Sedative Music

EFFECTS OF SEDATIVE MUSIC ON THE QUALITY OF SLEEP OF BREAST CANCER
PATIENTS
A Master’s Thesis
Proposal Presented to the
Faculty of the College of Nursing Graduate Studies
De La Salle Health Sciences Institute
Dasmarinas City, Cavite, Philippines
In Partial Fulfillment
of the Requirement for the Degree
Master of Arts in Nursing
Major in Medical-Surgical Nursing
Xin Zhang, RN
September 2019
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APPROVAL SHEET
This master’s thesis entitled, “Effects of sedative music on the quality of sleep
of the breast cancer patients”, prepared and submitted by Xin Zhang, RN, in partial
fulfilment of the requirements for the degree of Master of Arts in Nursing with
specialization in Medical-Surgical Nursing, has be examined and is recommended for
acceptance and approval for colloquium.
MA. LOVELLA M. MONDERIN-AURE RN, MAN

Thesis Adviser
THESIS REVIEW PANEL
Approved by the Committee on Colloquium with a grade of __________.
DAISY H. ALBERTO, RN, MAN, PhD MERCEDITA A. QUIAMBAO, RN, MAN

Member Member
NAOMI M. DE ARO, RN, MAN, EdD REYNALDO CRUZ, RN, MAN, EdD
Member Member
ALVIN D. CRUDO, RRT, EdD

Chair
Accepted and approved in partial fulfillment of the requirements for the degree
Master of Arts in Nursing Major in Medical-Surgical Nursing.
ALELY S. REYES, RN, MAN, PhD

Program Director
RESTITUTA C. TAN, PhD, RM, RN, RGC

Dean, College of Nursing
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TABLE OF CONTENTS
TITLE PAGE 1
APPROVAL SHEET 2
TABLE OF CONTENTS 3
LIST OF TABLES 4
LIST OF FIGFURES 5
CHAPTER
1. THE PROBLEM AND ITS BACKROUND 6

Introduction 6
Conceptual and Theoretical Framework 11
Statement of the problem
Hypothesis of the study
Scope and Delimitation of the Study
Significant of the study
Definition of the Term
2. REVIEW OF RELATED LITERATURE
Sedative music
Effects of Breast Cancer Patients to sleep
Sleep deprivation
Quality of sleep
Synthesis
3. METHOLOGY
Research
4
LIST OF TABLES
TABLE PAGE
1. The illustrated of Legend/Where of the research design.
2. The Quality of Sleep of Breast Cancer Patients among tumor
departments in hospitals in Henan Province in China in the Control
Group Before and After Sedative Music
3. The Quality of Sleep of Breast Cancer Patients among tumor
departments in hospitals in Henan Province in China in the Treatment
Group Before and After Sedative Music
4. Comparison on the Quality of Sleep of Breast Cancer Patients among
tumor departments in hospitals in Henan Province in China before
Sedative Music
tumor departments in hospitals in Henan Province in China after
Sedative Music
tumor departments in hospitals in Henan Province in China before
and after Sedative Music

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LIST OF FIGURES
FIGURE PAGE
9.1 The Independent Variable and the Dependence
Variable of Breast Cancer Patients in Hospitals in
China.
9.2 Enriching the Quality of Sleep of Breast Cancer
Patients among tumor departments in hospitals in
Henan Province in China Through Sedative Music
9.3 Profile of the Respondents According to Age
9.4 Profile of the Respondents According to civil status
9.5 Profile of the Respondents According to length of time
lack of sleep since Breast Cancer
9.6 Profile of the Respondents According to respondents’
educational background & occupation.
9.7 Profile of the Respondents According to respondents’
occupation.
Chapter 1
THE PROBLEM AND ITS BACKGROUD
Introduction
“I love sleep. My life has the tendency to fall apart when I'm awake, you know?”
― Ernest Hemingway (1899-1961)
Cancer is a serious issue in today’s World health Organization South-East Asia
Region, it has been statistically estimated that 1.1 million were killed by cancer. Most
notable one is Breast cancer it is one of the most pervasive cancer for females, and
remain increasingly a serious issue to date (“World Health Organization, 2017). Breast
cancer is the most frequent cause of death in females, incidents varies widely from
different countries, 27 out of every 100,000 people in Middle Africa and Easter Asia, and
92 out of every 100,000 people in North America. Women with low index of
development or income (15.4 per center of deaths) have more risk of breast cancer, due
to breast cancer treatment remains costly, compared to those with higher income (14.3
per center of deaths). Breast cancer in China is also the most common cancer in China
according to Jin-Li Luo, the latest data of China’s national cancer registry. An analysis
of the data shows that the cancer has increased at a rate of around 3.5% a year from
2000 to 2013, compared with a drop of 0.4% a year over the same period in the US
(Jin-Li Lou. 2017).

