Application Of Qur'an Murottal Therapy To The Level Of Insomnia In The Elderly In The Working Area Of Kedawung Health Center

Insomnia is a condition in which a person has difficulty getting to sleep or maintaining sleep, or an inability to sleep with marked difficulty sleeping at night for 1 month. Non-pharmacological therapy that can be done by giving Al-Qur'an murottal therapy because it does not cause side effects and provides a relaxing effect on peace of mind, thereby reducing the level of insomnia and psychological disorders. This study aims to understand the impact of Murottal Al-Qur’an therapy on the rate of insomnia in the elderly. This research method uses case studies and descriptive research using pretest and posttest questionnaires. In this case study, researchers used Murottal Al-Qur’an Therapy to see a decrease in the rate of insomnia over 2 weeks (frequency: 6 times). Based on the results of the level of insomnia obtained by the researcher regarding the administration of Al-Qur'an Murottal Therapy to Mrs. S, the level of insomnia dropped to 10 (mild insomnia). While the measurement results showed Mr. S, the level of insomnia dropped to 13 (Mild insomnia). The results of the development of the level of insomnia before and after the application of Al-Qur'an murottal therapy were a decrease in the level of insomnia in Mrs.S and Mr.S. The results of the final comparison between the two respondents, Mrs. S and Mr. S, showed that there were differences in the causal factors. There was a significant decrease in the rate of insomnia in the elderly after being given Murottal Al-Qur’an therapy using audio.


INTRODUCTION
Insomnia is a condition in which a person has difficulty getting to sleep or maintaining sleep or has an inability to sleep with marked difficulty sleeping at night for >1 month 1 .In 2021, the WHO (World Health Organization) noted that approximately 18% of the world's population has trouble sleeping 2 .
The prevalence of insomnia in the elderly worldwide is estimated at 13-47%, with a proportion of around 50-70% occurring at the age of over 65 years 1 .In 2018, the prevalence of insomnia and sleep disorders among the elderly in Indonesia was around 10%, meaning that approximately 28 million out of a total of 238 million Indonesians suffer from sleep disorders.On the islands of Java and Bali, the prevalence of this problem is quite high, at around 44% of the total number of elderly 2 .In Indonesia, the prevalence of sleep problems in the elderly aged 60 years and over is very high, at around 67%.Based on gender, it was found that insomnia can occur in women aged 60-74 years at a rate of as much as 78.1%.Meanwhile, elderly people aged 60 years and over found data on 7% of cases that complained of sleep problems 3 .
The elderly in Central Java have continuously increased; in 2021, the number of elderly people will increase to 12.71%.In Sragen Regency, the elderly group in order no.14 is 15.22% (Central Java Provincial Statistical Agency, 2021) 4 .Kedawung Subdistrict is ranked 4th with the largest population in Sragen, according to data from the Central Statistics Agency for Sragen Regency.While the level of elderly people in the Kedawung 1 Health Center area in 2023, including in Kedawung village, is 42.79%, the total number of elderly people is 5979 (Kedawung 1 Health Center, 2023).
