 

.W

i .LlBRARY
2008 Michigan State

University

 

 

 

 

This is to certify that the
thesis entitled

THE INFLUENCE OF PARTICIPANT-SELECTED VERSUS
EXPERIMENTER-CHOSEN MUSIC ON SUBJECTIVE SLEEP
QUALITY OF PEOPLE OVER 60 YEARS OF AGE

presented by

PO-JU CHEN

has been accepted towards fulﬁllment
of the requirements for the

MASTER OF degree in MUSIC THERAPY
MUSIC

 

 

Major Professor’s Signature
mgr /. 1 “'38

Date

MSU is an afﬁnnaiive-action, equal-opportunity employer

-.-__.-.-L-,--_,-A-__._A_ -r-.-._.-.—.- ----~-|‘1-|-l-0-0-

PLACE IN RETURN BOX to remove this checkout from your record.
TO AVOID FINES return on or before date due.
MAY BE RECALLED with earlier due date if requested.

 

DATE DUE DATE DUE DATE DUE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

5/08 KzlProlecc8PresICIRC/DateDue.indd

THE INFLUENCE OF PARTICIPANT-SELECTED VERSUS
EXPERIMENTER-CHOSEN MUSIC ON SUBJECTIVE SLEEP QUALITY
OF PEOPLE OVER 60 YEARS OF AGE
By

Po-Ju Chen

A THESIS
Submitted to
Michigan State University
in partial fulﬁllment of the requirements
for the degree of
MASTER OF MUSIC
MUSIC THERAPY

2008

ABSTRACT

THE INFLUENCE OF PARTICIPANT-SELECTED VERSUS
EXPERIMENTER—CHOSEN MUSIC ON SUBJECTIVE SLEEP QUALITY
OF PEOPLE OVER 60 YEARS OF AGE
By
Po-J u Chen

The purpose of this study was to examine the effect of music exposure on promoting
subjective sleep quality in the elderly population. Thirty-one participants over sixty were
randomly assigned to the control group and two experimental groups. Participants in
experimental groups were asked to listen to a 45-minute selection of music to fall asleep
every night for three consecutive weeks. The Pittsburgh Sleep Quality Index (PSQI) was
used to measure participants’ sleep quality for the pretest and posttest. Data were
analyzed using Independent-Samples t-tests comparing change scores. The results
indicated that older people who received music at bedtime for three consecutive weeks
improved their sleep quality signiﬁcantly more than older people who did not receive any
music. However, there was no difference in improvement of sleep quality between those
who received their chosen music at bedtime and those who received experimenter-chosen

music at bedtime. Either participant-selected or subject-selected music appears to

improve global sleep quality; whereas no improvement was found in the control group.

ACKNOWLEDGEMENTS

I would glad to express my gratitude and appreciation to many people who have been
involved in this thesis. First, a sincere gratitude is to Dr. Frederick Tims, my thesis
advisor, for his continuous encouragement and guidance throughout the project. I also
thank my committee members: Professor Roger Smeltekop for his valuable inspiration
and long-term support, and Dr. Cythia Taggart for her detailed advice and insightful
suggestions. All of my committee members’ professional guidance was truly crucial in
helping me to complete this project step by step.

I would like to express my great deal of appreciation to the seniors who volunteered
to participate in this study. Thank you also goes to Wei-Wen Hsu and Ruo-Sin Peng, my
special friends, for their personal help and support.

Finally, a sincere thank you goes to my parents, Lee Tsui-Ying and Chen Tsu-Ming,
who support me ﬁnancially to pursue my study in the United States. Also a very special
thank you goes to my sister, Po-Ling Chen, who always supports and encourages me.
Without their patience, generosity, and love, this thesis would never have been completed.

Thank you all!

iii

TABLE OF CONTENTS

 

 

 

 

 

 

 

 

 

 

LIST OF TABLES .......................................................................................................... VI

LIST OF FIGURE ........................................................................................................ VII

CHAPTER I

INTRODUCTION ............................................................................................................. 1
BACKGROUND AND SIGNIFICANCE - ..................................................... - __ _ - 1
PURPOSE AND RESEARCH QUESTIONS ........................................................................... 4

CHAPTER II

LITERATURE REVIEW ................................................................................................ 5
THE EFFECT OF MUSIC ON SLEEP QUALITY - __ ............. - - - 5
THE EFFECT OF PARTICIPANT-SELECTED MUSIC ON SLEEP 5
THE EFFECT OF RESEARCHER-SELECTED MUSIC ON SLEEP- 8
THE EFFECT OF SEDATIVE MUSIC ................................................... 11
THE EFFECT OF MUSIC ON SLEEP QUALITY OF OLDER PEOPLE ............................... 14

CHAPTER III

METHOD ........................................................................................................................ l7
DESIGN . ........................ - - -- - - ...... - .......... 17
PARTICIPANTS ................................ _ .......................... 17
MATERIALS ...... _ - - - -_ _ -- 17
PROCEDURE- - -- ........ -- - - -- l9
MEASUREMENT ............................................................................................................ 21

CHAPTER IV

RESULTS ........................................................................................................................ 23

CHAPTER V

DISCCUSSION AND CONCLUSIONS - - -- - - - ...... . 27

APPENDICES ................................................................................................................. 30

APPENDIX A

INITIAL IRB APPLICATION APPROVAL ........................................................... 31

APPENDIX B

CONSENT FORM ...................................................................................................... 33
APPENDIX C

RECRUITMENT LETTER ....................................................................................... 36

REFERENCES ................................................................................................................ 38

LIST OF TABLES

TABLE 1.

Participant-selected Music ........................................................................ 18
TABLE 2.

Experimenter-chosen Music ..................................................................... 19
TABLE 3.

Mean and Standard Deviations for Global PSQI Scores in Experimental Groups ...... 24
TABLE 4.

Mean Change Scores for Global PSQI Scores in Experimental Groups .................. 25
TABLE 5.

Mean for Global PSQI Scores in Music and Non-music Groups .......................... 26
TABLE 6.

Sleep Quality Components (change scores) in Music and Non-music Groups .......... 26

vi

LIST OF FIGURE

FIGURE 1.
Global PSQI Mean Scores between Three Groups .......................................... 23

vii

CHAPTER I

INTRODUCTION

Background and Signiﬁcance

Sleep disorders are common in elderly populations (Middlekoop, et al, 1996). In a
National Institute on Aging evaluation of late-life sleep complaints, more than 80% of
9000 people age 65 and older reported having experienced sleep disturbance (Schneider,
2002). Older adults tend to experience more frequent and longer awakenings, shortening
of total sleep time, and less deep Sleep (Espie, 1991; Miles & Dement, 1980; Prinz,
Vitiello, Raskind, & Thorpy, 1990). Research also indicated that aging goes along with
an increase in the length of stage 1 sleep (Reynolds, et al., 1985). In other words, seniors
may also experience longer sleep onset latencies (Prinz et al., 1990). However, the most
commonly reported insomnia symptom was difﬁculty maintaining sleep, which is
estimated to occur with 30% to 37% of elderly people (Gislason, et al, 1993).

The causes of insomnia are multiple, including physical illness, pain, changes in
central nervous system functioning and social, psychological, psychiatric,
pharmocological and environmental factors (Bliwise, 1989; Wilson & Nutt, 2007;
Zepelin, 1983). In addition, depression is one of the most common causes of insomnia in
the geriatric population. Untreated depression is likely to lead to insomnia. On the other
hand, unsolved insomnia can result in depression (Ancoli-Israel, 2004). Late-life
depression signiﬁcantly increases the risk for suicide. According to the National Vital
Statistics reported in 1997, persons age 65 and Older comprise 13% of the US

population, but 19% Of completed suicides (Buysse, 2004.) Insomnia may also cause

daytime sleepiness. According to researchers conducting a sub-study of participants from
the Cardiovascular Health Study (CHS), adults over age 65 who experience daytime
sleepiness have a greater risk of mortality and cardiovascular events (Ross & Shua—Haim,
2000). Therefore, daytime sleepiness caused by insomnia may increase Older citizens’
risk of death. The use of medicine is the most common intervention for insomnia.
However, dependence and impaired psychomotor and cognitive functioning result when
using drugs over a long period of time (Ashton, 1994). Consequently, elders who take
these drugs are in danger of car accidents, falls, and hip fractures, Often leading to long-
term care (Grifﬁn et al, 1989; Ray et al, 1992). In addition to medication, other
treatments for insomnia involve improving sleep hygiene, exercise, paradoxical intention
therapy, cognitive behavioral therapy, relaxation therapy, and stimulus control therapy
(Ringdahl, Pereira, & Delzell, 2004). Finding a suitable way to help the older people with
insomnia, is an ongoing issue with those who care for the elderly.

