Disclaimer: This is transcribed using AI. Expect (funny) errors.
Mindy Peterson: [00:00:00] I’m Mindy Peterson, and this is Enhance Life with Music, where we explore the ways music makes our lives better and spotlight the resources you can use to enhance your life with music. Today, we’re talking about a topic that hits close to home for me, which I’ll explain in a minute. We’re talking about sleep and how music can be used as an intervention for sleep disturbances, especially for older adults and those with dementia. Joining me today from Durham, North Carolina, is Dr. Darina Petrovsky, Assistant Professor at Duke University School of Nursing. Doctor Petrovsky’s research and teaching focuses on the intersection of music and dementia. Her work has been funded by the NIH and featured by the NIA. A fellow pianist, Doctor Petrovsky studied piano performance as an undergrad at University of Michigan and then completed her master’s and doctorate in nursing. She has completed two postdoctoral fellowships at New York University and University of Pennsylvania. Doctor Petrovsky’s background in music training and nursing science uniquely informs her research and goal of improving the lives of older adults living with cognitive impairment using nonpharmacologic approaches. Welcome to enhance life with music, darina.
Darina Petrovsky: [00:01:24] Great. Thank you for having me.
Mindy Peterson: [00:01:26] It’s great to have you; looking forward to this. I mentioned in my introduction that this topic hits close to home for me, and I do have special empathy for people who deal with sleep issues because I have severe insomnia for several years, about ten years ago, fortunately, I was able to eventually find a doctor who was able to figure things out for me, but I can personally vouch for the fact that sleep disturbances are incredibly disturbing. Mhm. Very common for older adults and those living with Alzheimer’s or other forms of dementia. I felt like I had Alzheimer’s during that time period of insomnia and so I can easily imagine how sleep issues compound and exacerbate the symptoms of people who do have a diagnosis and diminish their cognitive function exponentially, and their quality of life. And in addition to impacting their quality of life and just their general sense of well-being, sleep disruption can lead to more time in health care facilities, increased reliance on meds, faster disease progression, and greater susceptibility to other illnesses. And then you have this third party domino effect on their caregivers. When a patient’s sleep is disturbed, the caregivers sleep is disturbed as any parent of young children knows. And that affects their cognitive function and their emotional capacity, their immune system function and their quality of life. And we need to make sure our caregivers are being taken care of. We don’t have enough of them, and they’re often overworked and underpaid and overwhelmed and dealing with burnout. Enter your research. So tell us about your research on this topic of how music can be used to improve sleep for older adults and those living with dementia.
Darina Petrovsky: [00:03:24] Yes. Thank you. Mindy. Um, so my work started. You know, when I entered my PhD, I was really excited to look at the impact or examine the impact of music based interventions on older adults living with dementia, as well as their care partners. And as I was graduating with my PhD, I had, um, I had done some work in this space, but I really wanted to dive into the intervention piece. Right? Like how to actually make an impact. And sleep disturbances are symptoms under the umbrella of neuropsychiatric symptoms or behavioral symptoms in persons living with dementia, as you mentioned, they’re quite frequent and we don’t really have very good solutions. Non-pharmacological as well as pharmacological to treat. Um, sleep. So therefore, uh, an idea came to my mind when I was graduating thinking, okay, well, music has this ability to be culturally tailored to individuals. It has ability to be tailored to be sort of sleep inducing. Um, right. We can change the tempo, we can change the mode and other characteristics. So why can’t we put two and two together and use music and study music and how it can be used to improve sleep in this population? In addition, there has been a lot of advances in how we capture and measure sleep in our lives. Anything from actigraphy Actigraphy, which are more devices to measure sleep in a research setting all the way to wearables, AI watches and Fitbits. So it’s become more it’s become a little easier to measure the impact of sleep in everyday life. So considering all these different things and the fact that at that point, one of my mentors was doing a large clinical trial of a non-pharmacological intervention to improve sleep in those living with dementia. I thought it was a perfect opportunity to capitalize on my personal interest in music and behaviors, sleep and the mentorship of Doctor Nancy Hodgson. So I did that, and I wrote this grant and was in the middle of the start of the pandemic in 2020, and I was shocked that it was, uh, funded on the first try. I never had things funded on the first try before.