Insomnia can be influenced by several factors, such as aging, women experiencing insomnia more often, smoking habits, consumption of caffeinated drinks, medication, psychological stress, and noise 5 .Insomnia in the elderly is also caused by several factors, namely health factors, drug use, environmental conditions, nutritional status, psychological stress, and lifestyle, and can increase the risk of generative diseases 6 .In line with the research of Rulino and Santi (2019), factors contributing to the occurrence of insomnia in the elderly, such as a noisy environment and symptoms due to comorbidities that can disturb sleep, include polyuria and polyphagia in people with diabetes mellitus 7 .
The danger of insomnia in the elderly can make their body health disturbed and susceptible to the risk of heart disease and stroke due to irregular sleep quality.The impact of insomnia on the elderly will lead to depression, decreased quality of life, excessive anxiety, and easy memory problems or dementia 1 .The impact that often occurs in the elderly is anxiety or depression; insomnia also has an impact when doing homework or driving; and other daily activities can also be disrupted, which results in accidents such as falling 3 .
Insomnia can be treated with pharmacological and non-pharmacological methods.
In the pharmacological way, by taking medicine according to a doctor's prescription, this method actually has a faster effect, but if consumed in the long term, it is also not good for the health of the elderly, especially the kidneys, resulting in side effects of decreased kidney function 7 .Continuous use of drugs to help sleep without a therapeutic process for the basic complaint, so that it becomes drug dependence 8 .The non-pharmacological method is by making a sleep schedule, giving murottal Al-Qur'an therapy or aromatherapy, maintaining a diet by avoiding foods that cause insomnia, and routinely doing range of motion.So that a non-pharmacological method is given with Murottal Al-Qur'an therapy because it does not cause side effects on the health of the elderly body 9 .In line with the research of Safitri and Supriyanti (2021), listening to the murottal Al-Qur'an letter Ar-Rahman can have a relaxing and calming effect on the body, which means that a calm state of mind can indirectly make the body balanced and body immunity increase, so that the state of balance can reduce the level of insomnia and all psychological disorders.Al-Qur'an murottal research was carried out in the form of a group pretest-posttest.
Using a questionnaire for insomniacs consisting of 17 question items using a Likert scale with the accidental sampling technique With the criteria of age 60 and over, Muslims suffering from moderate and severe insomnia are able to participate in all research activities.How respondents listened to the Koran with a frequency of 3 x 10 minutes (for 2 weeks) every night they slept 9 .
Based on the results of a preliminary study conducted by researchers by conducting interviews in Kedawung Village, it was found that there were 13 elderly people, 7 of whom were male and 6 were female.According to the interview information obtained, as many as 5 people experienced insomnia, and 2 out of 5 experienced severe insomnia.They said it was difficult to get to sleep, and when they woke up at night, it was difficult to go back to sleep.One of the lanisa, if she can't fall back asleep, copes with listening to the radio, and the other sometimes reads Al-Fatihah or letters that are still memorized and rarely listens to murottal.
Based on the description above, it is important to understand the health behavior of insomnia in elderly patients.Therefore, researchers are interested in implementing research on the application of Al-Qur'an Murottal Therapy to the level of insomnia in the elderly.

