions Music therapy can effectively improve the sleep quality of elderly patients with blood disease and sleep disorders. Key words: Music therapy ; Elderly; Hematological diseases; Sleep disorders; Sleep quality

Aim: Abnormal daily sleep duration and quality have been linked to hypertension, diabetes, stroke, and overall cardiovascular disease (CVD) morbidity & mortality. However, the relationship between daily sleep duration and quality with subclinical measures of CVD remain less well studied. This systematic review evaluated how daily sleep duration and quality affect burden of subclinical CVD in subjects free of symptomatic CVD.Methods: Literature search was done via MEDLINE, EMBASE, Web of Science until June 2016 and 32 studies met the inclusion criteria. Sleep duration and quality were measured either via subjective methods, as self-reported questionnaires or Pittsburg Sleep Quality Index (PSQI) or via objective methods, as actigraphy or polysomnography or by both. Among subclinical CVD measures, coronary artery calcium (CAC) was measured by electron beam computed tomography, Carotid intima-media thickness (CIMT) measured by high-resolution B-mode ultrasound on carotid arteries, endothelial/microvascular function measured by flow mediated dilation (FMD) or peripheral arterial tone (PAT) or iontophoresis or nailfold capillaroscopy, and arterial stiffness measured by pulse wave velocity (PWV) or ankle brachial index (ABI).Results: Subjective short sleep duration was associated with CAC and CIMT, but variably associated with endothelial dysfunction (ED) and arterial stiffness; however, subjective long sleep duration was associated with CAC, CIMT and arterial stiffness, but variably associated with ED. Objective short sleep duration was positively associated with CIMT and variably with CAC but not associated with ED. Objective long sleep duration was variably associated with CAC and CIMT but not associated with ED. Poor subjective sleep quality was significantly associated with ED and arterial stiffness but variably associated with CAC and CIMT. Poor objective sleep quality was significantly associated with CIMT, and ED but variably associated with CAC.Conclusions: Overall, our review provided mixed results, which is generally in line with published literature, with most of the studies showing a significant relationship with subclinical CVD, but only some studies failed to demonstrate such an association. Although such mechanistic relationship needs further evaluation in order to determine appropriate screening strategies in vulnerable populations, this review strongly suggested the existence of a relationship between abnormal sleep duration and quality with increased subclinical CVD burden.

Sleep is one of the essential needs, which if not fulfilled will have an impact on changes in the biological or psychological condition of a person. Good sleep is often defined as a quality sleep. Along with aging, a person tends to be more difficult to achieve a good quality of sleep for themselves. Treatment of sleep disorder in elderly consist of non-pharmacological and pharmacological therapy, one of the forms of non-pharmacological therapy is a music therapy. The purpose of this study was to determine the effect of music therapy on sleep quality in elderly at a social residential in Bali. The study design that used was a pre-experimental study with one group pretest-posttest design. The number of sample was 31 persons that got a 2 weeks therapy. Sleep quality was measured using The Pittsburgh Sleep Quality Index at the end of each week to determine changes in sleep quality in elderly. Based on analytical test result using a paired t-test, it was found that the mean of sleep quality before therapy, after the first week and after the second week was (11.97), (10.90), and (8.58) respectively, with p-value 0.000. Therefore, it can be concluded that there is a significant improvement in sleep quality after music therapy in elderly. Recommendation for the elderly with poor sleep quality, in order to familiarize them self to listen to sedative music to help improve their sleep quality.

Update on Sleep and Psychiatric Disorders

Group to Issue Guidelines for Sleep Disorders

Beyond Nightmares: How Sleep Issues Might Trigger Post-Traumatic Stress Disorder

Sleep disorders are linked to development of type 2 diabetes and increase the risk of developing diabetes complications. Treating sleep disorders might therefore play an important role in the prevention of diabetes progression. However, the detection and treatment of sleep disorders are not part of standardised care for people with type 2 diabetes. To highlight the importance of sleep disorders in people with type 2 diabetes, we provide a review of the literature on the prevalence of sleep disorders in type 2 diabetes and the association between sleep disorders and health outcomes, such as glycaemic control, microvascular and macrovascular complications, depression, mortality and quality of life. Additionally, we examine the extent to which treating sleep disorders in people with type 2 diabetes improves these health outcomes. We performed a literature search in PubMed from inception until January 2021, using search terms for sleep disorders, type 2 diabetes, prevalence, treatment and health outcomes. Both observational and experimental studies were included in the review. We found that insomnia (39% [95% CI 34, 44]), obstructive sleep apnoea (55–86%) and restless legs syndrome (8–45%) were more prevalent in people with type 2 diabetes, compared with the general population. No studies reported prevalence rates for circadian rhythm sleep–wake disorders, central disorders of hypersomnolence or parasomnias. Additionally, several cross-sectional and prospective studies showed that sleep disorders negatively affect health outcomes in at least one diabetes domain, especially glycaemic control. For example, insomnia is associated with increased HbA1c levels (2.51 mmol/mol [95% CI 1.1, 4.4]; 0.23% [95% CI 0.1, 0.4]). Finally, randomised controlled trials that investigate the effect of treating sleep disorders in people with type 2 diabetes are scarce, based on a small number of participants and sometimes inconclusive. Conventional therapies such as weight loss, sleep education and cognitive behavioural therapy seem to be effective in improving sleep and health outcomes in people with type 2 diabetes. We conclude that sleep disorders are highly prevalent in people with type 2 diabetes, negatively affecting health outcomes. Since treatment of the sleep disorder could prevent diabetes progression, efforts should be made to diagnose and treat sleep disorders in type 2 diabetes in order to ultimately improve health and therefore quality of life.Graphical abstract

The National Heart, Lung, and Blood Institute (NHLBI) has a longstanding appreciation of the value of behavioral research. From the earliest days, when the concept of “coronary prone” behavior was introduced, to the growing recognition of the need for strategies to encourage health-promoting behaviors and lifestyles, to more recent efforts to incorporate health-related quality of life measures into our clinical studies, behavioral research has contributed much to our understanding of cardiovascular disease (CVD). Although still in its infancy, the application of this discipline to lung and blood diseases, sleep disorders, and transfusion medicine issues clearly offers much promise for advances in treatment and prevention. Acknowledging that many opportunities lie in biobehavioral research, in November 1995 the NHLBI convened the Task Force on Behavioral Research in Cardiovascular, Lung, and Blood Health and Disease to chart a course for future research efforts. Composed of national experts, it was charged to review the state of knowledge in biobehavioral research in cardiovascular, lung, and blood diseases and sleep disorders over the past 5 years; identify research opportunities; and develop a comprehensive plan, including scientific priorities, for NHLBI support of research on health and behavior for the next several years. During a series of meetings that spanned nearly 2 years, the task force worked to develop a report of its findings and conclusions. The report provides a detailed summary of accomplishments to date, highlights new scientific opportunities, and identifies specific recommendations for future research. The full text, with graphics, is available on the NHLBI Web site at http://www.nhlbi.nih.gov/nhlbi/sciinf/taskforc.htm. The synopsis that follows was excerpted from the executive summary of the task force report. The Institute is very pleased to have this task force report to guide its activities with respect to research on health and behavior. We are grateful to the task force chair, Dr …