Mindy Peterson: [00:05:49] Congratulations.
Darina Petrovsky: [00:05:50] But I think it was this combination and interest from the NIH to study sleep in older adults, which is continuing today, that I was able to kind of bridge these different disciplines together and examine the impact. So that’s how my interests in this area developed.
Mindy Peterson: [00:06:07] Now the common sleep disturbances. Is it typically insomnia and or waking up during the night like trouble falling asleep? Trouble staying asleep. Is that kind of cover it. Or are there other issues too, that I’m not aware of?
Darina Petrovsky: [00:06:20] I would say the most common yes or insomnia symptoms. So it’s inability to fall asleep and stay asleep. In addition, there are also other symptoms that the person may have with different types of dementias. You know, there’s not just one type. Alzheimer’s is the most common type of dementia, but in other types of dementia, for example, there are other symptoms like restless leg syndrome. Um, so it has other, um, features, sort of other phenotypical features. But I would say the most common sleep issues are what you said, an ability to fall asleep and then wake it up in the middle of the night and being unable to go back to sleep. And oftentimes also this sort of reversal of day night. So you can have an individual who is napping too much during the day, which then precludes them from falling asleep or staying asleep. And the cycle sort of repeats itself. So continuous napping and napping too much in the day is another common symptom in older adults.
Mindy Peterson: [00:07:23] Well, and for my time dealing with insomnia, the meds that are available for that, um, the side effects are pretty extreme. I remember when I was dealing with this, I looked at the side effects and was like, uh, no, I don’t think like that. I think the side effects of that are as bad as the side effects from not sleeping. And let’s figure out why I’m not sleeping instead of just putting a band aid over it and allowing the the problem to continue and get worse. So meds are not always a great option. And if there is a non-pharmacological approach that you can use to either mitigate your dependence on meds or eliminate your need for meds, it’s like, why not? So tell us some more about what your research has discovered about what kind of music is conducive to helping people fall asleep, stay asleep and just deal with these sleep issues and disturbances in general.
Darina Petrovsky: [00:08:16] My original study and entry into this area was a randomized clinical trial. It was a feasibility clinical trial in a sample of 33 older adults living with dementia and their caregivers. And that particular study, I started small and and wanted to build off of that. I offered individuals tailored music that had the sleep inducing characteristics, so certain beats per minute absence of vocals. I gave it this music to them on a device that was not originally built to play music. It was able to capture how the individuals used or how often they listened to music. But the interface, unfortunately, was not built for for that. What we found is that individuals really liked the music that I provided to them. They did speak that it helped them fall asleep. So our qualitative findings supported the use. We did not see any movement in objective measures of sleep. However, because of these encouraging qualitative findings, we were able to build off of that study. And now conducting my larger clinical trial in developing the technology to deliver this music targeting sleep. And so we were able to publish the results. I wrote my next grant and used the findings from that clinical trial to inform and sort of pivot towards more technology route and say, okay, well, we know music can be beneficial for sleep.
Darina Petrovsky: [00:09:47] We have music streaming services, but we don’t have something that can deliver this music to individuals remotely and consider individuals preferences in how they want to listen to this music and be developed with taking perspectives of those who will be using it. So I proposed sort of a user centered design approach and first figuring out, okay, well, I think I know what this intervention could look like, but why don’t we ask the individuals themselves first, and those individuals being those living with dementia as well as their caregivers, because sometimes and oftentimes it could be the caregivers that are providing music to the individuals. We took that approach. We’ve done two rounds of qualitative interviews, and now we’re going to take all that knowledge and what they told us they want to see in an app, to actually develop the prototype of the app and then launch it into a larger clinical trial to examine its effect and its feasibility.
Mindy Peterson: [00:10:46] So your first clinical trial that ended in 2020, I know you mentioned that you discovered that music without lyrics or vocalizations seemed to be more conducive for sleep.
