The Effect of Therapeutic Touch and Music Listening on Sleep Quality, Menopausal Symptoms and Quality of Life in Menopausal Women
Phase: NA
Conditions: Menopause
Sponsor: Inonu University

ID: Therapeutıc Touch And Musıc 
NCT ID not yet assigned 
İntial Release: 21.09.2021 
 
 
 
 
The Effect Of Therapeutic Touch And Music Listening On Sleep Quality, Menopausal 
Symptoms And Quality Of Life İn Menopausal Women 
 
Abstract 
Menopause is a natural phenomenon and physiological process in middle-aged women. 
It is noted that women most often complain of vasomotor symptoms and sleep disorders during 
the menopausal period, and therefore their quality of daily life is negatively affected. Reduce 
symptoms and improve quality of life for menopausal women they are applying for medical 
approaches due to the side effects of the method compared to music, yoga, armoterapi, 
teraopotik massage, physical exercise, sleep hygiene education, therapeutic touch, acupressure, 
acupuncture and cognitive behavioral therapy as a non pharmacological methods, it is observed 
that they resort to such methods. Therefore, the aim of this study is to investigate the effect of 
therapeutic touch and music listening on sleep quality, menopausal symptoms and quality of 
life in menopausal women. Therefore, the aim of this study is to investigate the effect of 
therapeutic touch and music listening on sleep quality, menopausal symptoms and quality of 
life in menopausal women. 
Introduction 
Menopause is a long period of life characterized by the permanent termination of the 
menstrual cycle due to the cessation of ovarian functions. It is the most important midlife crisis 
in which special physical and psychological differences occur, often associated with a decrease 
in estrogen levels [1], [2]. Although the natural age of menopause varies, it usually ranges from 
40 to 58 years, and the average age of menopause is accepted as 51 [2], [3]. When the average 
life expectancy of women is accepted as 80 years, women spend about a third or more of their 
life in the postmenopausal period. [4]–[7]. 
Along with the decrease in estrogen during menopause, symptoms related to hot flashes, 
night sweats, palpitations, irritability and sleep disorders are common. Especially sleep 
disorders are higher than in the pre-menopausal period. It has been reported that approximately 
40-60% of menopausal women have sleep-related symptoms with night awakenings as the most 
common complaint [7]–[9]. In the study of Lima et al. in which they included 819 climacteric 

women in Brazil; Deterioration in sleep quality was detected in 67% of the sample, more 
prominently in postmenopausal women [11]. The most common complaints during menopause 
are deterioration of sleep quality and chronic insomnia [4], [12]. Untreated sleep disorders and 
menopausal symptoms adversely affect health and especially reduce quality of life. When the 
literature is examined, poor sleep quality and insufficient sleep duration; hormonal changes, 
poor physical health, obesity, cardiovascular disease, diabetes, irritability, physical and mental 
burnout, and poor quality of life, such as short-term and long-term outcomes. It is stated that 
the symptoms seen in the menopausal period negatively affect the quality of life of women. [5], 
[6], [12]–[14].  
Although the effective treatment to be used to solve the sleep problems experienced 
during the menopause period, reduce the menopausal symptoms and improve the quality of life 
is medication or hormonal therapy, the use of non-pharmacological methods is increasing due 
to the potential side effects of these treatments and the harm outweighing the benefit [4], [ 15]. 
Some of these methods are music, yoga, armotherapy, therapeutic massage, physical exercise, 
sleep hygiene education, therapeutic touch, acupressure, acupuncture and cognitive behavioral 
therapy methods [1], [9], [16]–[20]. 
Therapeutic touch, which is among the non-pharmacological methods that have started 
to be preferred in recent years, is the interpretation of an ancient healing experience in the 
modern age. It is a non-invasive nursing intervention that channels energy using the hands. 
There are no known side effects associated with the use of therapeutic touch. Therapeutic touch 
is beneficial in reducing anxiety, pain and depression, and increasing relaxation and well-being 
[21]. Therefore, this calming effect of therapeutic touch also facilitates falling asleep and can 
improve quality of life by easing menopausal symptoms [20]. 
Another widely used non-pharmacological method is recital [25]. Perceived calming 
music lowers catecholamine levels, respiratory rate, heart rate, and blood pressure. Therefore, 
by providing physiological and psychological relaxation, music helps individuals to sleep 
better, reduce menopausal symptoms, and improve quality of life [27], [28]. In a metallysis 
study, it was determined that listening to calming music effectively improved sleep quality [29]. 
When the literature was examined, no study was found that examined the effects of 
therapeutic touch and music listening on sleep quality, menopausal symptoms and menopausal 
quality of life in menopausal women. It is thought that the findings obtained from the research 
will contribute to the literature. Based on all these, the aim of this study is to examine the effects 
of therapeutic touch and music listening on sleep quality, menopausal symptoms and quality of 
life in menopausal women. 