Many studies report that music is able to improve mood and help individuals cope
with stress (Watkins, 1997), and music has been shown to decrease anxiety and tension in
a variety of populations (Davis & Thaut, 1989). Studies have shown that sedative music
promotes relaxation of the body (Steelman, 1990; White, 1992), which in turn reduces the
circulation of norepinephrine (Gerra et al., 1998). Norepinephrine is related to sleep onset
as well as the amount of time in wakefulness at night (Prinz, Halter, Benedetti, &
Raskind, 1979). In other words, when the body is relaxed through music, circulation of
norepinephrine, which is associated with sleep onset, is also reduced (Tan, 2004).
Therefore, a sleep response can be expected via the responses of relaxation, distraction,

and a reduction in norepinephrine (Lai, 2001). Music can reduce muscular energy, heart

and respiratory rates, blood pressure, and alleviate psychological distress (Kartman,
1984), which are also related to sleep quality. Clinicians also reported that the use Of
tranquilizers and hypnotics could be reduced when listening to music at night (Prinsley,
1986). Thus, there is a possibility that music, as a non-pharmacological approach, could
be useful for sleep problems (Hanser, 1990).

Non- pharmacological interventions for sleep are underused by Western health care
providers, even though they may be more appropriate to insomnia patients than
pharmacotherapy (Morin, Gualier, Barry, & Kowatch, 1992). Non—pharmacological
therapies that have been investigated for sleep disorders include progressive relaxation,
therapeutic touch, sleep hygiene, chronotherapy, stimulus control instruction, sleep
restriction, bright light therapy, biofeedback, and paradoxical intention (Morin, 1993).
However, most of these interventions are expensive or time consuming. Therefore, music
therapy using recorded music, which is a more cost-effective non- pharmacological
therapy, might be useful to the elderly, many Of whom have limited ﬁnancial resources.
Music therapy has been viewed as a valuable part of treatment for elderly people
(Aldridge, 1994). Although there are many studies that examine the effect of music
therapy on sleep, only a few studies have investigated the effects of music therapy on
sleep in the older population (Johnson, 2003; Lai, 2001; Lindenmuth, Patel, & Chang,
1992; Mornhinweg & Voignnier, 1995). F urtherrnore, no study compares the effect of
participant-selected and experimenter-chosen music on sleep quality of Older people. A
study published in February 2005 in the Journal of Advanced Nursing found that
listening to soft music at bedtime assisted older adults in sleeping better and longer. Since

the use of music at bedtime may be a viable, indirect way to promote relaxation and

decrease insomnia for older people, a study examining the effects of music therapy on

sleep in Older population is worth implementing.

Mose and Research Questions

With the intent of improving sleep quality of older people, the purpose of this research
was to examine the effect Of music exposure on promoting subjective sleep quality in the
elderly population.

The research questions were as follows:

(1) Is there a difference in sleep quality between older people who receive their chosen
music at bedtime each night for three weeks and those who receive experimenter-
chosen music at bedtime each night for three weeks?

(2) Is there a difference in sleep quality between older peOple who receive music at

bedtime each night for three weeks and those who do not receive music?

CHAPTER II

LITERATURE REVIEW

MEffect of Music Ol_l Sleep Quality

Research has shown that music has positive effects on sleep (Field, 1999; Hernandez-
Ruiz, 2005; Johnson, 2003; Lai, 2001; Lasswell, 2001; Levin, 1998; Lindenmuth, Patel,
& Chang, 1992; Momhinweg & Voignnier, 1995; Tan, 2004; Zimmerman, Nieveen,
Bamason, & Schamdered, 1996). However, some studies Show inconclusive results
(Iwaki et al, 2003; Lazic & Ogilvie, 2006) or opposing effects of music on sleep
(Gitanjali, 1998; Rutter & Waring-Paynter, 1992; Sanchez & Bootzin, 1985). Because of
these contradictory results about the effects of music on sleep, for both theoretical and
practical uses, replicating a study about whether music has a positive effect on sleep

quality is valuable and necessary.

ﬂie Effect of Participant-selected Music on Sleep

Three studies examined the effects of participant-selected music from repertoire on
sleep (Johnson, 2003; Lai, 2001, Zimmerman, Nieveen, Bamason, & Schamdered, 1996).
In Lai’s (2001) study, participants were given ﬁve types of western music: synthesizer,
harp, piano, orchestra, slow jazz and one Chinese orchestra from which to choose.
Participants listened to their preferred music during their sleep at night for three
consecutive weeks. Sleep quality was measured with the Pittsburgh Sleep Quality Index
(PSQI) as a pretest and weekly posttests. Results suggested that older adults who received

music at bedtime had better global sleep quality than those who did not. In Johnson’s

(2003) study, ﬁfty-two women over the age of 70 were asked to select their own music to
listen to during the bedtime. They could change their preference nightly as long as they
stayed in the same musical category. The majority Of participants selected soothing
classical music, whereas the rest of participants preferred to listen to sacred music or new
age music. Results indicated that using music at bedtime decreased sleep latency and the
number of nighttime awakenings in older women.

Zimmerman et a1. (1996) studied the effects of music on postoperative pain and sleep
in coronary artery bypass graft (CABG) patients. Participants in the music treatment
group were asked to either select from ﬁve audio tapes or chose from three video
cassettes with soft music. They received their soothing music on the second and third
day. Instead of listening to music at bedtime, participants received music either in the
afternoon or every evening. Sleep was measured using the Richard-Campbell Sleep
Questionnaire. Results indicated that participants in music condition had better sleep
scores compared to the control group that did not receive either music or music video.

Thaut and Davis (1993) suggested that music therapists should encourage patients to
select music based on their personal preference when attempting to enhance relaxation
and reduce anxiety, because this might facilitate better sleep. When participants select the
music, they view the music as preferred, and the more choices the researcher gives the
subjects, the more likely it is that participants will ﬁnd their truly preferred music,
especially if they had their preferred music in mind. Therapists’ limiting choices of music
set by therapists may cause a problem. If participants show no preference within the
group of designated music selections, they might randomly choose music that is not what

they truly prefer. Consequently, this minor confounding variable may decrease the

validity of the study. TO avoid this pitfall in my study, participants in the participant-
selected music group are allowed to choose or provide their preferred music without any
limitations.

Two studies used participant selected music without any limitations set by the
researcher (Hemandez-Ruiz, 2005; Iwaki et al, 2003). In Hemandez-Ruiz’s study (2005),
fourteen abused women in the experimental group were instructed to listen to participant-
selected music combined with progressive muscle relaxation (PMR). One of the
participants in the experimental group could not specify his choice, so the researcher
suggested selections according to the participant’ preferred genre. The modiﬁed
Pittsburgh Sleep Quality Index (PSQI) was used to assess the effect of music intervention
on sleep quality for two days. Levels of fatigue were measured by using Fatigue Scale for
four consecutive days, and the State Trait Anxiety Inventory was used as pretests and
posttests to measure the anxiety during the therapeutic sessions held by the researcher for
two consecutive days. Results showed that music had a positive effect on reducing
anxiety and also resulted in improving sleep quality in the experimental group. In Iwaki
et al’s (2003) study, twenty participants who were accustomed to listening to music at
bedtime were monitored by a polysomnograph when they were taking a nap in the
laboratory. A series of pieces chosen from each participant’s preferred music album were
played as they fell asleep. Results showed that sleep latency was shorter for the
participants in the experimental group who were sleeping with music than for those who
did not listen to any music (the control group). However, this tendency reversed when the
participants were told to fall asleep as fast as they can. Participants who tried to sleep

quickly with music playing demonstrated increased episodic wakefulness and prolonged

sleep latency compared to the nO-music group. The results of this study indicated that
listening to preferred music promotes falling asleep for those who are used to listening to
music during bedtime. However, this may be only effective after balancing other factors,
such as the adjustment of one’s mood as it relates to the preferred music, and the skill of
listening to music for falling asleep. Within this framework, it is not clear if preferred
music promotes falling asleep or interferes with it. This outcome is different from the
results of other participant-selected studies discussed earlier (Lai, 2001, Johnson, 2003;
Eugenia, 2005). Future research concerning the effects Of participants’ preferred music

on sleep quality seems essential.