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With all the expensive treatments that has been serviced around the world one
important aspect that don’t seem to be vital in the treatment is proper sleep, Sleep is
vital to all human functioning, good sleep can help people easily concentrate; sleep is
also important to a number of brain functions, including how nerve cells communicate
with each other. However, sleep loss becoming a widespread problem in our daily life.
Statistics from Sleep advisor which last update on February 2019. 50 to 70 million
people in the US suffer from one or several sleep disorders (54 Shocking Sleep
Statistics, Data and Trends Revealed for 2019 n.d.). Sleep involves a complex set of
physiological and behavioral processes (Otte et al. 2015). Disruption of one or more of
these processes can result in a number of different types of sleep disturbances that may
occur independently or in combination. From one article of Sleep Medicine Research,
sleep problems are one of the major complaints in patients with cancer, before
treatment, while undergoing chemotherapy or radiation therapy, and after the
completion of cancer treatment (Sonia Ancoli-Israel. 2015). Sleep disorders (SD) is one
of the most frequent side effects experienced by patients with cancer. There are many
reasons explaining how cancer affect patients’ quality of sleep. Eric Zhou, PhD, a
clinical fellow at Dana-Farber and research fellow at Harvard Medical School, explains
that cancer doesn’t directly cause insomnia, per se, but many consequences of the
disease can trigger sleep dysfunction (Eric Zhou, 2014). Therefore, a cancer diagnosis,
side effects of treatment, undergoing chemotherapy or radiation therapy, and fear of
recurrence all can set the stage for insomnia. Sleep disorders is a common problem for
breast cancer patients (BCP), the history of formal classification of sleep disorders
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begins with the Diagnostic Classification of Sleep and Arousal Disorders (DSCAD)
published in 1979.
The next classification system was the International Classification of Sleep
Disorders (ICSD) published in 1990 and revised in 1997.This offered compatibility with
the International Classification of Disease (ICD-9). The next system was the ICSD-II
introduced in 2005 (M. Sateia, 2005). Insomnia is one common form of sleep disorders.
Insomnia is defined as a persistent difficulty with sleep initiation, duration, consolidation,
or quality, which occurs despite adequate opportunity and circumstances for sleep,
resulting in some form of daytime impairment (M. Sateia, 2014). In fact, Insomnia is
prevalent and is often a chronic problem in breast cancer patients. Study shows breast
cancer patients sleep pattern were studied through systematic investigations of sleep
disturbances (Fakih et al. 2018). Moreover, according to Kuo et al., poor sleep for
breast cancer patients caused by chemotherapy, radiation therapy, length of time
elapsed since diagnosis, recurrence of cancer, cancer stage kind of treatment, mental
reaction during treatment and diagnosis of cancer, environment, age, education,
menstruation and other factors all can cause sleep disorder ( Fahimeh Kashani, et al.
2014). Sleep disorders not only cause discomfort to patients with breast cancer and
influence their daily life and activities, but also affect existential identity, some patients
would not bother to take medicines and take treatments due to them having cancer.
Koopman et al. reported that in 63% of samples with metastatic breast cancer, one or
more types of sleep disorders were observed. (Koopman C et al.,2002) Furthermore, in
the study by Fortner et al., in 61% of a sample of 72 people with breast cancer, sleep
disorder was significantly observed.(Fortner et al. 2002). For sleep disorders, many
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factors are effective in causing sleep disorders, like using combined treatments,
including medications (e.g. benzodiazepines or melatonin receptor agonists) and non-
pharmacological treatments is also effective (Gregory M. Asnis et al. 2016). However,
using medicines would lead to many side effects like mental and psychical problem.
According to Fahimeh Kashani and Parisa Kashani reported that sedatives might cause
hypotension, weakening of vital functions, drowsiness, nausea, vomiting, and even
shock (Kashani and Kashani 2014). Moreover, Anderson and Vande Griend (2014) and
Thompson et al. (2016) conclude that the evidence on medicines should be cautious to
use in the treatment of insomnia, in the absence of psychiatric disorders, particularly in
light of its potential side-effects.
In addition, reported by an article, 80% of the populations of third-world countries
do not have access to even their basic medicines, or because of the high price of drugs,
they cannot buy and use them (Fariba Yaghoubinia et al. 2016). In recent years, there
has been increasing emphasis on exploring the effectiveness of non-pharmacological
interventions to promote sleep, such as minimizing nighttime disturbances, reducing
noise and light, increasing meaningful daytime activities, and using relaxation
techniques (such as aromatherapy, massage, guided imagery, ear plugs and eye
masks). Music therapy (MT) is one of the most common interventions of relaxation
techniques. One research based on 13 intervention studies with 1,154 participants,
which found that Relaxation techniques improved sleep quality 0–38 %, interventions to
improve sleep hygiene or reduce sleep interruptions improved sleep quantity 5 %, and
daytime bright light exposure improved sleep quantity 7–18 % (Ruth Tamrat, et al.
2014). Another study conducted that there are numerous non-pharmacologic options
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are using in clinical and several of these approaches have been found to be effective
even in patients with cognitive impairment (Nalaka S. Gooneratne et al. 2014). While
Sedative music therapy (SMT) is one of helpful therapy can be used in the treatment of
insomnia. SM refers to slow and calming songs that induces sleep, usually between 60
to 80 beats per minute, without accents, percussiveness, rhythmic complexity, or
syncopation (Andrew Manson. 2018). In one study, it mentioned that Alvin et al. found
positive effects for music in more than 80% of patients with insomnia according to
subjective and objective assessments (Chih-Kuang Chen et al. 2014). According to
Tabitha Trahan, et al. reported that 62% of respondents stated that they used music to
help them sleep among an online survey (n = 651). They reported fourteen musical
genres comprising 545 artists (Tabitha Trahan, et al. 2018).
According to my aunt’s experience, she suffered BC 6 years ago, I still remember
that she had poor sleep during that time, especially during the chemotherapy and
radiation therapy, I was interested in finding methods to help her at that time, however,
she moved to a hospital that’s in the capital of China, while I was studying, that is why, I
couldn’t help that time. After she recovered three years ago, according to what, she said
that she had listened to sedative music sometimes, which helped her before she sleeps,
the relaxing music that she would listen to it most of the time. From that moment, I
started to search about whether SM would improve the quality of sleep among BCP.
Besides, based on amount articles, there is a relationship between SMI and the quality
of sleep among BCP.