Aim 
The research was conducted to examine the effects of therapeutic touch and music 
listening on sleep quality, menopausal symptoms and quality of life in menopausal women. 
 
 
 
Research Hypotheses  
H10: Therapeutic touch does not affect sleep quality in menopausal women 
H11: Therapeutic touch affects sleep quality in menopausal women 
H20: Therapeutic touch does not affect menopausal symptoms in menopausal women 
H21: Therapeutic touch affects menopausal symptoms in menopausal women 
H30: Therapeutic touch does not affect quality of life in menopausal women 
H31: Therapeutic touch affects quality of life in menopausal women 
H40: Music listening does not affect sleep quality in menopausal women 
H41: Listening to music affects sleep quality in menopausal women 
H50: Listening to music does not affect menopausal symptoms in menopausal women 
H51: Listening to music affects menopausal symptoms in menopausal women 
H60: Music listening does not affect quality of life in menopausal women 
H61: Music listening affects quality of life in menopausal women 
 
3. MATERIALS AND METHOD 
3. 1. Type of Research 
The research was planned to be carried out as an experimental model with a pre-test 
post-test control group. 
3. 2. Place and Time of Research 
The research will be carried out with menopausal women between the ages of 45-59 
working at İnönü University in Malatya between August 2021 and July 2022. 
3.3. Population and Sample of the Research 
The population of the research will consist of 322 women between the ages of 45-59 
working at İnönü University at the time of the research. The sample will be menopausal women 
aged between 45-59 working at İnönü University. The number of samples in the study was 
calculated using the G*Power 3.1.9.4 program. Considering the 3-group (Experiment 1, 
Experiment 2, Control) and 2-measurement (Pretest, Posttest) research design in the 
calculation, medium effect size (d = 0.25), 5% margin of error (α = 0.05) and % for ANOVA 

test in Repeated Measures. When a power of 80 (1-β = 0.80) was taken, the sample size was 
found to be 36 for each group, 108 in total). 
Inclusion Criteria for Research; 
- 
Between the ages of 45-59 
- 
Not taking Hormone Replacement Therapy, 
- 
No psychiatric history, 
- 
Women who do not use any other CAM methods will be included in the study. 
Exclusion Criteria from Research; 
‾ 
Those who are in surgical menopause, 
‾ 
Having auditory problems that prevent listening to music, 
‾ 
Using any other TAT method, 
‾ 
Women who use drugs that affect sleep (using antidepressant, antihistamine, 
benzodiazepan, hypnotic and narcotic drugs) will be excluded from the study. 
 
 3.4. Randomization of Groups   
All women between the ages of 45-59 will be interviewed in the study. Menopausal 
women will be included in the study. Menopausal women who are eligible and agree to 
participate in the study will be listed. Then, using the Random Integer Generator method from 
the Numbers subheading from Random.org site, 1-108 single-group columns will be created. 
Women will be randomly assigned to numbers 1, 2, 3 based on list numbers. (At the beginning 
of the research, lots will be drawn to determine which number belongs to the experimental or 
control groups. 
4. Data Collection Tools 
Participant Identification Form,, Pittsburgh Sleep Quality Index (PUKI), Menopausal 
Symptoms Rating Scale (MDS), and Menopause-Specific Quality of Life Scale (MENQOL) will 
be used to collect data. 
 
