Classical Gamelan Music Therapy for Sleep Quality and Cardiovascular Parameters in Third-Trimester Pregnant Women: A Case Series

Fitriana Kurniasari Solikhah; Hasanudin Hasanudin

doi:10.62255/ijen.v2i1.217

Authors

Fitriana Kurniasari Solikhah Poltekkes Kemenkes Malang
Hasanudin Hasanudin Poltekkes Kemenkes Malang

DOI:

https://doi.org/10.62255/ijen.v2i1.217

Abstract

Background: Sleep disturbances severely impact third-trimester pregnant women, increasing adverse
obstetric risks. Non-pharmacological interventions are strongly preferred, yet culturally congruent
therapies like classical gamelan music remain critically underexplored in clinical practice.
Methods: In this prospective case series conducted between January and March 2026 in Indonesia, we
enrolled three third-trimester pregnant women experiencing severe sleep disturbances (Pittsburgh Sleep
Quality Index [PSQI] >5). Participants received a 3-day classical gamelan music therapy regimen (10–
15 minutes, twice daily). The primary outcomes included changes in PSQI global scores and sleep
duration, as well as secondary cardiovascular parameters including blood pressure.
Result: The three participants, aged 24 to 29 years, presented with severe baseline sleep fragmentation
(mean PSQI 13.7). Following the intervention, individual PSQI scores decreased substantially (Patient
A: 14 to 9; Patient B: 12 to 8; Patient C: 15 to 10). Mean nightly sleep duration increased from 3.8 to
6.0 hours. Concurrently, resting heart rates decelerated from a mean of 102 bpm to 81 bpm, and systolic
blood pressure normalized from 129 mmHg to 120 mmHg across all three individual participants.
Conclusion: A brief regimen of classical gamelan music therapy appears feasible and is associated with
marked improvements in subjective sleep quality and autonomic regulation in third-trimester pregnant
women. This culturally congruent, non-pharmacological intervention offers a safe, accessible adjunctive
strategy for gestational sleep management. Future large-scale randomised controlled trials with
objective polysomnographic endpoints are warranted to validate these preliminary findings and establish
definitive clinical efficacy and safety.

Keywords:

Pregnant Women, Sleep Quality, Gamelan Music, Music Therapy, Pregnancy Trimester, Sleep Wake Disorders, Blood Pressure, Heart Rate.

References

Banaei, M. et al. (2025) “Sleep quality during pregnancy: the role of anxiety, fear of childbirth, and obstetric factors - a multicenter cross-sectional study.,” BMC public health, 25(1), p. 3797. Available at: https://doi.org/10.1186/s12889-025-25142-5.

Chen, Y. et al. (2023) “Treatments and regulatory mechanisms of acoustic stimuli on mood disorders and neurological diseases.,” Frontiers in neuroscience, 17, p. 1322486. Available at: https://doi.org/10.3389/fnins.2023.1322486.

Cramez, C. et al. (2024) “Fetal and neonatal outcomes in syphilis infected pregnant women in Reunion Island: An observational retrospective multicentric study.,” PloS one, 19(11), p. e0309828. Available at: https://doi.org/10.1371/journal.pone.0309828.

Elhag, A. et al. (2025) “Accuracy of Fetal Transcerebellar Diameter in Predicting Gestational Age in Singleton Pregnancies During the Second Trimester: A Cross-Sectional Study in Sudan.,” Journal of clinical ultrasound?: JCU, 53(5), pp. 1062–1068. Available at: https://doi.org/10.1002/jcu.23973.

Ford, J.A. and Dahlin, C. (2024) “Cultural Advocacy for Indigenous Individuals With Serious Illness.,” The American journal of hospice & palliative care, 41(12), pp. 1482–1490. Available at: https://doi.org/10.1177/10499091231224794.

Froehlich Chow, A. et al. (2025) “Connecting cultural wisdom, physical literacy, and physical activity among older adults from diverse Indigenous communities: an exploratory review.,” International journal of circumpolar health, 84(1), p. 2582912. Available at: https://doi.org/10.1080/22423982.2025.2582912.

Gannamraju, S.K. and Chembrolu, V.H. (2025) “Lived experiences of spiritual emotional intelligence: a Bhagavad Gita-based indigenous model of psychological wellbeing.,” Frontiers in psychology, 16, p. 1730103. Available at: https://doi.org/10.3389/fpsyg.2025.1730103.