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Through reading articles and researches, I found the effect of music therapy to
sleep was proved by some researchers. For example Lafçi, Öztunç, and
Cukurova(2015) presented the effect of music therapy counseling on the sleep quality in
pregnant women; another study conducted in Singapore, which supports sedative music
listening as an effective intervention for older adults to improve sleep quality (Angela
Shum et al. 2014); one more study that conducted by Chih-Kuang Chen (2016), also
found that sedative music improved the quality of sleep by prolonging the duration of
deep sleep.
However, most existing studies mainly aim to prove whether music therapy has
an effect on sleep and whether it can promote people's deep sleep time, without paying
attention to the degree of effects, in this study, we would like to see the degree of
effects of music intervention to the quality of sleep among breast cancer patients.
Theoretical Framework and Conceptual Framework
This study is adapted to search the literature from inception until 2019 to find
relevant articles using 4 electronic databases: MEDLINE, CINAHL, PubMed, and Psych
INFO. These descriptive or intervention studies were mostly a theoretical, with no
identified theory, model, or framework. Keywords in the literature search included music,
sleep quality, and cancer.
This study was based on Model of Quality of Life and Spielman’s Three-Factor
Insomnia Model (Julie L. Otte, et al. 2010).

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MODEL OF QUALITY OF LIFE— The quality of life model identifies four areas that
define the quality of personal life. The model was developed within the nursing
discipline to describe the quality of life of cancer patients (Julie L. Otte, et al. 2010). This
model has been further studied in various cancer like breast cancer and also certified
that the specific symptoms or factors within each quality of life domain. In this study
each domain is stated to act singly or in combination with the other domains and
ultimately impact quality of life.
Spielman’s Three-Factor Insomnia Model — Spielman’s Three-Factor Insomnia
Model proposes interactions among predisposing, precipitating, and perpetuating
factors of insomnia. The model includes both stress and behavioral factors to explain
the evolution of insomnia and describe how individual differences cause initiation of
acute disturbances in sleep that become chronic. The model proposes that people with
insomnia have predisposing factors or traits that, when combined with life stress
(precipitating factors), lead to chronic insomnia if there are maladaptive coping
strategies (perpetuating factors). This cognitive-behavioral model is also known as the
3P model (Julie L. Otte, et al. 2010).
According to this study, sedative music will be an intervention method to examine
the effects of quality of sleep among breast cancer patients combined with the Model of
Quality of Life and Spielman’s Three-Factor Insomnia Model. The identified and
observed level of performance will become a significant sign to influence hypothesizes
of the study.
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Figure 1. The Independent Variable and the Dependence Variable of Breast Cancer
Patients in Hospitals in China.
Independent Variable Dependence Variable
The Effects to the

quality of sleep among
Sedative Music
breast cancer patients
Age
Civil Status
Length of time lack of sleep

since BC
Educational Background &

Occupation
Figure 1 presents the variables and their relationships, as shown in this
diagram, the independent variable in this study is sedative music, while the
dependent variable will be the effects to the quality of sleep among breast cancer
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patients. Moreover, this study will investigate the association of the demographic
variables namely age, civil status, length of time lack of sleep since Breast Cancer,
educational background & occupation.
Statement of the Problem
This study intends to exam the effects of sedative music on the quality of sleep of
breast cancer patients.
Specifically, this study answers the following questions:
1. What is the profile of the respondents in terms of age, civil status, and
length of time lack of sleep since Breast Cancer, Profile of the Respondents
According to respondents’ educational background & occupation?
2. What is the effect to the quality of sleep among breast cancer patients
before and after sedative music intervention between treatment and comparison
group?
3. Are there significant differences in the quality of sleep among breast
cancer patients before and after sedative music intervention between treatment
and comparison group?
Hypotheses of the Study

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It was hypothesized in the study that there are no significant differences on the
quality of sleep among breast cancer patients before and after sedative music
intervention between treatment and comparison group.
Scope and Delimitation
This study focuses on enriching the level of quality of sleep among breast cancer
patients, using sedative music. Through survey I will be choosing special participants,
and all the participants have to fit with the criteria.
The inclusion criteria were:
 volunteered to participate in the research,
 Hospitalization for a week
 Able to communicate,
 not having any auditory or speech problem,
 not taking any sleeping pills before or during the procedure of music-
therapy,
 aged ≥ 18 (adult age group),
 not having any psychiatric disorder diagnosis (Alzheimer, Parkinson etc),
 Not being drug – addicted.

