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Tune into good sleep with music.

Introduction

Living in today's fast paced society has led to an increase in stress-related disorders, a rise in a number of chronic diseases, as well as major disruptions in people's sleeping patterns. As musicians and educators, our lives are often "jam packed" with extracurricular activity including rehearsals, concerts and music competitions in addition to our regular work schedules and family life. As a result of the "busyness" and stress that accompanies performing and preparing others to perform, many of us suffer from sleeping problems. While the average person requires between 7 to 9 hours of sleep per day according to the National Sleep Foundation (2015), nearly 30% of adults reported an average of less than 6 hours of sleep per day on a National Health Interviews Survey (Schoenborn & Adams, 2010). What is alarming about these statistics is that chronic diseases including depression, cardiovascular disease, diabetes and obesity are connected to inadequate sleep. Thankfully, there is a wonderful non-pharmacological approach to assisting sleep function that we are already in tune with: Music.

What Happens When We Sleep?

It was thought until the 1940's that sleep was a time when the brain was relatively inactive. However, research indicates that the brain is active while we sleep, going through a number of cycles and various stages of alertness, functioning at times in the same manner as when a person is awake. The two main types of sleep are Rapid Eye Movement (REM) sleep and non-Rapid Eye Movement (NREM). As a person prepares to sleep, a slow decrease in the activation of neurons occurs in the transition from being awake to NREM sleep in a process that unfolds in three stages. The first phase lasts from 1-7 minutes, the second lasts 10 to 25 minutes and the third phase, which is also referred to as deep or delta sleep, ranges from 20 to 40 minutes. Delta sleep is typically followed by REM sleep, which then alternates with NREM sleep for the remainder of the sleep cycle. During REM sleep, there is increased brain activity and pulse as well as rapid eye movement.

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Sleep Disorders

I wonder how many people have never had trouble falling asleep; I don't imagine that the list would be very long. While many people do not have recurring sleep problems, it is not uncommon for people to sometimes find it more difficult to fall asleep. However, recurring sleep issues are an indication of a potential sleep disorder or health issue. There are more than 80 different sleep disorders that fall into a number of categories with the three primary ones being insomnia, hypersomnia, and parasomnia.

Insomnia is the most common sleep disorder and is mainly prominent in older adults, although it affects persons across the lifespan. Insomnia refers to a person's inability to fall asleep or to stay asleep, and it can occur for a short period of time or as a long term condition. Insomnia is also recognized as a sign and or symptom resulting from medical or psychiatric disorders as well as the outcome of lifestyle choices.

Fatigue and extreme feelings of sleepiness are part of the hypersomnia group of disorders. One disorder in this category is Narcolepsy: a neurological disorder that is a result of the brain's incapacity to regulate sleep and wake cycles. Narcolepsy is believed to be a consequence of some type of environmental trigger such as an infection in conjunction with abnormalities and genetic mutations disturbing biological factors in the brain. It is a primary hypersomnia, which means that it results in muscle weakness and excessive sleepiness.

The third category, parasomnia, is characterized by irregular events that occur sporadically during sleep such as teeth grinding, nightmares, and sleep-walking.

Apart from these three primary categories, there are also sleep related breathing disorders, (i.e. sleep apnea), and sleep related movement disorders, (i.e. Restless Legs Syndrome (RLS) among other common categories. Sleep apnea is a significant and serious disorder. Symptoms include temporary pauses or cessation of breathing, alongside sporadic and surface breathing which is the result of the upper airways being blocked. A pause in breathing is called an apnea, and an apnea can occur up to 30 times per hour, ranging from 10 seconds to even minutes. The most common treatment for sleep apnea is a mask type of device a person wears while sleeping that helps provide air during sleep. RLS is characterized by unpleasant sensations in the limbs generally the legs such as crawling, aching or tingling that occur during periods of rest or prior to sleep.