Gibbs, H.J., Czepiel, A. and Egermann, H. (2023) “Physiological synchrony and shared flow state in Javanese gamelan: positively associated while improvising, but not for traditional performance.,” Frontiers in psychology, 14, p. 1214505. Available at: https://doi.org/10.3389/fpsyg.2023.1214505.

Gibson, R. et al. (2024) “Maori perspectives on sleep and aging.,” Frontiers in sleep, 3, p. 1410856. Available at: https://doi.org/10.3389/frsle.2024.1410856.

Guo, J. et al. (2021) “The prevalence of and factors associated with antenatal depression among all pregnant women first attending antenatal care: a cross-sectional study in a comprehensive teaching hospital.,” BMC pregnancy and childbirth, 21(1), p. 713. Available at: https://doi.org/10.1186/s12884-021-04090-z.

Gurbuz, O. et al. (2022) “First trimester screening of serum advanced glycation end products levels of pregnant women who have risk factors for gestational diabetes and their obstetric outcomes: a preliminary case-control study.,” Journal of obstetrics and gynaecology?: the journal of the Institute of Obstetrics and Gynaecology, 42(7), pp. 3048–3054. Available at: https://doi.org/10.1080/01443615.2022.2081796.

Gustafsson, H. et al. (2017) “Maternal abuse history and reduced fetal heart rate variability: Abuse-related sleep disturbance is a mediator.,” Development and psychopathology, 29(3), pp. 1023–1034. Available at: https://doi.org/10.1017/S0954579416000997.

Heidarifard, S., Khoshnam Rad, N. and Khoshnam Rad, M. (2025) “The impact of COVID-19-related anxiety on obstetric complications and mental health in quarantined pregnant women.,” BMC infectious diseases, 25(1), p. 684. Available at: https://doi.org/10.1186/s12879-025-11073-4.

Ji, C. et al. (2024) “The role and outcomes of music therapy during pregnancy: a systematic review of randomized controlled trials.,” Journal of psychosomatic obstetrics and gynaecology, 45(1), p. 2291635. Available at: https://doi.org/10.1080/0167482X.2023.2291635.

Kawakami, S.-I., Ikegami, A. and Komada, Y. (2023) “Sleep habits and problems across gestational progress in Japanese women.,” The journal of obstetrics and gynaecology research, 49(4), pp. 1137–1143. Available at: https://doi.org/10.1111/jog.15573.

Konsam, M. et al. (2023) “Effectiveness of health literacy and relaxing music on quality of sleep and risk for antenatal depression.,” Indian journal of psychiatry, 65(10), pp. 1035–1043. Available at: https://doi.org/10.4103/indianjpsychiatry.indianjpsychiatry_180_23.

Kurniawati, A. et al. (2024) “Notation of Javanese Gamelan dataset for traditional music applications.,” Data in brief, 53, p. 110116. Available at: https://doi.org/10.1016/j.dib.2024.110116.

de la Calle, M. et al. (2024) “Assessment of Sleep Quality in Spanish Twin Pregnancy: An Observational Single-Center Study.,” Twin research and human genetics?: the official journal of the International Society for Twin Studies, 27(2), pp. 97–104. Available at: https://doi.org/10.1017/thg.2024.13.

Liamsombut, S. and Tantrakul, V. (2022) “Sleep Disturbance in Pregnancy.,” Sleep medicine clinics, 17(1), pp. 11–23. Available at: https://doi.org/10.1016/j.jsmc.2021.10.002.

Lu, Q. et al. (2021) “Sleep disturbances during pregnancy and adverse maternal and fetal outcomes: A systematic review and meta-analysis.,” Sleep medicine reviews, 58, p. 101436. Available at: https://doi.org/10.1016/j.smrv.2021.101436.

Magar, V. et al. (2026) “Indigenous Knowledge Systems & Psychedelic Science: Towards Ethical and Reciprocal Collaboration.,” Journal of psychopharmacology (Oxford, England), p. 2698811251387104. Available at: https://doi.org/10.1177/02698811251387104.

Maloney, S.I. et al. (2024) “Foundational features of indigenous pregnancy care: Lessons learned from indigenous pregnancy care providers.,” Midwifery, 135, p. 104025. Available at: https://doi.org/10.1016/j.midw.2024.104025.

Manconi, M. et al. (2024) “Sleep and sleep disorders during pregnancy and postpartum: The Life-ON study.,” Sleep medicine, 113, pp. 41–48. Available at: https://doi.org/10.1016/j.sleep.2023.10.021.

