Introduction
Epidemiological studies have shown that 40-57% of the elderly face sleep problems [1] and, to deal with sleep disorders, they use sleeping pills, such that 39% of sleeping pills are used by people over 60 years old [2]. This is while these drugs relieve sleep disorders temporarily [3]. The use of anti-anxiety drugs and barbiturates can increase insomnia in the elderly by 50% [4]. Other disadvantages of these drugs are drug dependence, resistant to drugs, and the cost imposed on people. To deal with sleep disorders, experts suggest non-pharmacological methods that increase the interaction between mind and body and thus support sleep [5]. Among these methods, music therapy and sleep hygiene can be mentioned that can make it easier to fall asleep and avoid behaviors that interfere with sleep. This study aims to assess the effect of music therapy (MT) and sleep hygiene (SH) education on sleep disorders of the elderly in Urmia, Iran.

Methods
This is a randomized controlled clinical trial. For sampling, the city of Urmia was first divided into two parts, north and south, where there were 18 comprehensive health centers in the northern part and 8 in the southern part. Among these centers, 9 centers from the north and 4 centers from the south were randomly selected. After the screening and interview, based on the inclusion criteria, 150 seniors over 60 years of age were selected from comprehensive health centers and divided into three groups of SH+MT, SH, and control using the block randomization method. To measure their sleep quality, the standard Pittsburgh sleep quality index (PSQI) was used, which was completed by the participants or by the researcher on behalf of them [6, 7]. The education program consisted of 4 one-hour sessions about the knowledge of the stages of sleep, how to provide a suitable environment for sleep, avoiding cigarettes, tea, coffee, soda, hunger and complete satiety, and having a regular sleep schedule, which was provided separately to the intervention groups. In the first group, the participants, after receiving the SH education, received MT by listening to a selected Azeri music for one month for 30-45 minutes before going to bed. After collecting the data, it was entered into SPSS software, version 21. To describe the data, Mean±SD, frequency and percentage were used. To know the baseline difference in the qualitative variables among the three groups, chi-square test was used. Kolmogorov Smirnov test was used to check the normality of data distribution and then one-way ANOVA test was used to compare the seven dimensions of PSQI among the three groups. Due to the significance of ANOVA test results, Bonferroni post hoc test was used to perform pairwise comparisons. The significance level was set at 0.05.

Results
Of 150 participants, 74.80% were female. Their mean age was 64.39±5.23 years. Most of them (58.48 %) had lower than high school education, 59.84% were not employed, and 79.52% were living in their own houses. There was no statistically significant difference among the three groups in terms of age, educational level, occupation, marital status, and gender. During the study, 13 people from the SH+MT group and 11 from the SH group were excluded from the study. The comparison of PSQI dimensions showed that subjective sleep quality (F=14.34, P=0.0001), sleep latency (F=10.05, P=0.0001), sleep duration (F=21.91, P=0.0001), habitual sleep efficiency (F=24.98, P=0.0001), sleep disturbances (F=15.37, P=0.0001), use of sleep medication (F=1.840, P=0.04) and daytime drowsiness (F=1.181, P=0.02) were significantly different among the three groups. As can be seen in Figure 1, before the intervention, the mean total score of PSQI was 15.93±3.13 in the SH+MT group and 16.31±2.57 in the SH group. After the intervention, they were significantly decreased to 13.67±2.24 and 15.28±3.57, respectively, which indicates the success of the intervention (P=0.001). In the control group, the score changed from 15.50±3.01 to 15.58±3.01 after the intervention, which is very low and negligible. 

Conclusion
Non-invasive interventions such as MT and SH education can be suitable alternatives for treating sleep disorders in older adults. By teaching SH strategies, lifestyle and habits can be improved for better sleep. Insomnia and sleep quality can be improved by complementary methods, such as MT using songs suitable for each culture. Therefore, it is suggested that these methods be used as non-pharmacological treatment methods for older people with sleep disorders by caregivers in families and nursing homes.

Ethical Considerations
Compliance with ethical guidelines
This study was app=roved by the Urmia University of Medical Sciences (Code: IR.UMSU.REC.1396.180). It was explained to the older adults about the objectives of the research and assuring them of the confidentiality of their information, informed consent was obtained from all participants.

Funding
This study was funded by Urmia University of Medical Sciences.

Authors' contributions
Conceptualization: All author; Methodology: Jamileh Amirzadeh Iranagh, Firouz Mohammadi, Vahid Ayoughi: Saeed Razi; Supervision: Jamileh Amirzadeh Iranagh, Parviz Salem Safi, Vahid Ayoughi and Ali Sedghiani.Investigation: Jamileh Amirzadeh Iranagh, Firouz Mohammadi, Vahid Ayoughi and Parviz Salem Safi; Writing–original draft, writing–review & editing, funding acquisition, resources: Jamileh Amirzadeh Iranagh. 

Conflicts of interest
The authors declared no conflict of interest.


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