Darina Petrovsky: [00:10:58] Yes. And that body of work actually comes from neuroscience. So there are these experiments, mostly done in a lab setting, that looked at what features of music are more conducive to sleep. And what they found is that, yeah, there are certain beats per minute which mimic our heartbeat that do not have vocals, because with vocals comes text meaning, and that could take a person’s attention away from falling asleep to actually be more excited about the music. And there’s also other features as well. And so what we actually found is that while certain beats permitted an absence of vocals, are very relaxing and sleep inducing for some individuals, others really wanted to hear the voice of their favorite artists, so I kind of had to balance between what we know works for sleep induction as opposed to this sort of strong preference. And so what I had done for those individuals is I still used their favorite artist or artists of the time when they were younger, but chose tracks from that album that are more sleep inducing as opposed to the sort of the most favorite hit of that particular album that the person would know or sing to or be excited by. So it was sort of a natural experiment as I was visiting people’s homes and asking them questions about their musical preferences, I found this sort of, you know, people always ask me, what music should we use for sleep? And I think that the preference should always take precedence over the type of music, and being able to combine sleep inducing characteristics with personal preference, I think, is the key to identifying music, especially for those with dementia.
Mindy Peterson: [00:12:46] I do hear that theme a lot that with music interventions there’s not really a one size fits all. I mean, you really have it really is something that works best when it’s tailored to the individual. So that makes sense. What are some other results from that first clinical trial? So you mentioned the tempo and matching the tempo to heart rate. Is there a specific beats per minute that is kind of ideal. Or does it just depend on what the person’s resting heart rate is?
Darina Petrovsky: [00:13:14] I would say it depends on the person’s resting heart rate, which of course can change as as we get older, or it’s much lower in individuals who are more physically fit. Essentially, the main results of that work is that music is a promising tool to affect sleep in older adults, but we need to have more user centered methods to develop this music, taking consideration not just the fact that we’re targeting older adults who may have both visual as well as sensory impairment, but we’re also targeting those who have cognitive impairment, who have memory issues and other symptoms, in addition to sort of. The next layer of complexity is that the caregiver can be quite heavily involved in delivering the music. And when I had originally designed the study, I don’t think I thought too much about how the role of the caregiver in this whole scenario, and I’ve had some caregivers part of that study say, well, I know you’re thinking about my loved one or my family member when you’re thinking about the music, but I could also benefit from some of this music, and it’s not going to be the same music as that person’s listening to. So can you maybe help me out and develop a playlist for me as well? Because I struggle with sleep as well. And so now I’m a lot more cognizant of that. And I think the findings from that original study opened my eyes a little more on the sort of maybe obvious to some people, but less obvious to me because I was so honed in on the on the person with dementia that I forgot that nobody lives in a vacuum. They live within a community and a family in a society. Sure.
Mindy Peterson: [00:14:52] Well, tell us about the second clinical trial that you’re, I think, in the middle of right now. Or are you toward the end of it, where are you in that process?
Darina Petrovsky: [00:15:00] No, I wish it was towards the end of it. I’m about halfway okay, about halfway through a five year study. And so the first two years were spent setting the groundwork, the interviews with caregivers, as well as those living with dementia, helping us identify the prototype features of of the app. So that work we just finished. And now we have identified an app developer in North Carolina who is working with us, who’s worked quite extensively with other Duke researchers, and we came to him and we said, here are things that our participants told us was important in developing the app. And together we are planning to develop originally the sort of the paper prototype, then have a prototype that’s on our phones that’s available in the Apple Store and Android stores, and then we will have a cohort of ten diets for those living with dementia, as well as their caregivers. And we’re going to give them the app for about a week. And we’re going to call them every day unobtrusively and ask them questions about, okay, you’ve used it today. What did you think? What would you change about it? What did you like about it? And then after each week we’re going to make changes after we discuss as a team and make those changes. And then with those changes, give it to the next item and so on and so forth. So we’re sort of making changes as we go along as opposed to waiting. So that’s the next immediate step. And then hopefully in early 2025 we’re going to launch the clinical trial. Because by that point we would have a product that would have been developed with users in mind tested by the users, and then we’ll be scaled up.
Mindy Peterson: [00:16:42] Okay, so the app that you’re developing in this second phase of your research is an app that’s being developed for research use, but also with the end goal of making it available to any consumer. Is that right?