METHODOLOGY
The type of research used in this study is case study and descriptive, with a pretest Research data collection used the Insomnia Severity Index (ISI) questionnaire, consisting of seven question items on a Likert scale.Its application by using the SOP sheet.
Furthermore, observations and analyses were processed into a frequency distribution table and percentages before and after being given Murottal Al-Qur'an therapy associated with theories that were in accordance with the results obtained in the explanation of the variables.Before the average insomnia level was 21, after 3 times the insomnia level dropped 3 levels (to moderate insomnia), and after 6 times it fell 8 levels to mild insomnia.

2.
Ms. S 20 16  13   Before the level of insomnia was moderate, the score was 20.After 3 times, the level of insomnia fell 4 levels (to moderate insomnia), and after 6 times, it fell 3 levels to mild insomnia.
Based on Table 3, the results of the level of insomnia obtained by researchers for Mrs. S show that after being given murottal Al-Qur'an therapy three times, at the 4th meeting, the insomnia score was 18 (moderate insomnia), and at the 6th and 7th meetings, after being given Al-Qur'an murottal therapy, the insomnia level dropped to 10 (mild insomnia).Measurement results Mr. S., after being given murottal Al-Qur'an therapy three times, at the 4th meeting the insomnia score was 16 (moderate insomnia); at the 6th meeting and the 7th after being given Al-Qur'an murottal therapy, the level of insomnia fell to 13 (insomnia mild).Before being given the application of Al-Qur'an murottal therapy to the two respondents, namely, first Mrs. S said that he was at home with his 2 children and 7 grandchildren, and every time he went to bed he complained of difficulty sleeping because he was busy with his grandchildren and rarely took part in sports from the puskesmas because it was a bit far.In with the theory that insomnia is a temporary sleep disorder, it is more difficult to start sleeping because the environment is noisy, and it is difficult to start sleeping again 7 .Lack of exercise can also cause insomnia because the body rarely moves, saving a lot of energy to keep the elderly active all night.In addition, people who never exercise tend not to sleep well and still feel tired when they wake up in the morning 11 .While the second respondent, Mr. S, also complains that every day he does activities in the fruit-planting garden, at night his body feels tired when he is asleep, and if he wakes up in the middle of the night and wants to sleep again, he can't.In accordance with the theory that, in fact, individuals who engage in intense or high physical activity can experience difficulty sleeping, which results in insomnia 12  Insomnia that is not controlled will affect physical and mental health.Basically, the elderly need an optimal sleep time of around eight hours so as to restore the body's condition so that it is not easily affected by sleep disturbances and can carry out activities properly 14 .
b.The level insomnia after being given Murottal Al-Qur'an Therapy Based on the table above, after the application of Al-Qur'an murottal therapy in Ngabean Village, Kedawung Village, Kedawung District, Sragen Regency, Central Java for 2 weeks 6 times given before going to bed with Murottal surah Ar-Rahman for 11.25 minutes, it can be seen that both respondents experienced a decrease in the level of insomnia, this is in accordance with research by 9 , which states that there is a difference between the level of insomnia before and after being given murottal therapy in the intervention group with (p-value = 0.000) which means murottal Al-Qur'an therapy in the elderly there was a decrease, while in the control group with (p-value = 0.126) which means there was no decrease in the level of insomnia in the control group data.In this study, the application of Al-Qur'an murottal therapy was carried out six times for two weeks, namely before going to bed, audio murottal surah Ar-Rahman was given for 11:25 minutes, and if the respondent had difficulty starting or maintaining sleep again, it could be done independently using a handphone and audio of surah Ar-Rahman qori Misyari Rasyid Al-Afasy, which has been given by researchers with the help of family members at home.

The results of measuring the level of insomnia in
The results of the development the level of insomnia before and after being given Al-Qur'an Murottal Therapy From the results of the application that has been carried out by researchers, it can be described that there are differences in the level of insomnia in Mrs.S and Mr. S before and after being given murottal Al-Qur'an therapy.The level of insomnia before being given murottal Al-Qur'an therapy to Mrs. S with a value of 21 (Moderate Insomnia) and to Mr. S with a value of 20 (Moderate Insomnia) And after being given Al-Qur'an murottal therapy six times for two weeks to Mrs. S with a value of 10 (Mild Insomnia) and to Mr. S with a value of 13 This is consistent with the theory (Salam,   2021) that the intervention group showed a significant decrease in the number of people suffering from insomnia after being given Al-Qur'an murottal therapy.Based on the results of the pretest, there were 11 people (73%) who suffered from moderate insomnia and 4 people (27%) who suffered from mild insomnia in the intervention group.After undergoing murottal Al-Qur'an therapy, the posttest results showed that only 5 people (33%) still suffer from mild insomnia, and the majority, namely 10 people (67%), no longer experience insomnia.
Al-Quran audio serves as a guide for the life of a Muslim and has the same effect as relaxing music therapy in releasing these hormones 15 .Audio therapy murottal Al-Qur'an can increase religious influence, thereby increasing life expectancy, reducing International Journal of Health Sciences is licensed under a Creative Commons Attribution 4.0 International License levels of anxiety, depression, and anger experienced by the elderly, and therefore improving their quality of sleep 9 .
Improved sleep is due to an increase in the work of the parasympathetic nerves.Al-Qur'an murottal therapy is able to stimulate the parasympathetic nervous system, which has the opposite effect of the sympathetic nervous system.Thus, there is a balance in the two autonomic nervous systems.This is what causes a relaxation response in the elderly so that the quality of their sleep is better 16 .
Al-Qur'an murottal therapy can stimulate the parasympathetic nervous system to have the opposite effect of the sympathetic nervous system.Therefore, there is a balance in the two autonomic nervous systems.This is what causes the relaxation response in the elderly, so that the quality of sleep becomes better.
Al-Qur'an murottal therapy is a non-pharmacological intervention using the sound of reciting the Qur'an as healing.This therapy can also reduce stress hormones, increase feelings of calm, and divert attention from anxiety and fear in patients 17 .So this application can affect the decrease in the level of insomnia in the elderly, and there are differences in the causal factors in the two respondents that can affect the decrease in the level of insomnia.

