235. Music platform sleep playlists on insomnia improvement in patients with anxiety disorders

Abstract Background Insomnia is a common comorbidity in anxiety disorders, worsening daytime function. Digital health interventions, particularly audio-based content on streaming platforms, are gaining attention for their accessibility. "Sleep playlists" on music platforms, often featuring ambient music and nature soundscapes, may theoretically promote relaxation by modulating autonomic activity. However, controlled studies systematically evaluating the effects of standardized sleep playlists on insomnia symptoms in anxiety patients are lacking. This study investigated the efficacy of a 4-week nighttime listening intervention using a mainstream music platform's standardized sleep playlist, targeting sleep quality and anxiety symptoms in patients with comorbid insomnia and anxiety. Methods This was a two-arm, parallel-group randomized controlled trial. Eighty-six anxiety patients with Pittsburgh Sleep Quality Index (PSQI) scores >7 were enrolled and randomized to a playlist intervention group (n = 43) or a wait-list control group (n = 43). Both continued existing treatments. The intervention group was instructed to listen to a designated sleep playlist on a specified music platform (e. g., NetEase Cloud Music "Deep Sleep" official playlist) for at least 30 minutes before bedtime nightly for 4 weeks. The playlist contained slow-tempo instrumental and linear synth pads. The control group received no directed audio intervention. The primary outcome was change in PSQI total score. Secondary outcomes included the Insomnia Severity Index (ISI), the Self-rating Anxiety Scale (SAS), and adherence (based on platform backend data). All scales were administered at baseline (T0) and post-intervention (T1). Data were analyzed using Analysis of Covariance (ANCOVA) in SPSS 23. 0, controlling for baseline scores. Results ANCOVA revealed that, after adjusting for baseline scores, the intervention group had a significantly lower adjusted mean PSQI score at T1 (9.2) than the control group (12.5), with a statistically significant between-group difference (F = 18.34, p<.001). The reduction in ISI scores was also significantly greater in the intervention group (p<.01). For anxiety symptoms, the intervention group showed a greater reduction in adjusted mean SAS scores (48.6) compared to the control group (52.1) (p<.05). Adherence data showed a mean weekly compliance rate of 78.4% in the intervention group. Follow-up feedback from a subset (n = 20) highlighted three core experiential themes: "Attentional Anchoring Effect" (85% reported music diverted thoughts from anxiety), "Environmental Masking and Safety" (80% felt sound masked nighttime noises, creating safety), and "Sleep Ritual Establishment" (75% stated regular listening became a sleep cue). Discussion A 4-week standardized sleep playlist intervention significantly improved sleep quality and partially alleviated anxiety in patients with comorbid insomnia and anxiety. Potential mechanisms may include establishing a conditioned relaxation response through regular auditory stimuli, providing non-pharmacological sensory shielding, and serving as a low-cognitive-load distractor. These findings support using readily accessible digital audio resources as a feasible adjunct tool for improving sleep within comprehensive anxiety management. Clinicians may consider "prescribing" such interventions as part of behavioral therapy. Future research should compare personalized versus standardized playlists, examine the effects of specific musical elements, and evaluate long-term utility in relapse prevention.