Darina Petrovsky: [00:16:57] Yeah, that’s that’s the million dollar question. Right. So I am at a university and there are individuals within our universities that help researchers and faculty members to think about how to commercialize products that the based on the research that they’ve conducted. So, yes, absolutely. I think as a nurse scientist, I’m very much thinking about, okay, I’m interested in creating this product, but I want it to be available widely. I want it to be an evidence based app that has shown potential to improve somebody’s sleep, and that sleep to be of individual living with dementia. And I think it could also be broadly applicable to other individuals outside of those living with dementia. Given how widespread sleep difficulties are, as you said at the start of the meeting. And so absolutely, I just don’t know yet exactly how that path will pan out. But I think keeping that goal in mind.
Mindy Peterson: [00:17:56] So the second phase of your trial, you and your team, you’re developing and testing a mobile app. I like the the name of it. It’s called Calming Music, personalized for sleep enhancement and persons living with dementia. But that’s been sort of condensed down using select letters to be, uh, somewhat of an acronym composer, not really an acronym. What would you how would you describe it? Yeah, it’s an amalgamation of all of those words.
Darina Petrovsky: [00:18:26] Yes, yes. If you talk to other researchers, especially in the medical world, we love coming up with like study names. Yeah. And study protocols and app names. And that also speaks to sort of this idea of branding, right. Like you’re developing something that has an identity, that has a purpose that then when developed and went out there, people can recognize. So that’s something I wasn’t truly comfortable with and in the beginning. But then I saw, you know, my mentors and others having these amazing caregiver interventions that had acronyms. And so I thought why not? And this is pre ChatGPT. So it took me, you know, a paper and pencil to to come out with that.
Mindy Peterson: [00:19:13] So we have composer. It helps caregivers tailor music to play before bedtime with the goal of a more restful night. And I love how you talk about the recipe for good sleeping music. Um. It includes enjoyable songs from the person’s youth, with a tempo of between 60 and 80 beats per minute. And as you mentioned, that will. That can vary depending on the person’s resting heartbeat. We discussed earlier how music without lyrics is is more conducive to sleep, but also songs that don’t have high pitched tones and fast driving rhythms, something that is lower pitch and maybe a slower rhythm. Is that right?
Darina Petrovsky: [00:19:58] Yes. And part of the other features that we’re discovering it is also how sort of the looks of the app icons and the buttons, things that that you necessarily think when you think about sort of a music player for older adults. So in addition to all the things that have to do with the selection of music is we’re also thinking a lot about how are those music choices presented to individuals in the most simplistic way, and what information do they have at their disposal? If, for example, they forget how to use this new app, what kind of help information should be available to them? So it’s it goes beyond just the music choices, but sort of the interface and all of the things that people think about when they’re developing an app.
Mindy Peterson: [00:20:49] Sure. I feel like this is a really timely topic, and this was confirmed to me just I was looking through the news today and in the New York Times just today. We’re recording this on the 15th of July. There was an article which I can link to in the show notes, but it’s it was titled How Poor Sleep Affects Your Risk of Dementia. And in the article, they said that getting too little sleep later in life is associated with an increased risk for Alzheimer’s. Uh, it was really interesting. They said that sleep acts like a nightly shower for the brain, washing away cellular waste that accumulates during the day. And some of this waste includes the protein. I’m not sure if I’m going to pronounce this right. Amyloid.
Darina Petrovsky: [00:21:32] Amyloid.
Mindy Peterson: [00:21:32] Yeah. Is that how you say it? Okay. And that protein is thought to be a key player in Alzheimer’s disease. Um, we all produce it during the day, but problems can come up when the protein accumulates in sticky clumps that are called plaques. And the longer someone’s awake, the more that can that can build up. So it was really interesting to read this article. And the one of the researchers who was quoted was saying, lack of sleep is probably not sufficient in and of itself to cause dementia, but it’s it’s definitely a risk factor for increasing your risk of dementia. So for those of us who don’t have a diagnosis, I would say prevention is always a timely topic and something that we’re all interested in. What can we do to reduce our risk of developing dementia and Alzheimer’s in our lives? Do you have some some go to research or go to tips or hacks for us and how we can utilize music to enhance our sleep now?
Darina Petrovsky: [00:22:34] Yeah, the topic of sleep and dementia. It’s it has sort of bidirectional pathway. Right. So we have a lot of research that shows exactly what you just said. That lack of or too little sleep or too much sleep. Right.