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The research data will be based on survey on the effects of sedative music on
the quality of sleep among women with breast cancer.
In this study, it will be specific on the Stage III of Breast Cancer, revolve around
their day-to-day method of treatment pertaining to having breast cancer among women
and the significant connection between treatment and its effects.
Significant of the Study
This research may be significant to the following:
Breast Cancer Patients. The characteristic and effects of the sedative music on
breast cancer patients, and see how they respond with the intervention, if their quality of
sleep will be improved, and see if they’re wellbeing and everyday routine improves.
Breast Cancer Doctors. To be able to contribute or assess this issue towards
breast cancer patients, the result of the respondent might help us with how we will
conduct the study to get better response.
Respondents’’ families/partners. This study may help facilitate among the
families or the partners to realize the importance of family support, which can further
them to more actively participate in the rehabilitative care of the respondents. It also can
help the integrity of a family and the patient.
Nursing Administrators. This study might provide nursing administrators more
awareness on the existence, applicability and usefulness of exercise intervention on
psychological health of cancer patient.

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Nursing profession. This intervention method could be included as one of the
interventions the professional nurses can use in any type of setting in improving or
preventing their clients’ way of living, specifically the effects to the severity of lack of
sleep among breast cancer patients.
Nursing Education. This study might be able to present new information
regarding the beneficial effects of exercise intervention for breast cancer patients who
are suffering from sleep deprivation. These promising alternative nursing interventions
could enhance the students’ basic knowledge on the care of breast cancer patient in
psychological disorders.
Nursing research. This study may serve as a reference to aid further
researches on the relationships between women who are suffering or have risk of
having psychological disorder like depression. Enlightenment from lived experiences of
patients may trigger the conduct of more in-depth or evidence-based researches so that
even better nursing instruction plan can be worked out.
Nursing practice. It is possible that the result of this study can be applied to
clinical nursing work especially for continuous nursing. By gaining a better
understanding and paying attention to the lived experiences of the respondents, nurses
may realize the importance of internal and external factors on breast cancer patients
and help form more realistic, holistic and patient-centered nursing plan especially for
discharged patients and implement the necessary interventions.
Definition of Terms.
The basic terms used in this study are defined in this study:
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Civil Status. This refer to the position or standing of a person in relation to
marriage and will be classified in this study as a.) Single b.) Separated d.) Widowed.
Sedative music. Researchers used sedative music as the main mode of sleep
intervention. In addition, most studies aimed for the use of client-preferred music, or
music that has been successfully utilized and implemented in previous studies. Sedative
music refers to slow and calming songs that induce sleep, usually between 60 to 80
beats per minute, without accents, percussiveness, rhythmic complexity, or
syncopation.in this study, sedative music will include Western classic (Bach: Allemande,
Sarabande; Mozart: Romance from Eine Kleine Nachtmusik 1; Chopin: Nocturne 2),
Chinese classic (Spring River in the Moonlight, Variation on Yang Pass), and New Age
(Shizuku, Lord of Wind), and Jazz (Everlasting, Winter Wonderland, In Love in
Vain).Some genres include Western classic (Bach: Allemande, Sarabande; Mozart:
Romance from Eine Kleine Nachtmusik 1; Chopin: Nocturne 2), Chinese classic (Spring
River in the Moonlight, Variation on Yang Pass), and New Age (Shizuku, Lord of Wind),
and Jazz (Everlasting, Winter Wonderland, In Love in Vain).
Age. This a period of human, measured by years from birth. The age
respondents in this study will categorized into a.)18-25 years old, b.) 25-35 years old,
c.) 36-40 years old, d.) 41-50 years old, e.) 60 years above.
Breast cancer patients of Hospitalization. This is defined as women aged 18
years old and above who has sleep deprivation, will undergo sedative music
intervention, which will improve their quality of sleep so these breast cancer patients will
be able to do their daily routine better.

