Abstract: Objective: To systematically evaluate the clinical efficacy of five-element music therapy in patients with post-stroke insomnia (PSI). Methods: A computerized search was conducted in databases including China National Knowledge Infrastructure (CNKI), China Science and Technology Journal Database (VIP), Wanfang Data Knowledge Service Platform (Wanfang), PubMed, Web of Science, and the Cochrane Library for randomized controlled trials( RCTs) on five-element music therapy for PSI published from the inception of each database to July 15, 2025. Two researchers independently screened the literature, extracted data, and assessed the risk of bias. Meta- analysis was performed using RevMan 5.4 software. Results:A total of 12 RCTs involving 911 patients were included. The meta-analysis results showed that the effects of five-element music therapy were superior to those of the control group in improving total effective rate [OR=6.02, 95% CI (3.33, 10.91), P<0.01], improving Pittsburgh Sleep Quality Index (PSQI) score [MD=-3.27, 95% CI (-4.07, -2.48), P<0.01], and reducing Self-Rating Anxiety Scale (SAS) score [MD=-7.97, 95% CI (-11.93, -4.01), P<0.01], Self-Rating Depression Scale (SDS) score [MD=-5.80,95% CI (-11.45,-0.15),P<0.05],Hamilton Depression Rating Scale (HAMD) score [MD=-4.74, 95% CI ( -8.30, -1.19), P<0.01], and Hamilton Anxiety Rating Scale (HAMA) score [MD=-3.64, 95% CI (-5.19, -2.08), P<0.01]. Conclusion: Five-element music therapy can effectively improve sleep quality and alleviate anxiety and depression in patients with PSI,demonstrating certain clinical application value.