Mindy Peterson: [00:22:48] I saw that too. That was really interesting. Like really too much sleep can can be a risk factor for developing dementia. That was really interesting.
Darina Petrovsky: [00:22:56] Yes. That usually comes from excessive napping or just sleeping to too much sort of above. Beyond that, 7 to 9 recommended 7 to 9 hour period of recommended sleep and then vice versa as well. So we also have studies that show the relationship the other way. For individuals who have a diagnosed or develop a diagnosis, then they also tend to struggle with sleep. So it’s the chicken or the egg, right? It’s it’s really hard to tease out that one direction. So we now have come to a conclusion that it’s a really bidirectional relationship. And as many maybe of the listeners are aware of, a lot of the about 40% of risk factors for dementia are modifiable, right? That includes exercise, cognitive stimulation, social activities, among others. Control of cardiovascular risk factors like diabetes. Having that under control, in addition to some of my work, has looked at how at simply attending or more complicated, participating in the arts, which include music, can help decrease the rate of cognitive decline later in life. And the only way to get the answers to those questions is using data from large, longitudinal studies that are representative of US population, and one of those studies is called Health and Retirement Study. Which is conducted based out of the University of Michigan.
Darina Petrovsky: [00:24:24] It’s one of the largest study in the US. And what I have done is I have worked with others to identify how early life, exposure to music and other arts activities, how it can be protective against cognitive decline later in life. What makes this work a little bit challenging is that there are, of course, many other longitudinal studies on aging, not just in the US, but there are across the world. Unfortunately, most of them do not have very good measures or instruments or scales that looked at arts participation earlier in life. Normally it’s clumped and under like social engagement measures and such. So it doesn’t let us tease out exactly the contribution of the arts right under that broader umbrella or more specifically, music participation. And so as we get these studies underway, as they’re undergoing, my sort of dream goal is to integrate some of these more specific measures of arts participation, because we really don’t know, is it simply attending arts that helps us? Is it learning how to play an instrument? Is it perhaps singing in a choir for some individuals and people ask me those questions, and we really don’t have that level of detail yet figured out. But we know that under the general umbrella of arts engagement, perhaps it is the social aspect of engagement in the arts that really helps us sort of shave off the risk for dementia or at least decrease that risk.
Darina Petrovsky: [00:26:01] So lots of questions to be answered in that arena. But I’m hoping that with additional studies in that area, we can really hone in on the role that music plays. One of the studies that I’m currently working on is looking using the Health and Retirement Survey. We’re going to answer a question of not what our exposure to the arts was in high school, but we’re also looking at groups of individuals who have maintained arts involvement over their lifetime at the time that they took the survey. And we’re comparing it to the group of individuals who had neither, who had no exposure to the arts in high school and are not doing arts at the time of the survey. And so I can’t reveal the results quite yet. But that’s a sort of a different way of looking at this. Is is it maybe is it enough to just study music in the arts when we’re adolescent or children, or do we really need to maintain that over our lifetime to help us avoid dementia diagnosis?
Mindy Peterson: [00:27:01] Well, it’s really interesting to hear a little bit of the behind the scenes, um, aspect of how this research research is conducted, sort of like a look at how the sausage is made, so to speak, because all of the research that’s going on right now, and I feel like there is an explosion of research, partly because of what you mentioned with the wearables, the the watches, the aura rings there, but also the fmris, you know, there’s so many non-invasive ways to now really see scientifically what’s happening when we’re listening to music or when we’re making music. And that is really leading to an explosion of research, which is fantastic because we need your research. We need this vital research to substantiate the powerful positive effects and the potential that music has on health in order. There’s so many of us musicians who are like, yeah, of course it works. But, um, you know, that’s not that’s not enough to justify insurance covering this and providing reimbursement. It’s not enough for, you know, a lot of other aspects of making this available to the masses. And so I’m just really grateful for the research that you’re doing to substantiate the efficacy of some of these interventions. Was there a place that we can go to Stay posted on the outcomes of your second phase of this clinical trial that you’re in.