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Occupation. It is the current job of the respondents which will be further classified
as (a) blue-collar or (be) white-collar job.
Lack of Sleep. This is also known as insufficient sleep or sleeplessness, is the
condition of not having enough sleep. The symptoms including fatigue, daytime
sleepiness, clumsiness and increased appetite leading to weight gain et al.
Educational Background. It is the background of education of the respondents
which will be further classified as (a) primary (b) junior-high (c) senior-high (d) bachelor
(e) master (d) doctor
Quality of Sleep. Research will use PSQI to measure the quality of sleep of the
respondents, which is classified as (a) Poor Sleep Quality (PSQI > 5) (b) Good Sleep
Quality (PSQI ≤ 5)
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Chapter 2
Review of Literature
This chapter presents the background information about the topics covered in this
study. It includes topics from books, journals thesis, research reports, conference
proceedings and other print and electronic sources.
The conceptual literature includes the following topics: (a) Sedative music therapy,
(b) Breast cancer Patients, (c) Sleep deprivation effects, (d) Quality of sleep.
Sedative Music Therapy
Music is fundamental to human social life around the world, and there is a growing
understanding that music can be an important influence on health and well-being
(Scottish Music and Health).
Health scientists believe that high or sustained levels of effects on psychology
actions. Music can enhance brain function in reading, writing, emotional intelligence,
reasoning and memorizing in human (Miendlarzewska and Trost, 2014). Music listening
for instance, has been suggested to beneficially impact on health via stress-reducing
effects (Habibzadeh, H. et al. 2015).
Stress may be the single most significant factor related to the increasing rate of
suicide which is considered responsible for many physical and psychological problems
(Hanser, 1985). According to this, Thomson et al, (2014) have recommended the usage
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of music as a self-therapeutic resource and in the treatment of young people with
psychopathology issues such as anxiety, and stress. Music therapy additionally, is
accepted by people with depression and is associated with improvements in mood.
Music was found to be a useful tool (Samuel Ken-En Gan, et al. 2015; M. Gómez
Gallego, 2015). Arroyo Palacios (2014) presented two similar musical interfaces, which
represent heart rate data by modulating the tempo, in promoting physiological relaxation
(heart rate and blood pressure), particularly sedative music, which is characterized by
slow tempo of 60 to 80 beats per minute (bpm) with a soft dynamic range (Samuel Ken-
En Gan, et al. 2015).
Music was also found to be a useful tool in promoting physiological relaxation
(heart rate and blood pressure), which is alleviate general anxiety, particularly sedative
music, which is characterized by slow tempo of 60 to 80 beats per minute (bpm) with a
soft dynamic range (Samuel Ken-En Gan, et al. 2015).
There are some studies have had a direct focus on the effects of using music
intervention of sleep. Lafçi, Öztunç, and Cukurova(2015) studied the effect of music
therapy counseling on the sleep quality in pregnant women. In this study, it was found
out that music-therapy provided to the music group before sleep affected positively their
quality of sleep whereas the quality of sleep of control group worsened more during
hospitalization period.
While other two studies have been conducted by Shum et al. (2014), on elders
which examined the effects of sedative music in the treatment of 28 older community-
dwelling elders suffering from insomnia in Singapore; one more study also focused on
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elders, which researched by Wang et al. (2016) with community-dwelling elders in Xi’an,
China. All the studies had provided an evidence to prove the effect of sedative music.
Twenty-four young adult students at Chang Gung University were invited to
participate in one study that conducted by Chih-Kuang Chen (2016), which concluded
that sedative music improved the quality of sleep by prolonging the duration of deep
sleep. Relaxing or sedative music has been shown to influence a person’s emotional
feelings and physiological responses. one article mentioned calm and soothing music is
found to be the most appropriate in reducing pain (Esra Akın Korhan, et al. 2014).
60 patients undergoing open heart surgery were enrolled in one study conducted
by Neda Mirbagher Ajorpaz, et al., which used sedative music as intervention to
evaluate the effect on postoperative pain in patients underwent open heart surgery, a
significant difference was observed between the mean of pain intensity in the
experimental groups before and after intervention (Neda Mirbagher Ajorpaz, et al.
2014).
Another study had proved that sedative music can influence the Electrocardiogram
(ECG) of 22 young female participants (Behzad Abedi, 2016); Costas I. Karageorghis,
et al. (2017) concluded one finding that the notion that slow, sedative music can
expedite the recovery process immediately after strenuous exercise.
All studies above showed that sedative music has many effects on people whatever
pregnant, elders, children, while sedative music can also as a significant intervention to
some disease such as pain, cardiovascular, sleep distorts.

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Effects of Breast Cancer Patients to Sleep
From Breast Cancer Network Australia (2015) defines breast cancer usually form
a tumor that can often be seen on an x-ray or felt as a lump. Malignant (cancer) if the
cells can grow into (invade) surrounding tissues or spread (metastasize) to distant areas
of the body. According to WHO (2018) breast cancer is the second leading cause of
death worldwide with 2.09 million cases. The health burden of cancer in China is
increasing, with more than 16 million people diagnosed each year and 12 million people
dying of cancer. Like most other countries, breast cancer is now the most common
cancer among Chinese women; China accounts for 12.2% of all newly diagnosed breast
cancers and 9.6% of global breast cancer deaths.
The type of breast cancer is also important in determining the most effective
treatment approach. The most common type of breast cancer is known as Hormone
Receptor-Positive breast cancer; accounting for around 75% of all breast cancers.
(Roche n.d.) This type of cancer grows in response to the hormones estrogen and
progesterone, and as such is likely to respond to therapies that aim to inhibit the growth
effects of hormones. Another type of breast cancer classified by the system is ‘HER2-
positive breast cancer’ which is typified by cells that make too much of a protein known
as HER2/neu. It represents 20–30% of Hormone Receptor Positive breast cancers.
Tumors that do not overexpress HER2/neu are described as HER2-negative.
Sleep disorders are common and persistent symptoms of cancer survivors,
especially those with a history of breast cancer. Most breast cancer survivors report
sleep disturbances within a few months of diagnosis, and 18% report continued
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insomnia 3 to 4 years after diagnosis. Importantly, sleep disorders predict poor quality of
life (Laura Q. Rogers,2015).
According to the National Comprehensive Cancer Network (NCCN) guidelines,
regular exercise is recommended as part of the “General Sleep Hygiene Measures” and
treatment for sleep disorders in cancer survivors. Sleep disruption and fatigue are
prevalent in early breast cancer patients and may affect clinical outcomes such as
cancer progression and survival. Significant levels of sleep disruption and fatigue have
been demonstrated after surgery and prior to adjuvant therapy, and chemotherapy
and/or radiation therapy may exacerbate this condition (Sara Vargas, et al. 2014).
Based on Kavita D. Chandwani, et al. (2014) , radiation therapy (XRT) is usually
the last step in a multimodal treatment regimen for women with breast cancer. Patients
often receive treatment-related adverse effects (fatigue, pain, lymphedema, neuropathy,
cardiotoxicity, sleep disorders, and cognitive problems) that have a negative impact on
the physical, psychological, social, and spiritual aspects of quality of life (QOL) and may
result in Negative health consequences.
According to Sheau-Yan Ho,et al. (2014), numerous studies have examined
individual symptoms of depression, fatigue, and sleep disorders in cancer populations;
however, a growing body of literature suggests that certain symptoms often co-occur
with symptomatic groups of cancer patients. Symptom clusters consist of three or more
complications that are related to each other. The existing literature supports depression,
fatigue and insomnia as a cluster of symptoms of cancer type, as measured by a
moderate correlation between all pairs of these symptoms simultaneously measured.