T_he Effect of Researcher-selected Music on Sleep

Six studies were found using researcher-selected music as an intervention for Sleep
(Field, 1999; Lasswell, 2001; Lazic & Ogilvie, 2006; Lindenmuth, Patel, & Chang, 1992;
Momhinweg & Voignnier, 1995; Tan, 2004). In Lindenmuth et al’s (1992) study, twenty
participants from a nursing home consisted often “healthy” older people and ten older
people diagnosed with senile dementia of the Alzheimer type (SDAT) were asked to
participate both in the control group and experimental group. A behavioral assessment
chart of Sleeping behavior, which consists of four categories: patient asleep, patient
restless, REM, and started tape, was used by the nurses on the hourly midnight shift from
11p.m. to 5 pm. Ten cassettes of Music for “Sound” Health composed of soft piano,
electric piano, and sounds of nature were used in this study. The period of conducting this
study was four-weeks. At the ﬁrst week, the nurses recorded data about original sleeping

pattern for control “healthy” elderly without using the music. In the second week, the

nurses were instructed to not only mark a check on the list for every hour but also play
the tape whenever they found the subject restless. Music for “Sound ” Health cassette was
also played whenever the patient was asleep. A basic sleeping pattern for SDAT control
group was obtained at the third week. At the ﬁnal week, nurses were instructed to play
the music to each SDAT participant whenever he or she was restless. Results indicated
that there was a signiﬁcant relationship between the use of music and the number of
hours of productive sleep between control and experimental SDAT patients.

In Momhinweg and Voignnier’s (1995) qualitative study, twenty-ﬁve elderly were
asked to listen to New Age and Baroque music, which all had tempi of less than 70 beats-
per-minute. Participants listened to one type of music for ﬁve days, played no music for
two days, and played the second for the next ﬁve days during their bedtime. Upon
awakening, they were asked to write their music and sleep experience in a log. The
outcome showed that almost all the participants, twenty-four out of twenty-ﬁve people,
asserted that their sleep disturbance was somewhat reduced after music intervention at
bed time.

In Tan’s (2004) study, the music used in the study was a collection Of different
adagios and Enya with tempi beginning at 78 beats-per-minute and gradually dropping to
48 beats-per—minute. Participants in the experimental group listened to this music on a
45-minute CD at nap time and bedtime every day for three consecutive weeks. PSQI was
used to assess sleep quality as pretest and three weekly posttests. Tan found that
participants who were given background music at naptime and bedtime daily for three

consecutive weeks signiﬁcantly improved their sleep quality globally.

In Lasswell’s (2001) study, women in the experimental group listened to researcher-
selected music with a Progressive Muscle Relaxation instruction. A seven-point Likert-
typc scale was used to measure relaxation levels after the intervention. Two self-reports
were used to assess sleep quality and daytime sleepiness. Results indicated that music
with PMR instruction not only increased the relaxation, but also promoted sleep quality.
However, there was no signiﬁcant difference on daytime sleepiness between groups. In
Field’s (1999) study, twenty-four children listened to classical guitar music at their
naptime for two days, and no music was given for another two days. Results showed that
the time before Sleep onset is much shorter when children received music at their
naptime.

Lazic and Ogilvie (2006) examined the effect Of music and general auditory
stimulation on sleep quality of ten female students, who were asked to participate in two
serious of four consecutive nights. All the ﬁrst nights served as an adaptation night, and
the following three nights were experimental nights. Participants either listened to music,
tones, or neither on the experimental nights. “Delta Sleep System,” which was claimed to
induce sleep, was used in the music experimental night. The researchers used standard
polysomnographic measures, quantitative analysis of the electroencephalogram, as well
as subjective ratings of sleep quality (PSQI and Stimulus evaluation questionnaire).
According to the objective physiological record, the results indicated that music does not
have signiﬁcantly better effect on improving sleep onset latency, Sleep efﬁciency, wake
time after sleep onset, or percent of slow wave sleep than the tones and control conditions

(Lazic & Ogilvie, 2006).

10

The subjects of these studies were children (Field, 1999; Tan, 2004), abused women
(Lasswell, 2001), and female students (Lazic & Ogilvie, 2006). There are two studies
focusing on the effect of experimenter-chosen music on sleep quality of Older people
(Lindenmuth, Patel, & Chang, 1992; Momhinweg & Voignnier, 1995). Besides, sedative
music was used as researcher-selected music in most of these studies (Lasswell, 2001;
Lindenmuth, Patel, & Chang, 1992; Momhinweg & Voignnier, 1995; Tan, 2004).
According to Gaston’s deﬁnition, the characteristics of sedative music are no accented
beats, no syncopation, non-percussive, and tempo around sixty to eighty (Gaston, 1951,
1968). The music generally is categorized as sedative when it is slow, quiet, melodic, and
improvised or loosely structured (Thaut & Davis, 1993). Studies have revealed that slow
music decreased cortisol hormone levels, plasma norepinephrine, levels Of anxiety, heart
rate, and blood pressure (Mockel, et al, 1994; Steelman, 1990; White, 1992). According
to the literature reviewed earlier, norepinephrine is related to sleep onset (Irwin, et al.,
1999) and the amount of night time wakefulness (Prinz, Halter, Benedetti, & Raskind,
1979). Studies have shown that listening to sedative music may reduce norepinephrine

(Gerra et al, 1998; Mockel et al, 1994), which in turn induces a sleep response.

The Effect of Sedative MILK!

Several studies conducted in clinical settings have suggested that sedative music may
promote sleep quality via muscle relaxation and distraction from thoughts (Tan, 2004).
However, there are still some studies with inconsistent results (Logan & Roberts 1984;
Rohner & Miller, 1980). Rohner & Miller (1980) examined the effects of using music on

reducing anxiety in hi gh-anxiety individuals. Participants were randomly assigned to four

music treatment conditions or to the control group. Comparable forms of the Eight State
Questionnaire (8SQ) were used as measurement. Results suggested that the main
hypothesis that music would decrease anxiety compared to no music was not supported.
In Logan and Roberts (1984) study, 25 university students received three different
treatment conditions: Stephen Halpem's music, "superleaming" music, and no music
during 20-min session. Participants' tension levels were measured on a 10-point
anchoring scale. A one-way analysis of variance (ANOVA) was used to compare the
effects of relaxation music on the tension level in different treatments. Results indicated
that there were no signiﬁcant differences between the treatment conditions. Because a
state of tension or anxiety is related to the quality of sleep, these outcomes, in turn,
conﬂict with the statement that sedative music may have positive effects on sleep.
Therefore, an assumption that therapist-chosen sedative music has a positive effect on
sleep quality may be questionable.

Besides these six studies (Field, 1999; Lasswell, 2001; Lindenmuth, Patel, & Chang,
1992; Momhinweg & Voignnier, 1995; Lazic & Ogilvie, 2006; Tan, 2004), Levin used
Brain music to promote sleep quality (Levin 1998). “Brain music” is individualized
music that transforms spontaneous bioelectrical activity of one’s EEG into music before
it is recorded. Thus, the music used in the study is neither subject-selected nor
experimenter-chosen. Forty-four patients with insomnia in the experimental group
listened to their own “Brain Music” before going to sleep. Levin indicated that “Brain
music” was found to have signiﬁcant positive effects on more than 80% of the insomniac

patients according to both subjective and objective measures.