The National Academy of Science estimates that between 50 and 70 million Americans are affected by a chronic sleep disorder (Colten & Altevogt, 2006). The sleep deprivation caused by sleep disorders may result in numerous problems such as depressed mood, memory and attention problems, as well as feeling sleepy during the day. As we age, there is an increase in the development of sleep disorders which are impacted by changes such as those brought on by our circadian rhythms, otherwise referred to as our "biological clocks". One such problem is that with an increase in age, we may experience a shift in our circadian rhythms that might tell us it is time to sleep in the middle of the day instead of at night. The depth of sleep also decreases with age, REM sleep declines and the number of times a person is aroused increases. Unfortunately, for people with neuropsychiatric disorders including dementia or depression, sleep issues are often a symptom of these already complex diseases.

Treatment of Sleep Disorders

Fortunately, with advances in medical care there are a number of treatments for sleep disorders. However, many people using the treatments still have trouble and are not symptom-free in their quest for sleep. Medication, natural products, lifestyle changes, sleep preparation, as well as alternative therapies including music, are all treatment options at present. Sleep medications are prescribed according to the problem or issue a person is having. For example, benzodiazepines are a type of medication that helps people to fall asleep and stay asleep. Natural products such as melatonin and valerian are also commonly suggested by naturopaths, medical doctors and pharmacists for assisting with sleeping problems. With respect to lifestyle changes, these include things such as reducing caffeine and alcohol intake and limiting the amounts of these substances after a certain time of day, quitting smoking, and losing weight. In addition, sleep preparation can also make an impact, and includes such changes as dedicating the sleeping area to sleep only, preparing the sleeping environment so that it is cool and dark, scheduling sleep, and maintaining a consistent schedule such as not sleeping in on weekends and going to bed at the same time each evening. Other alternative therapies include Cognitive Behavioural Therapy which might help to reduce anxiety or negative thoughts that impact sleep, as well as combining multiple strategies, such as medication and lifestyle changes. Cognitive Behavioural Therapy for Insomnia (CBT-1) "is a set of techniques based on a popular model of talk therapy that's designed to help people reframe disturbing thoughts" (Pearce, 2015, p. 50).

Benefits of Using Music to Assist Sleep.

So now we get to the good stuff. As musicians why not look to our tool and passion to help us fall asleep? The population in general is being encouraged more and more to use music to help facilitate sleep and reduce sleeping problems. Some of the reasons for this are quite obvious: music is easily used at home, low cost, noninvasive and non-pharmacological.

Research shows that music reduces stress and anxiety that is connected to sleeping problems by facilitating physical changes including: lowering heart and respiratory rates that may increase sleep quality (Brennan & Charnetski, 2000). Music has also been shown to decrease the amount of time required for a person to fall asleep while increasing their sleep duration, delta and REM sleep, as well as decreasing the number of times a person wakes up during their sleep cycle (Mornhinweg & Voignnier, 1995; Zimmerman, Nieveen, Barnason & Schamderer, 1996). Lai and Good (2005) found that older adults experienced better and longer sleep when they listened to soft music at bedtime. At the other end of the spectrum, Tan (2004) found that background music provided at naptime and bedtime with elementary school children afforded substantial improvements in global sleep quality over time.

So how does one go about selecting music to assist sleep? There is no prescription for specific music to assist sleep but there are general properties to consider alongside musical preference, which is highly important. Overall, instrumental music with slow rhythms that are paced at resting heart rate tempo (60 beats per minute) are suitable guidelines to begin your search for the right music for you. There are also a number of resources on the market today which have music created for sleep. For example, an app called Sleep Genius (2001) from iTunes and Music for Sleep by Dr. Jeffrey Thompson and Dr. Joseph Nagler, (Sounds True, 2015). Several years ago I collaborated with Canadian musician David Bradstreet (2007) and we have a CD entitled 'Therasleep' that has been created specifically to help people fall asleep and stay asleep for longer periods of time.

More formal music treatments may also be provided by a music therapist who could design an individualized sleep care plan for a person as well as potentially provide some live music or music therapy sessions depending on the client, their needs, location (home, hospital etc.) and the sources of their sleeping issues. For example, the music therapist and client may address sleep issues stemming from daily experiences of anxiety and stress by exploring the sources of stress and anxiety and providing an outlet for expression of their feelings, thus reducing or helping to manage anxiety. The end result could be the client finds new ways to manage stress and anxiety and an outlet for expression, thereby enhancing their quality of sleep over time.