4.1. Participant Identification Form 
Participant introduction form developed by the researcher using the literature; women's socio-
demographic characteristics (age, education level, occupation, economic status, marital status, family 
type, body mass index, number of children, chronic disease status, smoking and alcohol use status) and 
menopausal information (whether or not I can be in menopause, Menstrual pattern and menopause 
period) were created. 
 4.2. Pittsburgh Sleep Quality Index 

Developed by Buysse et al., it is a self-reported screening and evaluation test that 
provides detailed information about sleep quality and the severity and type of sleep disorder in 
the last month.The index consists of a total of 24 questions and 7 components. The sum of the 
scores from the seven components gives the total PUKI score. The total PUKI score can take a 
value between 0-21. The sleep quality of individuals with a total PUKI score of 5 or less was 
“good”; The sleep quality of individuals with a score above 5 points is evaluated as “poor”. 
Ağargün et al. conducted a Turkish validity and reliability study of the index and determined 
the Cronbach alpha internal consistency coefficient as 0.80. 
 
4.3. Menopause Rating Scale  
He scale was first developed in German by Schneider, Heinemann et al. in 1992 to 
measure the severity of menopausal symptoms and their effect on quality of life. The Turkish 
validity and reliability study of the scale was carried out by Gürkan in 2005. There are a total 
of 11 questions on the Likert-type scale, including menopausal complaints. Each question is 
scored from 0 to 4. The sum of the scores obtained from each item gives the total score of the 
scale. While the minimum score that can be taken from the scale is 0, the maximum score is 44. 
The scale consists of 3 sub-dimensions. The increase in the total score obtained from the scale 
shows the increase in the severity of the complaints, while at the same time it shows that the 
quality of life is negatively affected. The Cronbach alpha coefficient of the scale was found to 
be 0.84. 
4.4. Menopause Symptoms Rating Scale (MENQOL) 
The scale was developed by John R. Hilditch et al. in 1996 to develop a health-specific 
quality of life scale in menopause. The validity and reliability of the scale was determined by 
Kharbouch and Şahin in 2007 by adapting the scale to Turkish society. MENQOL is a 29-item 
Likert-type scale. Each question score is ranked from 0 to 6. A score of 0 indicates that women 
do not have any problems with that subject. A score of 1 indicates that there is a problem with 
that subject, it is experienced, but it is not disturbing at all. Scores between 2 and 6 indicate the 
severity and increasing degrees of the existing problem. An increase in the scale score indicates 
an increase in the severity of the complaints. The Cronbach's alpha coefficient of the scale was 
found to be 0.82 for the vasomotor domain, 0.81 for the psychosocial domain, 0.87 for the 
physical domain, and 0.89 for the sexual domain. 
5. Data Collection 
The data of the research will be collected by the researcher using face-to-face interview 
technique in the units where the people work between August 2021 and July 2022, from women 

who meet the conditions and volunteer to participate in the research. 
 
Therapeutic Touch Group 
 Each of the women will be informed about the purpose and content of the study at the 
first meeting, and informed consent will be obtained from the women who meet the 
conditions for participation and agree to participate. The pre-test data in the research 
will be obtained with the Participant Identification Form, PSQI,MRS and MENQOL. 
 After pre-test data collection, women will be given an appointment for therapeutic 
administration. 
 The therapeutic touch group will be applied to the therapeutic touch group once a week 
for four weeks in a suitable room in the Faculty of Nursing and on the specified day and 
time by the researcher. 
  At the end of the fourth week, post-test data will be obtained by filling in PSQI, MRS 
and MENQOL again. 
Music Listening  Group; 
 Each of the women was informed about the purpose and content of the study at the first 
meeting, and informed consent was obtained from the women who met the conditions 
for participation and accepted to participate. 
  The pre-test data in the research will be obtained with the Participant Identification 
Form, PSQI, MRS and MENQOL 
  Music stream, music will be uploaded to mobile phones. He will be asked to listen to 
music (relaxation music in the relaxation exercises CD prepared by the Turkish 
Psychological Association) for 30 minutes before going to sleep every day for four 
weeks. 
  At the end of the fourth week, post-test data will be obtained by filling in PSQI, MRS 
and MENQOL again. 
Control Group; 
 • Each of the women will be informed about the purpose and content of the study at the 
first meeting, and informed consent will be obtained from the women who meet the 
conditions for participation and agree to participate. 
 • The pre-test data in the research will be obtained with the Participant Identification 
Form, PSQI, MRS and MENQOL 

 • No action will be taken on the control group for four weeks. At the end of the fourth 
week, post-test data will be obtained by filling in PSQI, MRS and MENQOL again. 
 