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Sleep disorders, fatigue and depressive symptoms are common in breast cancer
(BC) patients and often have a negative impact on them. These symptoms usually
precede the onset of chemotherapy and significantly affect the patient's quality of life
(QOL). However, little is known about the trajectories of these symptoms over time,
especially after the end of chemotherapy (F Gaston-Johansson, et al 2015). The most
common sleep-related complaints in many cancer patients are symptoms of insomnia.
Difficulties in sleep, 66% reported that they had insomnia before cancer
diagnosis, and 58% reported that cancer aggravated their sleep problems. The fact that
cancer exacerbates sleep suggests that the challenges faced by cancer patients may
persist insomnia, which in turn may exacerbate other symptoms associated with cancer.
Although insomnia often becomes chronic in other populations, little is known about the
long-term trajectory of insomnia in cancer patients, especially after treatment (Sonia
Ancoli-Israe et al. 2014).
A study found that 80% of patients receiving chemotherapy and more than two-
thirds of patients with metastatic breast cancer have poor sleep, which is associated
with many negative physical and mental health outcomes. Sleep duration and
interruption are associated with mortality. However, the exact relationship can be
complicated, as some studies have shown that short sleep duration is associated with
earlier mortality, while other studies indicate that this relationship is a secondary
relationship, with shorter and longer sleep durations. Both can predict a shorter lifetime
(Oxana Palesh, et al 2014).

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One study, through investigated three time points: non-depressive symptoms of
breast cancer patients, coexistence and interrelationship between fatigue and sleep
disorders: pre-treatment after adjuvant chemotherapy, 6 to 8 months after treatment and
after treatment. Pasquale F. Innominato et al. (2016) support the view that depression,
fatigue and sleep disorders manifest as symptom clusters. Fatigue may precede non-
expressive symptoms of depression in premenopausal women with breast cancer and
represent potential intervention targets.
Although there are many factors that affect the quality of sleep in breast cancer
patients. One study found that young survivors of breast cancer (YS) often reported
more survival symptoms such as fatigue, depression, sexual difficulties, and cognitive
problems than older survivors (OS). Even more importantly, YS performs worse than
AC and OS in terms of body image, anxiety, sleep, marital satisfaction, and fear of
recurrence (Victoria L. Champion, et al. 2014).
Sleep deprivation
Sleep deprivation is defined as obtaining inadequate sleep to support adequate
daytime alertness, Sleep deprivation is inversely proportional to hours of sleep and it
may have a substantial adverse effect on general health and quality of life, Sumi Rose,
et al (2018), Sleep is an important biological necessity, Cognitive functions can be
defined as cerebral activities that lead to knowledge, including all means and
mechanisms of acquiring information, it’s importance to our daily performance is
essential.
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Lack of sleep is a common condition in everyday life, either related to
psychosocial demands or related to working shift hours. In healthy individuals, this may
induce decreased alertness and vigilance, Klumpers UMH, et al. (2015), researched
that together with a general decline in mood. Total sleep deprivation (TSD) has been
associated with general psychomotor slowing and diminished cognitive performance. In
affective disorders, only one night of sleep deprivation may improve mood in 40–60% of
subjects with major depressive disorder, whereas bipolar patients may even turn into
(hypo)mania. Thus, in humans, sleep deprivation is clearly related to altered emotional
and affective functioning. Sleep is a normal human function that is detrimental to
sustaining life yet; individuals are affected differently by their sleep schedule, when an
individual routinely has poor sleep habits paired with sleep loss can have a negative
impact on one’s health. By failing to obtain an efficient amount of sleep each night, there
is an increased possibility of there being one or more adverse effects on the individual’s
cognitive capabilities. Mathew Schumacher, et al (2015).
Jean C.J. Liu, et al. (2015), Overlooked that sleep deprivation is also modulate
reactivity to episodic psychosocial stress. To date, only two human studies have
explored the effects of sleep deprivation on stress reactivity. Wright et al. (2015) Cortisol
and inflammatory proteins are released into the blood in response to stressors and
chronic elevations of blood cortisol and inflammatory proteins may contribute to ongoing
disease processes and could be useful biomarkers of disease. How chronic circadian
misalignment influences cortisol and inflammatory proteins, however, is largely
unknown and this was the focus of the current study, sleep-wakefulness physiology
28
modulate daily patterns in most behavioral and physiological systems which triggers
physiological stressors.
Sleep deprivation is common among university students, and has been
associated with poor academic performance and physical dysfunction, due to the
burden of academic work and social pursuits. The reasons for poor sleep hygiene
include alcohol and caffeine intake, stimulants, and technology, which prevent students
achieving sufficient sleep time and quality, Yusuf Patrick, et al (2017).
Bahammam, et al (2015) revealed that sleep deprivation is associated with poor
academic performance. A sleepy fatigued person is accident prone, judgment impaired,
and more likely to make mistakes and bad decisions as well as it affects the academic
performance of the medical student.
Lafçi and Öztunç (2015) mentioned some symptoms that sleep disorders may
result in fatigue, tiredness, depression and problems in daytime functioning. The
importance of sleep is nowadays recognized in the field of economics, where it is shown
that sleep disturbances contribute to decreased the employees’ performances at a high
cost for the employers, In general, the lack of sleep affects working memory, creativity,
decision making, multitasking ability, response time, and focus [4]. Not getting enough
sleep prevents the brain from restoring its effectiveness, as it needs to work harder to
accomplish the same amount of work, Davide Fucci, et al (2018). Ming Ye, et al (2018)
revealed that the brain functional network of the clustering coefficient, characteristic
path length and local efficiency are significantly increased but the global efficiency
decreased significantly in sleep deprivation. Additionally, significant alterations in nodal