Morett, L.M., Feiler, J.B. and Getz, L.M. (2022) “Elucidating the influences of embodiment and conceptual metaphor on lexical and non-speech tone learning.,” Cognition, 222, p. 105014. Available at: https://doi.org/10.1016/j.cognition.2022.105014.

Okoror, C.E.M. and Omuemu, V.O. (2023) “Knowledge of obstetric danger signs among antenatal clinic attendees in South-South Nigeria.,” Health care for women international, 44(10–11), pp. 1363–1378. Available at: https://doi.org/10.1080/07399332.2021.1941025.

Pan, E.Y. and Wang, W. (2025) “Elements of music that work to improve sleep, a narrative review.,” Frontiers in sleep, 4, p. 1707162. Available at: https://doi.org/10.3389/frsle.2025.1707162.

Papatzikis, E. et al. (2024) “Music medicine and music therapy in neonatal care: a scoping review of passive music listening research applications and findings on infant development and medical practice.,” BMC pediatrics, 24(1), p. 829. Available at: https://doi.org/10.1186/s12887-024-05275-z.

Peiris, M.S.K. and Sundarapperuma, T.D. (2024) “Determinants of sleep quality among pregnant women in a selected institution in the Southern province, Sri Lanka.,” PloS one, 19(7), p. e0305388. Available at: https://doi.org/10.1371/journal.pone.0305388.

Revathi, J.J., Ts, M. and M, P. (2025) “Prevalence of Medical Disorders During Pregnancy in India: A Comprehensive Observational Study to Assess the Prevalence of Hypertension, Diabetes, and Thyroid Disorders During Pregnancy in Indian Women.,” Cureus, 17(6), p. e86441. Available at: https://doi.org/10.7759/cureus.86441.

Saripudin, M. and Badrujaman, A. (2026) “Integrating cultural rituals and social support into perinatal mental health frameworks: Lessons from indonesian pregnancy traditions.,” Asian journal of psychiatry. Netherlands, p. 104821. Available at: https://doi.org/10.1016/j.ajp.2025.104821.

Sharp, A., Delcenserie, A. and Champoux, F. (2018) “Auditory Event-Related Potentials Associated With Music Perception in Cochlear Implant Users.,” Frontiers in neuroscience, 12, p. 538. Available at: https://doi.org/10.3389/fnins.2018.00538.

Sweet, L. et al. (2020) “A Review of Sleep Architecture and Sleep Changes During Pregnancy.,” Obstetrical & gynecological survey, 75(4), pp. 253–262. Available at: https://doi.org/10.1097/OGX.0000000000000770.

Varela, P. et al. (2017) “Association between gestational diabetes and perinatal depressive symptoms: evidence from a Greek cohort study.,” Primary health care research & development, 18(5), pp. 441–447. Available at: https://doi.org/10.1017/S1463423617000317.

Wang, Q. et al. (2016) “The Effects of Music Intervention on Sleep Quality in Community-Dwelling Elderly.,” Journal of alternative and complementary medicine (New York, N.Y.), 22(7), pp. 576–584. Available at: https://doi.org/10.1089/acm.2015.0304.

Yamasato, A. et al. (2020) “How Prescribed Music and Preferred Music Influence Sleep Quality in University Students.,” The Tokai journal of experimental and clinical medicine, 45(4), pp. 207–213.

Young, J. et al. (2017) “UNITING CULTURAL PRACTICES AND SAFE SLEEP ENVIRONMENTS FOR VULNERABLE INDIGENOUS AUSTRALIAN INFANTS.,” Australian nursing & midwifery journal, 24(9), p. 37.

Zambrano Harvey, A. et al. (2023) “Indigenous communities in Colombia: A cultural and holistic view of cancer management.,” International journal of cancer, 152(7), pp. 1314–1319. Available at: https://doi.org/10.1002/ijc.34410.

Zhu, B. et al. (2018) “Adaptation of the Pittsburgh Sleep Quality Index in Chinese adults with type 2 diabetes.,” Journal of the Chinese Medical Association?: JCMA, 81(3), pp. 242–247. Available at: https://doi.org/10.1016/j.jcma.2017.06.021.

Zhu, P. (2026) “The influence of background music on adolescent self-efficacy: Mediating effects of emotion and moderating effects of music cultural preference.,” Acta psychologica, 264, p. 106519. Available at: https://doi.org/10.1016/j.actpsy.2026.106519.