6. Application of Research 
           6.1. Nursing Initiative 
Experimental Groups; 
Therapeutic Touch Group: At New York University, Dr. It was developed by Dolores 
Krieger and Dora Kunz in the 1970s (Meehan, 1998). In order to perform the therapeutic touch 
application, the researcher attended the training prepared by the International Association of 
Therapeutic Touch and received a certificate (Appendix -). In order to examine the effects of 
therapeutic touch on menopausal symptoms, sleep and quality of life, women will be given 
therapeutic touch, lasting for 15 minutes, once a week for four weeks (Macrae, 2000).In the 
therapeutic touch application; 
a) The transaction will be explained to the woman, 
b) The woman will be seated on the chair, 
c) The Practitioner will center by keeping his body, mind, and emotions quiet, focused, 
prepare himself for practice, and remain centered throughout the enterprise. 
d) Goodwill will be made to help the woman get treatment, 
e) In order to scan the energy field, the whole body of the patient will be held with the 
palms of the practitioner's hands facing the patient and will be moved with a soft movement 
from 8-12 cm from head to toe, the state of the energy field will be evaluated by noticing the 
differences in the sensory cues on the palm surfaces of the hands. 
f) Sweeping movements will be done calmly, gently and rhythmically to clear and 
correct imbalances in the energy field. 
g) Energy will be modulated to restore flow 
h) The energy field will be re-evaluated, if there is an imbalance, the stages will be 
repeated. 
i) The woman will be grounded, the treatment will be terminated, 
j) The woman will be listened to and feedback will be received 
 
Music Listening Group: After the pre-test data, the women were asked to listen to the 
relaxation music included in the relaxation exercises CD prepared by the Turkish Psychological 
Association every day for four weeks in a comfortable environment at home for 30 minutes 
before bedtime. The average sleep time of women will be learned and cell phone alarms will 

be set to ring one hour before bedtime every day for four weeks to remind women to listen to 
music before bedtime. 
Variables of the Study 
Dependent Variable: The mean scores obtained from the PSQI, MSDS, and MÖYQÖ scales 
constitute the dependent variables of the study. 
Independent Variable: Therapeutic Touch and Music Concert practices constitute the 
independent variable of the research. 
Control Variables: Women's socio-demographic characteristics (age, education level, 
occupation, economic status, marital status, family type, body mass index, number of children, 
chronic disease status, smoking and alcohol use) and menopausal information (menopausal or 
not). absence, menstrual cycle and menopause duration) constituted the control variables of the 
study. 
 
Statistical Analysis of Research Data 
IBM SPSS Statistics 22.0 package for evaluation of research data program was used. In the 
evaluation of the data, percentage, mean, standard deviation, normal distribution, t-test in 
independent groups, t-test in dependent groups and ANOVA tests, multiplex linear regression 
and correlation analyzes were used. Statistical significance level p;0.05 has been accepted as. 
 
Ethical Principles of Research 
In order to carry out the research; Ethics committee approval (2021/2299) was obtained from 
the Inonu University Health Sciences Non-Interventional Clinical Researches and Publication 
Ethics Committee (Annex-) and the necessary permissions were obtained from the Inonu 
University Personnel Department (Annex-) where the research was conducted. The women 
participating in the study were included in the study after an explanation was given about the 
study before the study and an "Informed Consent Form" was received verbally and in writing. 
 