d. Comparison of Final Results Between Two Respondents
The results obtained from the above explanation can be described as follows: after 2 weeks of application, it was carried out 6 times with a time of 11:25 minutes before going to bed, where there was a decrease in the level of insomnia, down 11 points in Mrs.S and down 7 points in Mr.S.In the results of measuring the level of insomnia, there is a difference in the decrease in the level of insomnia between the two respondents; this difference arises because of differences in activity habits between the two respondents.The pathways of the auditory system carry audio stimuli to the auditory area, including the neural pathways involved in emotional circuitry.These audio stimuli trigger psychophysiological responses through their effects on the limbic system, which can stimulate the release of hormones such as serotonin, dopamine, and norepinephrine at the synapses, thereby helping to reduce stress.

International
These results are supported by research from Safitri & Supriyanti (2021) which showed that client I experienced a decrease in the level of insomnia from moderate to mild with a score of 12, whereas previously the score was 18.Meanwhile, client II initially experienced moderate insomnia with a score of 17, but after undergoing therapy with murottal al qur'an, the score dropped to 13 for mild insomnia.
From these results, it can be concluded that murotal Al Qur'an therapy is effective in reducing the level of insomnia in the elderly 10 .
One way to reduce the level of insomnia is through murottal Al-Qur'an therapy.This therapy has spiritual value and can provide a relaxing effect thanks to the activation of endorphins, which increase feelings of relaxation and comfort.Surah Ar-Rahman is recited with a soft and melodious rhythm that can increase feelings of relaxation, calm, and a sense of serenity and help the elderly to sleep.This is consistent with the theory 15 that the benefits of murottal Al-Qur'an therapy with a slow and harmonious tempo are that it can reduce stress hormones, trigger natural endorphins, increase feelings of calm, and divert attention from feelings of fear, worry, and

CONCLUSION
Based on the results of research on the application of Al-Qur'an murottal therapy to reduce the level of insomnia in the elderly, it can be concluded that there was a decrease in the two respondents after being given Al-Qur'an Murottal therapy, and there was a comparison of the final results between the two respondents in Mrs. S because it was influenced by noisy environmental factors and rarely exercised, whereas in Mr. S it was due to activity and activity factors.

Compliance with ethical standards
a. Informed consent This consent statement was given, and the interviewee was informed about the purpose of the nursing activity to be carried out.Researchers provide choices to respondents, whether respondents are willing or not to do research to become respondents.

b. Anonymity
The author maintains the confidentiality of the respondent's identity by including the respondent's initial name in the research report.

c. Confidentially
The author guarantees the confidentiality of research results and data from case studies and their problems.The identity of the respondent, medical condition, and other Based on research conducted by Syukriana et al. (2021), The effect of Murottal Al-Qur'an Therapy on the level of insomnia in the elderly at the Usuku Wakatobi Health Center with 30 respondents and the results of the p-value = 0.000 <  = 0.05 mean that there is a decrease in the level of insomnia in the elderly after being given Murottal Al-Qur'an Therapy 9 .Based on research conducted by Riskiana and Endang (2021) on the application of Murottal Al-Qur'an Therapy to treat insomnia in the elderly using 2 patients aged over 60 years, the results of the client 1 study decreased from moderate insomnia to a score of 18 to a mild insomnia score of 12.While client 2 experienced a decrease from moderate insomnia (a score of 17) to mild insomnia (a score of 13) 10 .
and posttest carried out at the Elderly Services of Kedawung Village, Kedawung District, on May 22-June 3, 2023.This study involved two individuals, namely two elderly respondents who were adjusted to the inclusion and exclusion criteria.Elderly aged 60-74 years who experience moderate to severe insomnia, are Muslims, can hear and see, live with their families, and are willing to be respondents.International Journal of Health Sciences is licensed under a Creative Commons Attribution 4.0 International License