12

Many studies indicated that music has a positive effect on inducing sleep or
improving sleep quality (Field, 1999; Hemandez-Ruiz, 2005; Iwaki et al, 2003; Johnson,
2003; Lai, 2001; Lasswell, 2001; Lindenmuth, Patel, & Chang, 1992; Momhinweg &
Voignnier, 1995; Tan, 2004; Zimmerman, Nieveen, Bamason, & Schamdered, 1996).
However, there is no research comparing the difference between the effect of participant-
selected music and experimenter-chosen music on promoting sleep quality. The factors
under consideration when participants select the music are quite different from those of
researchers when choosing music for clients for use at bedtime. While the experimenters
consider the characteristics and the structure of music itself, the participants consider
their own feelings and preference, their familiarity, and their past experience with the
music (Thaut &Davis, 1993). These different factors raise the question of whether these
two types of music might have different effects on sleep quality. Therefore, my study
compares a difference between preferred music selected by the participants and music
selected by the therapists on the sleep quality. The therapist-chosen music is chosen
speciﬁcally from the sedative music category.

There is one study comparing the influence of participant-selected and experimenter-
chosen music on affect, anxiety, and relaxation (Thaut & Davis, 1993). F ifty-four
participants were randomly assigned to either the control or one of two experimental
groups. Results showed that subjects in all three groups achieved signiﬁcant relaxation
responses. Therefore, both participant-selected and experimenter-chosen music were
effective in relieving tension in the study, as was the control. According to the study, rock
and popular music, which are both types of excitative music, were selected most often by

participants, whereas the experimenter chose sedative music as a music intervention.

Although the participant-selected and experimenter-chosen music were different, there
was no difference in the decreased anxiety levels between participants who selected their
own music and those who listened to music that was selected by the researcher in this
study. Therefore, it is unclear whether preferred music chosen by participants or sedative
music selected by experimenter has more effect on promoting relaxation. There may be
no real difference between the effect of listening to participant-selected music and the
effect of listening to experimenter-chosen music on affect, anxiety, and relaxation.
Because promoting relaxation is associated with sleep quality, examining the difference
between participant-selected music and experimenter-chosen music on sleep quality may

be helpful to clarify this issue.

He Effect of Mgsic on Sleep Quality of Older People

Four studies were found examining the effects of music on sleep in the elderly
population (Johnson, 2003; Lai, 2001; Lindenmuth, Patel, & Chang, 1992; Momhinweg
& Voignnier, 1995). In Lindenmuth et al’s study (1992), only number Of hours asleep
was measured. The results revealed a signiﬁcant relationship between the use of music
and the number of hours of productive sleep between control and experimental SDAT
patients, while no signiﬁcant relationship was found between control and experimental
“healthy” elderly. In Momhinweg & Voignnier’s (1995) study, the authors used a
qualitative approach to examine the effects of intervention on one quasi-experimental
group. As a result, twenty-four participants out of twenty-ﬁve participants asserted that
their sleep disturbances were somewhat reduced because of the use of music. However,

only sleep disturbance was assessed, and there was no control group. Other elements of

sleep quality, such as sleep onset latency, presence of pain, and daytime dysfunction, etc,
were not assessed in these two studies. The results of these two studies give other
researchers preliminary information about the effect of music on sleep of older people.
Lai (2001) and Johnson (2003) set inclusion criteria and exclusion criteria for screening
their samples. In addition, two kinds of self-reported measurement were used in both
studies. In Lai’s study, PSQI and a sleep log measured the sleep quality, whereas
Stanford Sleepiness Scale (SSS) (Hoddes, Dement, & Zarcone, 1972) and a sleep log
were used in Johnson’s study. According to Herscovitch and Broughton (1981), SSS is
sensitive to deﬁcits in alertness after short-term cumulative partial sleep deprivation
(PSD). However, it generally does not predict individual performance efﬁciency, so it
cannot act as a substitute for performance measures in studies involving chronic sleep
loss (Herscovitch, & Broughton, 1981). Since the sample of my study may include
participants who suffer chronic insomnia, the use of SSS to assess their sleep might
threaten the validity of the study. Therefore, my study is used PSQI as a measurement
tool. In Johnson’s study, data were collected for music intervention for ten nights after
assessing condition with no music for ten nights. The intervention time is quite short in
Johnson’s study compared to Lai’s study, which had three weeks of music intervention.
Researchers recommend that three weeks is a suitable period of time for observing sleep
quality (Roehrs, Zorick, & Roth, 1994; Walsh, et al., 1994) and any new intervention’s
impact (Hoch & Reynolds, 1986; Wang, 1997) on promoting sleep. Therefore, three
weeks is the time period for music intervention in my study, and PSQI is administrated as
a pre and post test. Among these four studies, participant-selected music was used in two

studies (Johnson, 2003; Lai, 2001 ), while experimenter-chosen music was used in the

other two studies (Lindenmuth, Patel, & Chang, 1992; Momhinweg & Voignnier, 1995).
There is no study comparing the difference between the effect Of participant-selected
music and experimenter-chosen music on promoting sleep quality of older people. A
study examining the difference between participant-selected music and experimenter-

chosen music on sleep quality of older people is worth implementing.

CHAPTER III

METHOD

Design

This quantitative study is a pretest-posttest design. The independent variable
consisted of three levels: participant-selected music listening, experimenter-chosen music
listening, and no music listening. The dependent variable is sleep quality measured by the
Pittsburgh Sleep Quality Index (PSQI) (Buysse, Reynolds III, Monk, Berman, & Kupfer,

1989).

Participants

Thirty-three senior citizens living in the retirement centers and their homes in
Michigan began to participate in this study, but two participants became ill and dropped
from the study, resulting in thirty-one participants. The average age of these thirty-one
participants (19 women and 12 men) is 74 (range: 60 ~ 99). All participants were alert,
oriented, and capable Of reading, speaking, and communicating with others verbally. All
participants conﬁrmed the ability to hear radio or music easily without a hearing aid.

They were able to understand, to follow directions, and to manage the CD player.

Materials
Before the intervention, participants in the participant-selected group were asked to
report the music they thought might help them sleep better. After getting the information,

either the investigator found the music for them or the participants provided the music

themselves (Table 1). Experimenter-chosen music was selected according to whether it
corresponded to the characteristics and structure of sedative music, which can be
described as slow, quiet, with no accented beats and syncopation (Gaston, 1951; Thaut &
Davis, 1993). Sedative music from ten albums that are speciﬁcally marketed as the music
for better sleep and relaxation was used (Table 2). The length of the tape was determined
based on the results of the following studies. The duration Of sleep latency in Older people
is about 13 to 35 minutes (Gislason, et al., 1993, Hayter, 1983). Tension was decreased
after listening to sedative music for 25 to 30 minutes (Uplike, 1990; White, 1992).
However, Lai (2001) suggested use of a 45- minute cassette recording of music
compositions to guard against music ending earlier than sleep onset. Therefore, the
researcher used a CD that is approximately 45 minutes for this study. Four participants
who did not have a CD player or any required hi-ﬁ equipments in their room were
provided such equipment by the researcher.

TABLE 1.

Participant-selected Music

 

 

Subject Selection
C1 Slow classical music
( Telemann: Triple Concerto Largo for Strings)
C2 Debussy: Clair De Lune
C3 Golden Oldies
C4 Golden Oldies
C5 Soothing Classical music
C6 Soothing Classical music
C7 Buddhism Prayer Song
Classical Relaxation
Heal of the Hand
C8 New Age
C9 Classical music
C10 Instrumental music with natural sound
C11 Soft music with ocean sound

 

TABLE 2

Experimenter-chosen Music

 

 

Selection Album Artist
Meditation#7- Songs of Serenity, Relax Unwind and Meditate Robbie Cooper
Bedtime Lullaby

Delta Waves Sleep Cycle Brannan Lane

Concerto for Violin

and Strings in F
minor, Op.8, No.4,

R.297 "L'invemo" -

2. Largo
Underwater

Good Ni ght~Sleep
Tight

Marche Funebre,
Lento Excerpt

Adagio for Sleep

Brahms' Lullaby

Meditations for
Dreams,
Relaxation, and
Sleep

Sleep, Little Sarah

Various: Baroque for Beauty Sleep - Sweet
Dreams for Beautiful Dreamers

Sleep Mom, Dad & Baby

One Heart: Healing Native and Classical Flute
Melodies for Stress Reduction, Relaxation,
Meditation

