It’s hard enough to get a toddler to go to sleep. Now imagine helping a toddler get a good night’s sleep in a pediatric intensive care unit (PICU), full of beeps and tubes and strangers and medicines. Sleep is important for everyone’s mental and physical health, but it’s particularly important for children who are in the middle of a medical crisis.
This summer and fall, a group of music therapy and music business students from Augsburg College tried to address that problem when they created and recorded 14 original pieces of music designed to help children in the University of Minnesota’s Masonic Children’s Hospital PICU get restful sleep. Their music is now available to patients and their parents through the hospital’s in-room GetWellNetwork.
Annie Heiderscheit, director of Augsburg’s master of music therapy program, has been doing clinical work at Children’s for a decade, providing support and music therapy to physicians and their patients. So when a doctor told her that she was working on a study about using music to improve sleep for PICU children, she jumped at the opportunity to help with the research.
“She came to me and asked, ‘What music should I use?’” Heiderscheit recalled. “I said, ‘Music for sleep is very unique because we need it to be very slow. Usually around from 60 beats per minute moving down to 40 beats a minute because music can move us into our slowest brain-wave pattern.’”
Heiderscheit knows all to well that it is hard to find pre-recorded music at such slow tempos, but she thought of a solution: Students in her music therapy senior-seminar course are required to work on a community service project. Maybe they could take on the project as part of the seminar.
“I said, ‘We could create music for that,’” Heiderscheit said. “That’s part of what music therapists can do. We can create music specifically to meet a need for a patient.’”
Heiderscheit went back to class and spoke with her students. “I presented it as a potential community engagement project,” she said. “They were really interested. So we took the class to the hospital, got to observe a patient room on the PICU, and got a sense of the challenges children face in getting restful sleep while they are there. ”
Intensive care units are designed to keep people alive, not to help them sleep. And while places like Masonic Children’s Hospital do a good job at the “keeping children alive” part, the experience of being in a PICU environment can wreak havoc on a little person’s internal clock. Heiderscheit explained that children can even experience a condition known as “ICU psychosis,” where their days and nights are completely turned around.
“They might sleep during the day and stay up all night,” she said. “There is so much activity going on. People are coming in and out to check exams and procedures, so it interrupts their sleep process. Medications or physical discomfort can do the same things. I’m often called into the hospital as a music therapist. Staff will ask, ‘Can you help them get to sleep?’ These children are just not getting good sleep, and that can affect them on a physical and mental level.”
The sleep solution
Creating music designed to put a child to sleep isn’t as easy as simply recording a soothing version of “Hush Little Baby.” Heiderscheit explained that research has shown that there are specific elements required to get the human brain to move toward sleep using music.
“The body naturally entrains or synchronizes with rhythms,” She said. “For example, if you have ever been to an aerobics class and they’re playing music at a faster tempo, they are working to increase your heart rate. When we are relaxing and getting ready to fall asleep, we are working to decrease the heart rate, to facilitate what we call a relaxation response.”
Music that encourages people to fall asleep starts at an average heart rate of approximately 120 beats per minute and then slowly reduces the tempo to as low as 40 beats per minute.
“I talked with students about music for sleep,” Heiderscheit said. “We had to spend time talking about how we use music for sleep and styles of music and specific elements within the music that we really need to leverage to help young patients fall asleep. Then the students went into creating their original pieces.”
Music therapy students composed original pieces that met Heiderscheit’s criteria. Then they worked with students from the college’s music business department to record the pieces. Dain Estes is a music business instructor with extensive experience working in recording studios. He guided his students through the process of capturing the music therapy students’ work.
“This was an extremely difficult assignment because of how the heartbeat works,” Estes said. “Starting every song at 120 beats per minute and bringing it down to 40 beats per minute is not as easy as it sounds.”
At first, music therapy students expected that the students doing the recording would be able to help them get their music to meet the proper rhythmic requirements.
“The first question we were getting from music therapy students was, ‘Can’t you just slow it down for us?’” Estes recalled. “You can speed up and slow down audio, but it really destroys the audio when you go from 120 beats per minute to 40, so we had to tell them that they had to get the timing right themselves.”
To do that, the groups of students worked out a strategy.
“In the end we were actually playing with a metronome,” Estes said. “We programmed the metronomes to the point where we would feel the players naturally descend from 120 to 40 beats per minute. Then we’d loop the part of the song that was more stable at 120 beats per minute and at 40 beats per minute,” he chuckled, and added: “That took us a while to figure that out.”
Genre for ZZs
The best kind of music to put a child to sleep turned out to soft, repetitive and instrumental.
“When we introduce language into a song then our brains begin to process,” Heiderscheit said. “We wanted to keep the music general enough so that a child of any age can process it. Music for sleep needs to be simple without a lot of complex dynamic shifts.”
Some instruments just don’t work well for sleep, the students discovered.
“I had a student who wanted to play a saxophone,” Estes said, “but we realized it was just too loud. No mater how you play it, a saxophone is the kind of instrument that couldn’t get low or soft enough.”
The best go-to-sleep instruments turned out to be piano and guitar. And the style of music that was deemed best for sleep? The best way to describe it would be “new age,” Estes said.
“I felt the students, especially the piano players, were looking for the most relaxing, repetitive melodies they could find,” he continued. “We didn’t want the melodies to be distracting or familiar.”
The songs are intended to help lull the listener to sleep, but not to play all night long.
“It helps them move from that wake state to that relaxed state to that sleep state,” Heiderscheit said.
The set of songs are now available to PICU patients, with a new question on the horizon: Could even younger children benefit from music therapy while in the Neonatal Intensive Care Unit (NICU?)
“I just had a meeting on the NICU a couple of weeks ago,” Heiderscheit said. “We are looking into the question of whether we can use music to help these really fragile patients. I’ve started performing live music there, but the next project may be: Can our students create lullabies that would be appropriate for these tiny babies? We are working on finding answers.”