 
 
 
 
 
 
 
 
 
 

REFERENCES 
[1] 
Z. Abedian, L. Eskandari, H. Abdi, and S. Ebrahimzadeh, “The effect of acupressure 
on sleep quality in menopausal women: A randomized control trial,” Iran. J. Med. Sci., 
vol. 40, no. 4, pp. 328–334, 2015. 
[2] 
K. L. Marlatt, R. A. Beyl, and L. M. Redman, “A qualitative assessment of health 
behaviors and experiences during menopause: A cross-sectional, observational study,” 
Maturitas, vol. 116, no. March, pp. 36–42, 2018, doi: 10.1016/j.maturitas.2018.07.014. 
[3] 
“AGOG,” 2021. https://www.acog.org/womens-health/faqs/the-menopause-years. 
[4] 
M. Kamalifard, A. Farshbaf-Khalili, M. Namadian, Y. Ranjbar, and S. Herizchi, 
“Comparison of the effect of lavender and bitter orange on sleep quality in 
postmenopausal women: A triple-blind, randomized, controlled clinical trial,” Women 
Heal., vol. 58, no. 8, pp. 851–865, 2018, doi: 10.1080/03630242.2017.1353575. 
[5] 
P. A. Naghan et al., “Sleep disorders and mental health in menopausal women in 
Tehran,” Tanaffos, vol. 19, no. 1, pp. 31–37, 2020. 
[6] 
Q. Xu and C. P. Lang, “Examining the relationship between subjective sleep 
disturbance and menopause: a systematic review and meta-analysis,” Menopause, vol. 
21, no. 12, pp. 1301–1318, 2014, doi: 10.1097/gme.0000000000000240. 
[7] 
A. Moudi, A. Dashtgard, H. Salehiniya, M. Sadat Katebi, M. Reza Razmara, and M. 
Reza Jani, “The relationship between health-promoting lifestyle and sleep quality in 
postmenopausal women,” Biomed., vol. 8, no. 2, pp. 34–40, 2018, doi: 
10.1051/bmdcn/2018080211. 
[8] 
D. Cintron et al., “Efficacy of menopausal hormone therapy on sleep quality: 
systematic review and meta-analysis,” Endocrine, vol. 55, no. 3, pp. 702–711, 2017, 
doi: 10.1007/s12020-016-1072-9. 
[9] 
Y. Cao et al., “Effect of acupuncture on insomnia following stroke: study protocol for a 
randomized controlled trial.,” Trials, vol. 17, no. 1, p. 546, 2016, [Online]. Available: 
http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=119628073&site=e
host-
live%0Ahttp://ovidsp.ovid.com/ovidweb.cgi?T=JS&PAGE=reference&D=prem&NE
WS=N&AN=27852282%0Ahttp://www.trialsjournal.com/home/%0Ahttp://ovidsp.ovi
d.com/ovidweb.cgi?T=JS&PAGE=r. 
[10] A. M. Lima et al., “Loss of quality of sleep and associated factors among menopausal 
women,” Cienc. e Saude Coletiva, vol. 24, no. 7, pp. 2667–2678, 2019, doi: 
10.1590/1413-81232018247.19522017. 
[11] H. Attarian, H. Hachul, T. Guttuso, and B. Phillips, “Treatment of chronic insomnia 
disorder in menopause: Evaluation of literature,” Menopause, vol. 22, no. 6, pp. 674–
684, 2015, doi: 10.1097/GME.0000000000000348. 
[12] A. Crivello, P. Barsocchi, M. Girolami, and F. Palumbo, “The Meaning of Sleep 
Quality: A Survey of Available Technologies,” IEEE Access, vol. 7, pp. 167374–
167390, 2019, doi: 10.1109/ACCESS.2019.2953835. 
[13] O. Troynikov, C. G. Watson, and N. Nawaz, “Sleep environments and sleep 
physiology: A review,” J. Therm. Biol., vol. 78, no. October, pp. 192–203, 2018, doi: 
10.1016/j.jtherbio.2018.09.012. 
[14] H. Hachul and D. N. Polesel, “Insomnia Pharmacotherapy: a Review of Current 
Treatment Options for Insomnia in Menopause,” Curr. Sleep Med. Reports, vol. 3, no. 
4, pp. 299–305, 2017, doi: 10.1007/s40675-017-0090-3. 
[15] R. F. Afonso et al., “Yoga decreases insomnia in postmenopausal women: A 
randomized clinical trial,” Menopause, vol. 19, no. 2, pp. 186–193, 2012, doi: 
10.1097/gme.0b013e318228225f. 
[16] A. Johnson, L. Roberts, and G. Elkins, “Complementary and Alternative Medicine for 