Classical Music For Sleep

Liquid Mind VIII: Sleep

Sleep Soundly

The Velocity Of Love

Lullabies and Butterﬂies

Maria Graf

Music For Sleep
& Relaxation
Maria Kostelas

Dr. Jeffrey
Thompson

Liquid Mind
Steven Halpem

Suzanne Ciani

Gordon Gibson

 

Procedure

This study had a pretest and a posttest with one control group and two experimental

groups. Thirty-three participants were randomly assigned to each group (two participants

dropped out of the study). The investigator instructed both treatment groups to ensure a

standard procedure for music therapy treatment. The investigator came to a participant’s

residence to implement the standard protocol at the ﬁrst treatment session. The
instructions for using music to fall asleep were as follows: First, participants were asked
to lie in bed as usual in their residence with a comfortable room temperature, wearing
comfortable pajamas or their customary bedclothes. Whether the light was turned off or
left on dim depended on the participant’s custom. Second, the investigator played the CD
with participant-selected or experimenter-chosen pieces at a comfortable loudness level.
Participants could choose whether to use earphones. Third, participants were asked to
close their eyes and lie in a comfortable position. Lastly, the investigator asked
participants to open their eyes and told them to listen to 45-minute selection music to fall
asleep every night within these three weeks. They were told to just let the music continue
if they fell asleep. If participants did not fall asleep within 45 minutes, they could replay
the music again. Participants in the treatment groups were asked to do so for three
consecutive weeks. Since participants in the control group were told to observe their
sleep patterns for three weeks, the investigator did not give the standardized instruction to
them. After three weeks, participants in the control group received a sedative music CD,
which was designed to be helpful to their sleep quality. All participants were told this
before the pretest to avoid John Henry Effect.l During the three-week intervention, the
researcher checked each participant’s situation and progress by phone weekly. All

participants were asked to ﬁll out the PSQI before and after the three-week period.

 

l A tendency for members of the control group in certain experiments to adopt a
competitive attitude towards the experimental group, thereby negating their status as
controls. (A Dictionary of Psychology, 2001)

20

Measurement

The Pittsburgh Sleep Quality Index (PSQI) (Buysse, Reynolds III, Monk, Berman, &
Kupfer, 1989) was used to measure participants’ sleep quality for the pretest and posttest.
PSQI is an effective instrument for measuring the quality and patterns of sleep in older
adults (Smyth, 2003). According to Buysse et a1 (1989), PSQI provides a valid and
standardized measure of sleep quality and offers an index that is easy for participants to
use and researchers to interpret. PSQI is composed of seven components of sleep quality:
perceived Sleep quality, sleep latency, sleep duration, sleep disturbance, use of
medication, daytime dysfunction. Scoring of answers was mostly based on a four-point
(0-3) scale. The score range for PSQI is from O to 21.The higher the score, the more
negative it shows on the Likert Scale, and the worse the quality of sleep. According to
Buysse et al, a global score of ﬁve points or above indicates that the client has poor sleep
quality.

The PSQI can be used for both an initial assessment and ongoing comparative
measurements with Older adults across all health care settings (Smyth, 2003). Its
reliability coefﬁcient for all seven components is .83 (Cronbach’s alpha), which indicates
that PSQI has a high degree of internal consistency. A signiﬁcant relationship between
the global score and scores from each of the seven components has been established. The
original version of PSQI is a self-report questionnaire that indicates any sleep
disturbances over the last month. To ﬁt the purpose of this study, a modiﬁed version of
PSQI was used changing the instructions to “over the past three weeks”

The deﬁnitions of the components Of sleep quality in this study are as follows: (1)

Sleep latency is deﬁned as the time from when the person ﬁrst tries to fall sleep to the

21

actual onset of sleep, and it shows number of minutes needed to fall asleep and number of
times during the previous three weeks the person had difﬁculty falling asleep. (2) Sleep
duration is deﬁned as actual time a person is sleeping, and it shows number of sleep
hours per night. (3) Perceived sleep quality is deﬁned as the perception a person holds
about his or her sleep, and it is measured by asking a person to rate his or her sleep
quality over the last three weeks on a 4-point scale. (4) Sleep efﬁciency is deﬁned as the
ratio of total sleeping time to total nocturnal time in bed. It is measured by number of
hours in sleep divided by the number of hours a person spends in bed, and then multiplied
by 100 to be expressed as a percentage. (5) Sleep disturbance is deﬁned as when a person
has difﬁculty falling asleep and awaking earlier or later than desired. It is measured by
adding the sum of the nine different ways of awakenings on a 4-point scale (6) Use of
sleep medication is deﬁned as the use of pharmacological help for Sleep. It is measured
by asking a person about how often he or she has taken medicine to help sleep and asking
to rate the frequency of using sleep medicine on a 4-point scale. (7) Daytime dysfunction
is deﬁned as a person who does not feel well rested during the day. It is measured by
adding the score of the frequency the person stays awake to the score on how much of a
problem it is to keep enthusiasm during the daytime (Buysse et al., 1989; Lai, 2001; Tan,

2004)

22

CHAPTER IV

RESULTS

Subjective sleep quality was the dependent variable of this study and was measured
using the PSQI. Data were entered into SPSS-WINDOWS software version 15.0. Global
PSQI mean scores at the pretest and posttest between the control and two experimental
groups are shown in the Figure 1. To assure equality of the three groups, the pretest
scores Of the PSQI were examined by using One-Way ANOVA. The result showed that
there were no differences among the pretests Of these three groups, F (2, 28) = 0.007, p=
0.993. In other words, at the beginning of the study the three comparison groups were

essentially equal.

Figurel. Global PSQI mean score between groups

 

 

 

M
8.5
\\ "9" control
8
\\ + experiment
7. 5 er-selected
\\ + participant-
7 \\ selected
6.5

pretest posttest

 

 

 

 

 

PSQI Mean Score

 

 

 

 

 

The ﬁrst research question sought to determine if there was a difference in sleep
quality between older people who received their chosen music at bedtime and those who
received experimenter-chosen music at bedtime each night for three weeks. The global
PSQI mean scores and standard deviations for participant-selected music and
experimenter-selected music group are shown in Table 3 and Table 4. The higher the
score, the poorer the sleep quality is. Both participant-selected and experimenter-selected
group had high mean pretest scores (over 5), which indicates poor sleep quality overall.
However, the mean score in both groups at posttest are lower. The global PSQI change
score was calculated by subtracting the pretest from the posttest. An independent-
Samples t-test with these change score revealed that there was no signiﬁcant difference
between the two experimental groups, t(18)=-0.088, p=0.931. In other words, there was
no difference in improvement of sleep quality between older people who received their
chosen music at bedtime for three weeks and those who received experimenter-chosen
music at bedtime. At that point, the two experimental music groups were collapsed. into

one music condition for later comparisons with the non-music control group.

 

 

 

TABLE 3
Mean and Standard Deviations for Global PSQI Scores in Experimental Groups
Std. Error
Group Mean N Std. Deviation Mean
Experimenter- pretest
selected 8.6667 9 4.50000 1.50000
P05tle$t 6. 7778 9 4.68449 1 .56150
Participant- pretest
selected 8.4545 11 4.32120 1.30289
posttest 6.4545 1 1 3.53167 1 .06484

 

 

 

 

 

 

 

24

TABLE 4
Mean Change scores for Global PSQI Scores in Experimental Groups

 

 

 

 

Std. Error
group N Mean Std. Deviation Mean
change Expenmenter- 9 _21111 225073 ,75359
selected
Parl'c'Pan" 1 1 .2.0000 3.16228 .95346
selected

 

 

 

 

 

 

The second research question of this study addressed a comparison of the effect of the
music on sleep quality of older people between those who received music at bedtime each
night for three weeks and those who did not receive music. The global PSQI mean scores
and standard deviations for music and non-music groups are shown in Table 5. An
Independent-Samples t-test was used with the change scores. According to Levene's Test
for equality of variances, equal variances could not be assumed, so a statistical correction
was made to account for the fact that the variances could not be assumed to be equal. The
result indicated that there was a statistically signiﬁcant difference between the music and
non-music groups, t(28.254)=2.753, p=0.01. Older people who received music at bedtime
for three consecutive weeks improved their sleep quality signiﬁcantly more than older
people who did not receive any music. As for the seven sleep quality components,
Independent-Samples t-tests with change scores were calculated. According to Levene's
Test for equality of variances, equal variances could not assumed for the change scores of
perceived sleep quality, sleep latency, sleep disturbance, and daytime dysfunction. Again,
a statistical correction was made. The results showed that only sleep disturbance and

daytime dysfunction attained a signiﬁcant difference. These are displayed in Table 6.