29
efficiency were also found in sleep deprivation, involving anterior cingulate, inferior
parietal, supramarginal gyrus, caudate nucleus, thalamus are significant decreased, and
the middle temporal gyrus are significant increased.
Sleep deprivation can adversely affect the brain and cognitive function. A 2000
study, by the UCSD School of Medicine and the Veterans Affairs Healthcare System in
San Diego, used functional magnetic resonance J Psychiatry Psychiatric Disord imaging
(fMRI) technology to monitor activity in the brains of sleep-deprived subjects performing
simple verbal learning tasks. The study showed that regions of the brain's prefrontal
cortex, an area that supports mental faculties such as working memory and logical and
practical ("means-ends") reasoning, displayed more activity in sleepier subjects.
Researchers interpreted this result as indicating that the brain of the average sleep-
deprived subject had to work harder than that of the average non-sleep-deprived
subject to accomplish a given task. They therefore concluded that the brains of sleep-
deprived subjects were attempting to compensate for adverse effects caused by sleep
deprivation. In 1998, Watts and Strogatz found the small worm’s neural network shows
the feature of small world, and concluded that human brain system also has a complex
network of small-world properties, then studies confirm the inference. Since then,
human brain research became the branch of the complex networks, which widely used
to study brain diseases, cognitive tasks, and the others. Many brain diseases reflects
the small world property degenerate, which tend to random networks when compared
with the normal control, such as Alzheimer's patients, and attention-deficit/hyperactivity
disorder (ADHD) patients.