Based on Table 4 ,
a comparison of the decrease in the level of insomnia in Mrs.S and Mr. S for 2 weeks was carried out six times, and the time was 11:25 minutes.e-ISSN : 2987-0836 DOI : https://doi.org/10.59585/ijhsInternational Journal of Health Sciences is licensed under a Creative Commons Attribution 4.0 International License a.The level of insomnia before being given Murottal Al-Qur'an Therapy Based on the results of the pretest before the application of Al-Qur'an murottal therapy to Mrs. S and Mr. S in Kedawung, Sragen The level of insomnia before implementation was Mrs. S value 21, while Mr. S value 20.The level of insomnia suffered by both respondents is moderate insomnia.There are various factors that affect insomnia in the elderly, including stress, anxiety, and depression; activity or work; lack of exercise; a noisy environment; use of drugs; poor eating patterns; and decreased body function 11 .The theory shows conformity with the obtained during the study of Mrs. S., who has moderate insomnia because of the noisy environment and lack of exercise.Meanwhile, during the study, Mr. S experienced moderate insomnia due to work and activity factors.
. Elderly who experience sleep disturbances and experience abnormal changes in sleep and rest patterns are caused by the aging process, which makes them more susceptible to sleep disturbances, especially for those who are elderly with poor sleep quality 13 .International Journal of Health Sciences is licensed under a Creative Commons Attribution 4.0 International License Insomnia that is not treated immediately can affect the psyche, causing anxiety and depression and weight gain.With this, the elderly tend to experience long-term sleep disturbances and are unable to initiate or maintain sleep.Insomnia makes a person tired at work and causes a risk of work accidents, which can increase risk of more severe diseases in the long term, such as hypertension, DM, and heart attacks 11 .
Mrs. S before being given pretest results with a value of 21 (Moderate Insomnia) In the first week, it decreased to a value of 18 (Moderate Insomnia).And the second week decreased after being given a value of 10 (Mild Insomnia).The results of measuring the level of insomnia in Mr. S before being given pretest results with a value of 20 (Moderate Insomnia) In the first week after being given therapy, it decreased to a value of 16 (Moderate Insomnia).And in the second International Journal of Health Sciences is licensed under a Creative Commons Attribution 4.0 International License week, it decreased after being given Al-Qur'an murottal therapy with a value of 13 (Mild Insomnia).
Journal of Health Sciences is licensed under a Creative Commons Attribution 4.0 License The habit of doing activities can affect the level of insomnia in the elderly, and a noisy environment is one of the factors contributing to insomnia in the elderly because they cannot start sleeping properly and feel disturbed.This is in accordance with the theory 12 .One of the factors related to decreased cognitive function is a change in the performance of the organ.The brain plays a role in sending signals that tell the body to feel tired and sleepy.This can help a person sleep soundly at night, but the brain's neurons start to weaken, and this results in these signals not working Reciting murottal Al-Qur'an results are the same as listening to relaxing music therapy by involving auditory stimulation mechanisms in the cerebral limbic system.
Journal of Health Sciences is licensed under a Creative Commons Attribution 4.0 International License tenseness.In addition, this therapy can improve the body's chemical balance, thereby lowering blood pressure and slowing down breathing, heart rate, pulse, and brain wave activity.Based on the description above, researchers can conclude that differences in activity habits and environmental factors in the elderly can affect the decrease in insomnia levels.As shown by the results of measuring the level of insomnia in Mrs. S, who had a noisy environment and rarely exercised, she experienced a decrease of 11 points, and Mr.S, who often carried out activities, experienced a decrease of 7 points.

Tabel 1. The results of measurements before the application of murottal Al-Qur'an therapy to clients with insomnia and sleep disorders
Based on table 1, the value of insomnia in both respondents before murottal therapy was carried out was: for Mrs. S, an insomnia score of 21 is included in the moderate insomnia category, while for Mr.S, an insomnia score of 20 is included in the moderate insomnia category.

Table 2 . Measurement results after applying Al-Qur'an murottal therapy to clients with insomnia and sleep disorders
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