25

TABLE 5
Mean and Standard Deviations for Global PSQI Scores in Music and Non-music Groups

 

 

 

Std. Error

N Mean Std. Deviation Mean
pretest Non-music 11 8.6364 4.43334 1.33670
music 20 8.5500 4.28553 .95827
505“” N°“'"‘“S'° 11 8.5455 4.15605 1.25310
music 20 6.6000 3.97889 .88971

 

 

 

 

 

 

 

TABLE 6
Sleep quality components (change scores) in Music and Non-music Groups

 

t df Sig. (2-tai1ed) Mean Difference

 

Perceived sleep quality -1.128 28.917 0.269 025
Sleep latency -0.755 26.085 0.457 -0. 15909
Sleep duration 1.296 29 0.205 0.231818
Sleep efficiency —0.890 29 0.381 -O.25909
Sleep disturbance -3.099 28.491 0.004 044091
Use Of sleep medication -1.688 29 0.102 -0.29091
Daytime dysfunction -2.599 28.889 0.015 -0.69091

 

In summary, an Independent-Samples t-test with change scores in both experimental
groups indicated that there was no signiﬁcant difference between participant-selected and
experimenter-selected groups. An Independent-Samples t-test was also used with the
change scores in music and non-music groups. The result indicated that there was a
signiﬁcant difference between the music and non-music groups. Moreover, among the
seven sleep quality components, only sleep disturbance and daytime dysfunction showed

a statistically signiﬁcant difference between the music and non-music groups.

26

CHAPTER V

DISCCUSSION AND CONCLUSIONS

The purpose of this study was to examine the effect of music on sleep quality of
people over sixty. A difference between music and nonmusic groups was found using the
PSQI. , which means that people who received music at bedtime for three consecutive
weeks improved global sleep quality compared to people who did not receive music. This
outcome is consistent with previous research (Lai, 2001, Eugenia, 2005, Lasswell, 2001;
Tan, 2004; Zimmerman, Nieveen, Bamason, & Schamdered, 1996), which all showed
that music has a positive effect on enhancing sleep quality. This ﬁnding also corresponds
to previous studies with older people (Johnson, 2003; Lai, 2001; Momhinweg &
Voignnier, 1995), which suggests that older people receiving music have better sleep.
Music also resulted in signiﬁcantly less sleep disturbance and less daytime dysfunction,
as indicated by PSQI scores. Even though Lai’s research (2001) indicated signiﬁcantly
better perceived sleep quality, sleep latency, sleep efﬁciency, and daytime function, but
not less sleep disturbance, future research is encouraged to continue exploring the
components of sleep quality and their relationship to music-assisted sleep.

Concerning the research question whether there is a difference in sleep quality of
Older people between those who receive their preferred music at bedtime and those who
receive experimenter-chosen music, although the sedative music chosen by the
experimenter from the albums is especially marketed for sleep and relaxation, the current
study found that there is no difference in sleep quality between the use of therapist-

selected and participant-selected music. It should be noted that the music marketed for

27

sleep and relaxation was no more effective than music that was chosen by the participants
according to their preferences. This ﬁnding is similar to that of Thaut and Davis’s study
(1993) in which both subject-selected music and experimenter-chosen music induced
signiﬁcant relaxation. In this case, commercial music produced to induce relaxation was
no more effective than music selected by the participants as preferred music.

It is worthy to mention that all participants in the participant-selected group preferred
slow, quiet, melodic music which were also qualities of the sedative music chosen by the
experimenter. Two participants in the experimenter-chosen group addressed their
discomfort about the properties of the music after intervention, while none of the
participants in participant-selected group complained about it. And while the two music
groups did not differ in outcome, this lends support to the idea that it may be that it is the

properties of the music that is the primary factor for better sleep.

Suggestions

As Figure 1. shows(on page 23), it illustrates an increasing distance between the
music groups and the no music control, suggesting the possibility that a period of time
longer than three weeks may yield a better improvement in sleep patterns. Although
researchers report consistency between subjective and objective estimates of sleep (Morin
et al. 1993; Kramer et a1. 1999), there is one study that does not support this claim. In
Lazic and Ogilvie (2006), participants tended to think that the music helped them fall
asleep faster, but the opposite tendency was observed from the polysomnography
measures. Three studies using polysomnography measures did not ﬁnd signiﬁcant effects

of music on improving sleep quality (Gitanjali, 1998; Sanchez & Bootzin, 1985; Lazic &

28

Ogilvie, 2006). Therefore, it is recommended that physiological measurement, such as
polysomnography, wrist-acti-graph, and non-invasive thermistor, should be combined
with psychological tests in the improvement of sleep quality.

As mentioned before, all Older people in the participant-selected group preferred
slow, quiet, melodic music which were also qualities of the sedative music chosen by the
experimenter. This lends support to the idea that it may be the properties of the music that
is the primary factor for better sleep. However, the population of this study is older
people over sixty. This notion may not generalize to other age groups. Future research is
recommended to examine the difference between participant-selected and researcher-
selected music on sleep quality of different age groups.

In summary, receiving music at bedtime for three consecutive weeks for people over
sixty signiﬁcantly improved global sleep quality. Moreover, there was no difference
between the sleep quality of those who received experimenter-selected music and those
who received participant-selected music. Both participant-selected and subject-selected
music appeared to improve global sleep quality, while no improvement was found
without the music.

With the above in mind the effectiveness of sedative music used to improve sleep
quality would suggest that nursing homes and extended care facilities would be wise to
use music to improve their residents’ quality of sleep. Likewise, music therapists and
nurses are encouraged to use this cost-effective, non-pharmacological intervention to help
older people living either in nursing homes or their own homes improve their sleep

quality.

29

APPENDICES

30

APPENDIX A

INITIAL IRB APPLICATION APPROVAL

31

 

‘ I I
‘ ‘ . ’ ".11 l'.
.1 . .irr

 

 

.1;
"f' 80

OFFICE OF
REGULATORY
AFFAIRS

Human Research
Protection Programs

 

 

 

 

 

 

 

 

 

BIOMEDICAL & HEALTH
INSTITUTIONAL REVIEW
BOARD (BIRBI

COMMUNITY RESEARCH
INSTITUTIONAL REVIEW
BOARD (CRIRB)

SOCIAL SCIENCE!
;EHAVIORAL l EDUCATION
INSTITUTIONAL REVIEW
BOARD (SIRB)

202 Olds Hal.

East Lansing M cnigan
45:24-1046
517-355-2130

Fax 5174324503

.‘M.’ nJinanresearchmsuedu
1F.B@msu.edu

- \ I «L
7 ' run 1.
‘ \xl l-:l’l" ,

1! “r ,3 '1': .‘(lfll‘ﬂlnﬂ'l'v’f'llcllt'h

u, 4.41' opp-,1 . witty Hutu'ulimi

MICHIGAN STATE Initial IRB

 

U N I \r E R S I T Y Application
February 1. 2008 Approval
TO: Frederick TIMS

School Of Music
201 Music Practice Building

Re' IRB# 07-1064 Category: EXPEDITED 7
Approval Date: February 1, 2008
Expiration Date: January 31, 2009

Title: The Influence of Participant-Selected versus Experimenter-Chosen Music on Sleep Quality of People
over 60 Years Of Age

The Institutional Review Board has completed their review Of your project. I am pleased to advrse you that your
project has been approved.

The committee has found that your research project is appropriate in design, protects the rights and welfare of
human subjects. and meets the requirements Of MSU'S Federal Wide Assurance and the Federal Guidelines (45
CFR 46 and 21 CFR Part 50). The protection of human subjects in research is a partnership between the IRB
and the investigators. We look forward to working with you as we both fulfill our responsibilities

Renewals: IRB approval is valid until the expiration date listed above. If you are continuing your project. you
must submit an Application for Renewal application at least one month before expiration If the project is
completed. please submit an Application for Permanent Closure.