In a variety of clinical settings including palliative care, music therapists provide bedside music to stimulate and increase sleep duration for people experiencing sleep issues. A typical way that this unfolds is that a music therapist might begin by improvising music in a style and tempo that mirrors a person's heart and respiratory rates. Once matched, the therapist may then begin to alter the music to lower the client's heart and respiratory rates in an effort to induce sleep. Music therapists also consider the sound wave properties of music to influence the various brain wave lengths that also will induce sleep such as the theta and delta waves.

Concluding Thoughts

You are not alone if you are having sleeping issues. If you do experience problems, I encourage you to try a natural remedy such as music, especially since music is so important in our lives. It is hoped that there will be further research in the years ahead that looks at using low frequency sound stimulation to investigate and treat underlying causes of many sleep issues such as mood, pain and anxiety; as well as more research on the use and effectiveness of 'natural' sleep remedies.

References

Bradstreet, D. (2007). Therasleep [Digital music album]. Theramusic. Retrieved from http://itunes.apple.com/

Brennan, F. X. & Charnetski, C.J. (2000). Stress and immune system function in a newspaper's newsroom. Psychol, 87, 218-222.

Colten, H. R., & Altevogt, B.M. (Eds.). (2006). Sleep Disorders and Sleep Deprivation: An Unmet Public Health Problem. Washington, DC: National Academies Press (US); 2006. Available from: http://www.ncbi.nlm.nih.gov/books/NBK19960

Lai, H. L., & Good, M. (2005). Music improves sleep quality in older adults. Journal of Advanced Nursing, 49(3), 234-44.

Mornhinweg, G.C., & Voignier, R. R. (1995) Music for sleep disturbance in the elderly. Journal of Holistic Nursing, 13(3), 248-254.

National Center for Health Statistics. Vital Health Stat, 10(245). Retrieved from http://www.cdc.gov/nchs/data/series/sr_10/sr10_245.pdf.

National Sleep Foundation. (2015). National Sleep Foundation: Sleep Duration Recommendations. Retrieved from http://sleepfoundation.org/sites/ default/files/STREPchanges_1.png.

Pearce, T. (2015, May). Talk yourself into a good night's sleep. Canadian Living, pp. 50-51.

Schoenborn, C. A., & Adams, P.F. (2010). Health behaviors of adults: United States, 2005-2007.

Sleep Genius. (2015). Sleep Genius, LCC (Version 1.10.5) [Mobile application software]. Retrieved from http://itunes.apple.com/

Sounds True. (2015). Joseph Nagler. Retrieved from http://www.soundstrue.com/store/joseph-nagler-5401.html

Tan, L. P. (2004). The effects of background music on quality of sleep in elementary school children. Journal of Music Therapy, 41(2), 128-150.

Thompson, J. (2001). Natural Music for Sleep [Digital music album]. The Relaxation Company.

Retrieved from https://itunes.apple.com/us/album/natural-music-for sleep/id269186405/

Zimmerman, L., Nieveen, J., Barnason, S., & Schamderer, M. (1996). The effects of music interventions on postoperative pain and sleep in coronary artery bypass graft (CABG) patients. Sch Inq Nurs Pract, 10(2):153-74.

Dr. Amy Clements-Cortes is Assistant Professor, Music and Health Research Col laboratory (MaHRC), University of Toronto; Senior Music Therapist/Practice Advisor, Baycrest; Instructor and Supervisor, Wilfrid Laurier University and a Registered Psychotherapist, Amy has extensive clinical experience working with clients across the lifespan, She has given over 90 conference and/or invited academic presentations, is published in peer reviewed journals and books, and has supervised over 35 music therapy internships, 30 undergraduate research studies, and 3 Masters students MRPs. She is the President for the World Federation of Music Therapy, Managing Editor of the Music and Medicine journal, director of Notes By Amy www.notesbyamy.com. Amy is on the editorial review board of the Journal of Music Therapy, Voices, and Music Therapy Perspectives.
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Title Annotation:music and health
Author:Clements-Cortes, Amy
Publication:Canadian Music Educator
Article Type:Report
Geographic Code:1CANA
Date:Sep 22, 2015
Words:2274
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