Darina Petrovsky: [00:28:29] I will definitely share my university profile with you, and I think you can put in the show notes as well, as I also have been inspired recently in thinking about how to translate and make my work more available to the audiences. I started a Substack newsletter that would help, I think, bridge some of this work and talk about sort of the latest research in this area and what we can learn from it. Sort of translation of research findings are great.
Mindy Peterson: [00:28:58] Any other resources that you want listeners to be aware of in this subfield of how they can use music to enhance sleep?
Darina Petrovsky: [00:29:06] I would say one of the resources that I really enjoyed so far that I think would be of interest to listeners is actually the National Institute on Aging. There is a blog as well as sort of the news and pages through their website, which is how some of my work got out there as well. They have excellent sleep education resources that I could share with you, and they’re also investing a lot of research dollars in developing approaches to improve sleep in older adults across many different diseases and states. So that announcement for funding just went out a couple months ago. So I’m assuming, you know, research moves a little slow, but I was swimming in about a year or so. You’re more and more research is going to be funded in this area. So I really see them as a leader in providing sleep education materials and keeping the public up to date on sort of the latest and the greatest in this area, in addition to, you know, National Sleep Society and other organizations that specifically focus on sleep. But I think the National Institute on Aging Resources, I think, are especially helpful for individuals.
Mindy Peterson: [00:30:17] Great. Yeah, that sounds like a wonderful resource. We’ll include links in the show notes for that. Wonderful. Well, thank you again for this research that you’re doing. Because like I said, those of us who are musicians, it just seems like a no brainer that this would be very effective. I know when I was dealing with insomnia, music was definitely a huge part of my coping mechanisms, my coping skills, and just a part of inducing rest and relaxation so I could get to that point of sleeping. So those of us who are in this world tend to like you’re kind of preaching to the choir, but we need your research to make this more available to the masses and to bring about greater reimbursement by insurance companies and just make it more widely used in hospital facilities, and bringing it to the point where it can be prescribed and so on. So really grateful for the valuable research that you’re doing. As you know, I ask all my guests to close out our conversation with a musical ending, a coda by sharing a song or story about a moment that music enhanced your life. Is there a song or story that you can share with us today in closing?
Darina Petrovsky: [00:31:30] Sure. One of the stories that come to mind. So we, um, we had just moved into our house in North Carolina, and so I’m arranging pictures on the wall, and one of the pictures that I was actually putting up on the wall today was a photograph of me at my senior recital when I was graduating from the University of Michigan with my bachelor’s. And at that point, my grandmother had inspired a lot of my music work and how I grew up with music. And, um, she had cognitive impairment, and I could tell that she was, you know, her her time maybe not was coming, but she wasn’t doing very well, you know, physically. And so one of the ways I wanted to sort of paying homage to her was my senior recital consisted of all Russian composer music. I’m originally from Russia, had immigrated to the States in 2001, and so that was an amazing way to I think, obviously to showcase my culture. It also, I also selected pieces of music that had personal meaning to her. So when she was, you know, hearing and she was at the recital, she was able to attend, that also was a special way, I think, to connect through music.
Darina Petrovsky: [00:32:42] I would know, you know, maybe we didn’t use words right, like as much. And that was such a special moment. And I had a photographer come out. Of course, we recorded it. And that was really like ingrained in my mind for many years and still is, um, sort of a way to finish on a strong note to connect my culture, our family sort of together. And I really had a blast doing that performance. And now look at pictures. It’s right next to our piano at home, and so I can tell my kids about it. And that was just a very memorable moment. I think for me and the the piece that I played for the second half was pictures at an Exhibition by Mussorgsky, which is about, you know, 45 minutes long. It’s very complex, uh, but it goes through and showcases a lot of Russian culture and Russian sort of influence. And it was absolutely a joy to play. You know, I’m sure I had made mistakes, but I really just absolutely loved doing it.
Mindy Peterson: [00:33:43] Wow.
Darina Petrovsky: [00:33:43] So that was a great memory.
Mindy Peterson: [00:33:45] Yes, it sounds like it. What a great way to honor your heritage, honor your grandmother, connect with your grandmother, and provide an event and repertoire for her that she could probably still really connect with, since that musical memory is the last to fade away. Yes. Very special.
Transcribed by Sonix.ai