Revisions: The IRB must review any changes in the project, prior to initiation of the change. Please submit an
Application for Revision to have your changes reviewed. If changes are made at the time Of renewal, please
include an Application for Revision with the renewal application.

Problems: lf issues should arise during the conduct of the research. such as unanticipated problems, adverse
events. or any problem that may increase the risk to the human subjects, notify the IRB Office promptly. Forms
are available to report these issues.

Please use the IRB number listed above on any forms submitted which relate to this project. or on any
correspondence with the IRB office.

Good luck in your research. If we can be Of further assistance, please contact us at 517-355-2180 or via email
at lRBchmsu edu. Thank you for your cooperation.

Sincerely.

ﬂuoéz

Peter Vasilenko. PhD.
SIRB Chair

6: Po-Ju Chen

4912 S. Hagadorn Rd, Apt.No.35
East Lansing. MI 48823

32

APPENDIX B

CONSENT FORM

33

CONSENT FORM
Project Title: The Influence Of ParticipantvSelected versus Experimenter-Chosen

Music on Sleep Quality of People over 60 Years of Age.

You are being asked to participate in a research project called “The Influence
of Participant-Selected versus Experimenter-Chosen Music on Sleep Quality of
People over 60 Years of Age” to examine the effect of music exposure on
promoting sleep quality over a three-week period with peOple who are between 60
and 85 years old. You will either receive your selected music or music selected

by the research to listen to at bed time, or have no music to fall asleep to.

Your participation is voluntary. As a participant, you will be asked to listen
to a 45 minute selection of music at bed time, unless you are in the group who
receives no music. You will be asked to do so for three consecutive weeks.
During these three weeks, you will also have one session with the music therapist.
You will be asked to ﬁll out a standard questionnaire on your quality of sleep at the
beginning and end of this three week period. There are no known serious risks
associated with participation in this study. If at any point you feel tired or
uncomfortable during your bedtime because Of the music, you can stop

participating at any time.

Your results will be kept conﬁdential to the maximum extent allowed by the
law. To protect against a breach of conﬁdentiality, your responses will be
identiﬁed by number rather than name and no names will be used in any report of
the research ﬁndings. Your responses will be entered in a spreadsheet, and the
originals will be shredded upon the completion of the research. All results will be

This consent form was approved by the Social Science/Behavioral/Education Institutional Review Board

(SIRB) at Michigan State University. Approved 2/1/08— valid through 1/31/09.
This version supersedes all previous versions. IRB # 07-1064.

34

treated in strict confidence and you will remain anonymous in any report of
research ﬁndings. You are offered a CD as a token of appreciation you’re your
participation. If you stop participating at any time during the intervention, you
will still get the music CD. If you wish, information about the ﬁndings will be
made available to you.

If you have any questions or concerns about this research project, please feel
free to contact the investigators at the following location:
Frederick Tims, Ph.D., MT-BC.
College of Music , Michigan State University
East Lansing, MI 48824-1043, USA.
Phone: (517) 353-9856, Email: tims@msu.edu

 

PO-Ju Chen, MT-BC.
Phone: (517) 305-6936, Email: chenpojl@msu.edu

If you have questions or concerns regarding your rights as a study participant,
or are dissatisﬁed at any time with any aspect of this study, you may contact
anonymously, if you wish :

Peter Vasilenko, Ph.D.

Director of Michigan State University’s Human Research Protection Program
202 Olds Hall, East Lansing, MI 48824, USA.

Phone: (517) 355-2180, Fax: (517) 432-4503, E-mail:irb@msu.edu

 

Signature
Date:

 

Thank you for your participation. Your signature below indicates your

voluntary agreement to participate in this study.

This consent form was approved by the Social Science/Behavioral/Education Institutional Review Board
(SIRB) at Michigan State University. Approved 2/1/08— valid through 1/31/09.
This version supersedes all previous versions. IRB # 07-1064.

35

APPENDIX C

RECRUITMENT LETTER

36

MICHIGAN STATE

U N l V E R S l T Y
Dear Residents,

 

Hello! My name is Po-Ju Chen. I am a music therapy student at Michigan
State University. I also work part time as a music therapist in Burcham Hills
Retirement Community. I am conducting a research about examining the
effect of music on Sleep quality of Older adults. Your participation may
contribute to the understanding Of the beneﬁts of music therapy on sleep
quality of seniors. Your participation is voluntary. As a participant, you
will be asked to listen to a 15 to 45 minute selection of music at bed time,
unless you are in the group who receives no music. You will be asked to do
so for three consecutive weeks. You will be asked to ﬁll out a questionnaire
on your quality of sleep at the beginning and end of this three week period.
There are no known serious risks associated with participation in this study.
Your results will be kept conﬁdential to the maximum extent allowed by the

law. You are offered a CD as appreciation for participating in this research.

.LWT] If you are interested in knowing more or participating in this study, please

\\

join us in an information session or contact me directly at (517) 305-6936

The information session will be held on:

 

What: The effect of music on sleep of the elderly
When: Wednesday, February 6, 2008, from 3:00 — 4:00 pm

COLLEGE OF Place: Burcham Hills ~ Ada Whitehouse Room

MUSIC

1USiC We will have some music and refreshments during this informational session.
Therapy
Area Thank you very much!
Michigan State University PO-Ju Chen., MT-BC.

201 Music Practice Bldg.
East Lansing, MI
48824-1043
517/353-9856

FAX: 517/4320811

httpllwwwmuslcmsuedu

37

REFERENCES

Aldridge, D. (1994). An overview Of music therapy research. Complementary Therapies
in Medicine, 2, 204-216.

Ancoli-Israel, S. (2004, January). Sleep disorders in older adults: A primary care guide to
assessing four common sleep problems in geriatric patients. Geriatrics, 59, No.1,
38-40.

Andrewm, C. (2001) A dictionary of psychology. Oxford, Eng: Oxford University Press.

Ashton, H. (1994). Guidelines for the rational use of benzodiazepines: When and what to
use. Drugs, 48, 25-40.

Bliwise, D. L. (1989). Normal aging. In M. H. Kryger, T. Roth, & W. C. Dement (Eds),
Principles and practice of sleep medicine (pp.24-29). Philadelphia, PA: W.B.
Saunders.

Buysee, D. J., Reynolds, III, C. R, Monk, T. H., Herman, S. R., & Kupfer, D. J. (1989).
The Pittsburgh Sleep Quality Index: A new instrument for psychiatric practice and
research. Psychiatry Research, 28, 193-213.

Buysse, D. J. (2004, February). Insomnia, depression, and aging: assessing sleep and
mood interactions in older adults. Geriatrics, 5 9, 47-51.

Espie, CA. (1991) The psychological treatment of insomnia. Chichester: John
Wiley & Sons Ltd.

Davis, W. B., & Thaut, M. H. (1989). The inﬂuence of preferred relaxing music on
measures Of state anxiety, relaxation, and physiological responses. Journal of Music
Therapy, 26, 168-187

Field, T. (1999). Music enhances sleep in preschool children. Early Child Development
and Care, 150, 65-68.

Gaston, E. T. (1951). Dynamic music factors in mood change. Music Educators Journal,
3 7, 42-44.

Gaston, E. T. (1968). Man and music. In E. T. Gaston, Music in therapy (pp. 7-29). New
York: Macmillan.

Gerra, G., Zaimoric, A., F ranchini, D., Palladino, M., Giucastro, G., Reali, N., Maestri,
D., Caccavari, R., Delsignore, R., & Brambilla, F. (1998). Beuroendocrine responses
of healthy volunteers to “techono-music”: Relationships with personality traits and
emotional state. International Journal of Psychophysiology, 28, 99-111.

38

Gislason, T., Reynisdottir, H., Kristbjarnarson, H., & Benediktsdottir, B. (1993). Sleep
habits and sleep disturbances among the elderly: An epidemiological survey.
Journal of Internal Medicine, 234(1), 31-39.

Gitanjali, B. (1998). Effect of the Karnatic music raga "Neelambari" on sleep
architecture. Indian Journal of Physiology and Pharmacology, 42, 1 19-122.

Hanser, S. B. (1990). A music therapy strategy for depressed Older adults in the
community. Journal of Applied Gerontology, 9, 283-298.