Menopause,” J. Evidence-Based Integr. Med., vol. 24, pp. 1–14, 2019, doi: 
10.1177/2515690X19829380. 
[17] H. Özcan, S. Çakmak, and E. Salman, “Complementary and Alternative Medicine 
Methods Used for Sleep Disturbance in Menopause,” J. Turkish Sleep Med., vol. 7, no. 
3, pp. 207–213, 2020, doi: 10.4274/jtsm.galenos.2020.84803. 
[18] O. Vardar, S. Özkan, and P. Sercekus, “Postmenopozal kadınlarda uygulanan egzersiz 
programının uyku kalitesine etkisi,” Cukurova Med. J., vol. 45, no. 3, pp. 1108–1114, 
2020, doi: 10.17826/cumj.701697. 
[19]  j. V. Dall, “Promoting sleep with therapeutic touch,” Addict. Nurs. Netw., vol. 5, no. 1, 
pp. 23–24, 1993. 
[20] A. Tabatabaee, M. Z. Tafreshi, M. Rassouli, S. A. Aledavood, H. AlaviMajd, and S. K. 
Farahmand, “Effect of Therapeutic Touch in Patients with Cancer: a Literature 
Review,” Med. Arch. (Sarajevo, Bosnia Herzegovina), vol. 70, no. 2, pp. 142–147, 
2016, doi: 10.5455/medarh.2016.70.142-147. 
[21] M. J. Cordi, S. Ackermann, and B. Rasch, “Effects of Relaxing Music on Healthy 
Sleep,” Sci. Rep., vol. 9, no. 1, pp. 1–9, 2019, doi: 10.1038/s41598-019-45608-y. 
[22] Y. H. Liu, C. C. S. Lee, C. H. Yu, and C. H. Chen, “Effects of music listening on 
stress, anxiety, and sleep quality for sleep-disturbed pregnant women,” Women Heal., 
vol. 56, no. 3, pp. 296–311, 2016, doi: 10.1080/03630242.2015.1088116. 
[23] G. T. Dickson and E. Schubert, “How does music aid sleep? literature review,” Sleep 
Med., vol. 63, pp. 142–150, 2019, doi: 10.1016/j.sleep.2019.05.016. 
[24] C.-T. Chen et al., “Effect of music therapy on improving sleep quality in older adults: 
A systematic review and meta-analysis,” 2021, doi: 10.1111/jgs.17149. 
[25] J. Cohen, Statistical Power Analysis for the Behavioral Sciences., 2nd ed. 1988. 
[26] D. J.Buysse, C. F.ReynoldsIII, T. H.Monk, S. R.Berman, and D. J.Kupfer, “The 
Pittsburgh sleep quality index: A new instrument for psychiatric practice and research,” 
Psychiatry Res., vol. 28, no. 2, pp. 93–213, 1989. 
[27] M. Ağargün, H. Kara, and Ö. Anlar, “Pitsburg Uyku Kalitesi İndeksinin Geçerliği ve 
Güvenirliği.,” Türk Psikiyatr. Derg., vol. 7, no. 2, 1996. 
[28] Ö. C. Gürkan, “Menopoz semptomları değerlendirme ölçeğinin Türkçe formunun 
güvenirlik ve geçerliliği.,” Hemşirelik Forumu Derg., vol. 3, pp. 30–35, 2005. 
[29] J. R. Hilditch et al., “A menopause-specific quality of life questionnaire: Development 
and psychometric properties,” Maturitas, vol. 24, no. 3, pp. 161–175, 1996, doi: 
10.1016/S0378-5122(96)82006-8. 
[30] N. H. ŞAHİN, N. H., Kharbouch, S. B., & Şahin, “Menopozal dönemlerdeki yaşam 
kalitesinin belirlenmesi.,” Florence Nightingale Hemşirelik Dergisi, vol. 15, no. 59, pp. 
82–90, 2007. 
[31] C. T. Meehan, “Therapeutic touch as a nursing intervention,” J. Adv. Nurs., vol. 28, no. 
1, pp. 117–125, 1998, doi: 10.1097/00004650-198711000-00004. 
[32] J. Macrae, Therapeutic Touch. izmir: Ege Meta Yayınları, 2000.