Effect of Music Therapy on Improving Sleep Quality in Older Adults

A Systematic Review and Meta-analysis

Chia-Te Chen NP, MS; Heng-Hsin Tung RN, FNP, PhD, DNP; Ching-Ju Fang MLIS; Jiun-Ling Wang MD; Nai-Ying Ko RN, PhD; Ying-Ju Chang RN, PhD; Yen-Chin Chen RN, PhD


J Am Geriatr Soc. 2021;69(7):1925-1932. 

In This Article

Abstract and Introduction


Objectives: Poor sleep quality is a common issue among older adults; it can lead to a poor quality of life and impairments in cognitive function and physical health. This study aimed to conduct a systematic review and meta-analysis of the effect of listening to music on sleep quality in older adults.

Design: Systematic review and meta-analyses.

Setting: Five databases, including Embase, Ovid Medline, Cochrane Library, Scopus, and the Index to Taiwan Periodical Literature System, were searched to identify studies assessing the efficacy of music therapy in older adults aged 60 years and older published through February 20, 2021.

Participants: Adults aged 60 years and older.

Measurements: We searched English- and Chinese-language studies of randomized control trials. All studies were reviewed by two independent investigators. The primary sleep outcome was the Pittsburgh sleep quality index. The Cochrane Collaboration tool was used to assess the risk of bias, and Review Manager 5.3 software was used to conduct the meta-analysis.

Results: Five randomized control trials were included in the meta-analysis. Older adults who listened to music experienced significantly better sleep quality than those who did not listen to music [mean difference (MD): −1.96, 95% CI −2.23 to −1.73, P = 0.003]. The subgroup analysis revealed that older adults who listened to sedative music obtained a more effective improvement in sleep quality than those who listened to rhythm-centered music (MD: −2.35, 95% CI –3.59 to −1.10, P = 0.0002). Furthermore, listening to music for longer than 4 weeks (MD: −2.61, 95% CI −4.72 to −0.50, P = 0.02) was to be effective at improving sleep quality.

Conclusions: Music therapy is safe and easy to administer and can effectively improve sleep quality among older adults, particularly those listening to more sedative music for at least a four-week duration.


Sleep disturbance is a common symptom in older adults due to age-related changes in sleep architecture and circadian regulation. According to previous epidemiological studies, 40–70% of older adults are estimated to have sleep problems,[1] and up to 41.4% of community-dwelling older adults suffer from insomnia.[2] Common complaints are "frequently waking up in the middle of the night" or waking up early in the morning".[3] Unresolved sleep problems in older adults lead to a poor quality of life, cognitive impairment, and emotional distress, as well as a decline in physical function and increased risk of falling incidents.[4–8]

Listening to sedative music may be an effective strategy to improve sleep quality in older adults.[8] Music has also been classified as sedative and rhythmic in terms of the level of arousal. Sedative music is commonly characterized by a slow tempo of 60–80 beats per minute, a soft volume, and smooth melody,[9,10] while rhythmic music is characterized by fast tempos, a loud volume, and rhythmic patterns.[11] Based on psychophysiological theory, listening to sedative music can improve sleep by modulating sympathetic nervous system activity and the release of neuroendocrine levels of cortisol, thereby lowering levels of anxiety and stress responses.[12–15] However, the effect of listening to music on improving sleep quality among community-dwelling older adults remains unclear. Chang et al[16] found that listening to music promotes better sleep quality. Lai and Good[17] also obtained similar results and showed that listening to music improves sleep quality in community-dwelling older adults aged at least 60 years. However, Yap et al[18] found that older adults who listened to rhythmic-centered music (i.e., drum or percussion instrument sounds) did not experience significantly improved sleep quality or the level of depression compared to a control group.

A previous systematic review and meta-analysis of randomized controlled trials (RCTs) confirmed that listening to music is potentially a successful nonpharmacological intervention for improving sleep quality in adults.[19,20] As the effects of music therapy on improving sleep quality in older adults remain uncertain, the aim of this study was to conduct a systematic review and meta-analysis to evaluate the effects of listening to music on sleep quality in older adults.