Hayter, J. (1983). Sleep behaviors Of older persons. Nursing Research, 32, 242-246.

Hemandez-Ruiz, E. (2005). Effect of Music Therapy on the Anxiety Levels and Sleep
Patterns of Abused Women in Shelters. Journal of Music Therapy, 42(2), 140-158.

Herscovitch, J ., & Broughton, R. (1981). Sensitivity of the stanford sleepiness scale to

the effects of cumulative partial sleep deprivation and recovery oversleeping. Sleep,
4(1), 83-91.

Hoch, C. C., & Reynolds, C. F. 111. (1986). Sleep disturbances and what to do about
them. Geriatric Nursing, 7(1), 24-27.

Irwin, M., Thompson, J., Miller, C., Gillin.J. C., & Ziegler, M. (1999). Effects of sleep
and sleep deprivation on catecholamine and interleukin-2 levels in humans: Clinical
implications. Journal of Clinical Endocrinology and Metabolism, 84(6), 1979-1985.

Iwaki, T., Tanaka, H., & Hori, T. (2003). The effects of preferred familiar music on
falling asleep. Journal of Music Therapy, 40(1), 15-26.

Johnson, J. E. (2003). The use of music to promote sleep in older women. Journal of
Community Health Nursing, 20(1), 27-35.

Kartman, LL. (1984). Music hath charms. Journal of Gerontological Nursing, 10(6), 20-
24.

Lai, H. L. (2001). The effects of music therapy on sleep quality in elderly people.
Unpublished doctoral dissertation, Case Western Reserve University, Cleveland.

Lasswell, A. (2001). The effects of music assisted relaxation on the relaxation, sleep
quality, and daytime sleepiness of sheltered, abused women. Unpublished master’s
thesis, Florida State University, Tallahassee, USA.

Lazic, S. E., & Ogilvie, R. D. (2006). Lack of efﬁcacy of music to improve sleep: A

polysomnographic and quantitative EEG analysis. International Journal of
Psychophysiology, 63(3), 232-239.

39

Levin, Y. I. (1998). Brain music" in the treatment of patients with insomnia.
Neuroscience & Behavioral Physiology, 28(3), 330-335.

Lindenmuth, G. F ., Patel, M., & Chang, P. K. (1992). Effects of music on sleep in healthy
elderly and subjects with senile dementia Of the Alzheimer type. American Journal of
Alzheimer ’8 Care and Related Disorders & Research, 7(2), 13-20.

Logan, T. G., & Roberts, A. R. (1984). The effects of different types of relaxation music
on tension level. Journal of Music Therapy, 21, 177-183.

Middlekoop, H. A., Smilde-van den Doel, D. A., Neven, A. K., Kamphuisen, H. A., &
Springer, C. P. (1996). Subjective sleep characteristics of 1485 males and females

aged 50-93: Effects of sex and age, and factors related to self-evaluated quality of
sleep. Journal of Gerontology, 51(3), M108-115.

Mockel, M., Rocker, L., Stock. T., Vollert, J ., Danne, O., Eichstadt, H., et al. (1994).
Immediate physiological responses of healthy volunteers to different types of
music: Cardiovascular, hormonal and mental changes. European Journal of Applied

Miles L. E., & Dement, W. C. (1980). Sleep and aging. Sleep, 3, 119-220.
Physiology and Occupational Physiology, 68(6), 451-459.

Morin, C. M., Gualier, 8., Barry, T., & Kowatch, R. A. (1992). Patients’ acceptance of
psychological and pharmacological therapies for insomnia. Sleep, 15, 302-305.

Morin, C. M. (1993). Insomnia: Psychological assessment and management. New York:
The Guilford Press.

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

Prinsley, D. (1986). Music therapy in geriatric care. Australian Nurses Journal, 15(9),
48-49.

Prinz, P. N., Halter, J ., Benedetti, C., & Raskind, M. (1979). Circadian variation of
plasma catechnolamines in young and old men: Relation to rapid eye movement and
slow wave sleep. Journal of Clinical Endocrinology and Metabolism, 49, 300-304.

Prinz, P. N., Vitiello, M. V., Raskind, M. A., & Thorpy, M. J. (1990). Geriatrics: Sleep
disorders and aging. New England Journal of Medicine, 323, 520-526.
Biological Psychiatry, 20, 431-42.

Ray, W. A., Grifﬁn, M. R., & Downey, W. (1989). Benzodiazepines of long and short

elimination half-life and the risk of hip fracture. Journal of the American Medical
Association, 262, 3303-3307.

40

Ray, W. A., Fought, R.L., & Decker, M. D. (1992). Psychoactive drugs and the risk of
injurious motor vehicle crashes in the elderly drivers. American Journal of the
Epidemiology, 136, 873-883.

Reynolds, C. F., Kupfer, D. J ., Taska, L. S., Hoch, C. C., Spiker, D. G., Sewitch, D. E., et
a1. (1985). EEG sleep in elderly depressed, demented, and healthy subjects.

Ringdahl, E. N., Pereira, S. L., & Delzell, J. E. (2004). Treatment of Primary Insomnia.
The Journal of the American Board of Family Practice, 17, 212-219.

Roehrs, T., Zorick, F., & Roth, T. (1994) Transient and short-term insomnia. In M.H.
Kryger, T. Roth, W. C. Dement, (ed.), Principles and practice of sleep medicine. (2nd
ed.) pp. 486-493, Philadelphia: W. B.

Rohner, S. J ., & Miller, R. (1980). Degrees of familiar and affective music and their
effects on state anxiety. Journal of Music Therapy, 17, 2-15.

Ross, J. S., & Shua-Haim, J. R. (2000, February). Daytime sleepiness may increase Older
patients’ risk of death. Journal of the American Geriatrics, 55(4), 22.

Rutter, S., & Waring-Paynter, K. (1992). Prebedtime activity and sleep satisfaction of
short and long sleepers. Perceptual and motor skills, 75, 122.

Sanchez, R., & Bootzin, R. R. (1985). A comparison of white noise and music: Effects of
predictable and unpredictable sounds on sleep. Sleep Research, 14, 121.

Schneider, D. L. (2002, May). Insomnia: Safe and effective therapy for sleep problems in
the older patient. Geriatrics, 5 7, No.5, 24-35.

Smyth, C. (2003). The Pittsburgh Sleep Quality Index. Dermatology Nursing, 15(2), 195-
196.

Steelman, V. M. (1990). Intraoperative music therapy: Effects on anxiety, blood pressure.
AORN Journal, 52(5), 1026-1034.

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.

Thaut, M. H., & Davis, W. B. (1993). The inﬂuence of subject-selected versus
experimenter-chosen music on affect, anxiety, and relaxation. Journal of Music

Therapy, 30(4), 210-223.

Uplike, P. A. (1990). Music therapy results for ICU patients. Dimensions of Critical Care
Nursing, 9(1), 39-45.

41

Walsh, J. K., Hartman, P. G., & Kowall, J. P. (1994). Insomia. In s. Chokronerty (Ed.),
Sleep disorders medicine: Basic science, technical considerations, and clinical
aspects (pp.219-239). Boston, MA: Butterworth-Heinemann.

Wang, Y. W. (1997). Effect of acupressure on the sleep disturbance of Taiwanese
elderly. Unpublished doctoral dissertation, Case Western Reserve University,
Cleveland.

Watkins, G. R. (1997). Music therapy: Proposed physiological mechanisms and clinical
implication. Clinical Nurse Specialist, 11, 43-50.

White, J. M. (1992). Music therapy: An intervention to reduce anxiety in the myocardial
infarction patient. Clinical Nurse Specialist, 6(2), 58-63.

Wilson, S. & Nutt, D. (2007). Treatment of insomnia. Psychiatry, 6(7), 301-304.

Zepelin, H. (1983). A life span perspective on sleep. In A. Mayes, Sleep mechanisms and
functions in humans and animals —An evolutionary perspective (pp. 126-160). New
York: Van Nostrand Reinhold.

Zimmerman, L., Nieveen, J ., Barnasan, S., & Schamderer, M. (1996). The effects of

music interventions on postoperative pain and sleep in coronary artery bypass graft
(CABG) patients. Scholarly Inquiry for Nursing Practice, 10(2), 153-174.

42