30
Studies showed that sleep deprivation, disrupts many aspects of our health body,
mind is affected and our daily lives are burdened by this mental/physical impairment.
Sleep deprivation can aff ect human abilities and neural functioning in various
ways. Th e occurrence of these diff erent eff ects of sleep deprivation has been
observed in previous studies by tracking changes at the macro, meso and micro levels
The macro level describes the effect of sleep deprivation on human behavior,
including cognitive functions, emotional processes, muscular activity, kinematics, as
well as a range of behaviors that involve crude changes in large brain regions such as
the prefrontal cortex, thalamus and hippocampus. The meso level entails studying the
effect of sleep deprivation at the level of neural activity from larger areas of the brain all
the way down to smaller clusters of cells. Cell clusters at the meso level still manage to
form more or less well defi ned functional units in terms of structure (e.g., the
hypercolumn in the visual cortex) and in terms of activity (e.g., neural synchrony).
Finally, the micro level deals with the molecular and cell level, i.e. the level of ion
channels, gene expression and protein synthesis. Besides the fact that studies on sleep
deprivation use various forms of sleep deprivation and look at variables at diff erent
levels of neural functioning, it is also important to mention that they are conducted on
human volunteers or by means of experimental animal. In this regard, direct evidence
for sleep deprivation in humans has mostly been looked for in indicators of the macro
level functioning. The meso level is alsorelatively well researched in human beings,
while changes at the molecular and cell level have been researched mainly by using
experiments on animals. In review articles, the results gathered from human subjects at
31
the macro level of functionality (e.g., reduced ability of cognitive tasks or changes in
electroencephalography (EEG) rhythm) are often explained by cellular mechanisms
studied in rats (e.g., increased amounts of adenosine in certain parts of the brain)6 .
Such an approach in solving the problem of the eff ect of sleep deprivation on neural
functioning in humans is incomplete; however, for now, it offers an accessible manner of
researching the problem, as well as a possible basis for targeted search for specific
mechanisms in human subjects in future studies (within the realm of possibility). In
human life, the periods of activity and rest alternate. In order to survive, human beings
need to work, and in order to be able to perform everyday activities properly they need
sleep. For this reason, nature has designated cyclic (circadian) alternation of waking
and sleeping periods. Being too occupied with everyday life, people nowadays
frequently neglect their need for sleep, which can lead to a number of disorders in
various body systems and subsystems. Modern society often makes it imperative to
increase productivity, even at the cost of sleep deprivation. However, research has
shown that it is not wise because a longer period of sleep deprivation or chronic
shortening of its duration will necessarily lead to a decline of cognitive functions in
individuals, thus also leading to a decline in the quality of their productivity. Sleeping is a
natural state of the human body, which involves cyclic alternation of two main stages,
non-rapid-eye movement (NREM) sleep and rapid-eye movement (REM) sleep. NREM
sleep consists of stages 1 (N1) and 2 (N2) light sleep, which is followed by stages 3 and
4, during which deeper, slow-wave-sleep (SWS) occurs. A night of suffi cient sleep
consists of five to six major phasic changes (cycles). Despite the fact that each major
sleep cycle lasts for 90 minutes, the duration of individual phases within the cycle
32
changes during the night in such a way that the REM phase gradually deepens,
whereas the NREM phase shortens. The sleep cycle is clearly structured, considering
that each sleep phase is characterized by specific chemical, cellular and anatomic
events Tatjana Trošt Bobić, et al (2016). Sleep deprivation and deficiency have a high
prevalence in western societies. The National Sleep Foundation reported that less than
half (44%) of all Americans receive a good night’s sleep almost every night [5].
According to the National Institute of Health, sleep deficiency is a broad concept that
occurs (a) if an individual does not get enough sleep (sleep deprivation), (b) if an
individual’s sleeping habits are out of sync with the body’s natural circadian rhythm
(sleeping during the wrong time of the day), and (c) if the quality or quantity of sleep is
diminished due to a sleep disorder or external factors [6]. Our review will focus on four
specific variations of sleep deficiency: insomnia, acute total sleep deprivation (TSD),
partial sleep deprivation (PSD), and night shift workers. Acute TSD refers to the
avoidance of sleep for a period of at least one night. PSD, or sleep restriction, refers to
the reduction in the total sleep time relative to one’s usual baseline during a 24-hour
period. PSD is the most common form of sleep deprivation encountered in everyday life
in modern societies. Insomnia is defined as a predominant complaint of dissatisfaction
with sleep quantity or quality, associated with one or more of the following symptoms:
difficulty initiating sleep, difficulty maintaining sleep characterized by frequent
awakenings or problems returning to sleep after awakenings, or early morning
awakenings with inability to return to sleep [8]. A shift worker is anyone who follows a
work schedule that is outside the typical “9 to 5” business day. According to the Bureau
of Labor Statistics, millions of Americans are considered shift workers, including doctors
33
and nurses, pilots, bridge builders, police officers, customer service representatives,
and commercial drivers. Such workers often do not sleep in sync with the circadian
rhythm, are sleep deprived, and experience frequent sleep disturbances. In contrast to
insomnia, there is more literature on the effects of TSD on endothelial function. One
particular study which examined cardiologists on call for 24 hours showed that, after
being on call, along with an increase in blood pressure (BP), thirteen out of the fifteen
physicians had a brachial artery dilatation that did not reach 4.4%, and five of them did
not have any dilation at all. This analysis attributes the difference in endothelial function
to stress since it is traditionally accepted that mental stress is linked to activation of the
sympathetic nervous system, Michelle Kohansieh, et al (2015).
Quality of sleep
Despite its utter mundanity, sleep resists simple scientific explanation. It appears
to recuperate the body and refresh the mind, but exactly how isn’t at all clear. The brain
appears to be as active in some of the throes of somnolence as it is in sustaining
wakefulness. By inquiring into all that happens in the brain and body during sleep,
researchers aim to paint a more complete picture of why people sleep—and why sleep
sometimes goes awry, as Science News staff writers Tina Hesman Saey and Laura
Sanders report in this special section. Scientists seeking the reasons for sleep hope to
discover some evolutionary insight: Mammals sleep presumably because it offers some
survival advantage. But recent work suggests that explaining sleep as an adaptation for
saving energy doesn’t add up. Scientists are skeptical that saving energy is the only (or
even the main) reason that sleep has evolved, as described in the article “The why of
34
sleep.” Extreme fatigue is the closest humans ever come to sleep while still aware
enough to ponder its mysteries. At those times, sleep pulls hard, like a current sweeping
up a tired mind, carrying consciousness away. How the brain controls this transition
between wake and sleep lies at the heart of disorders such as insomnia and narcolepsy,
as discussed in “Sleep gone awry. According Omar I Modayfer, et al (2016), sleep
quality is defined as “the degree to which restful sleep is maintained during the night,
where a healthy normal individual feels refreshed upon waking up and throughout the
day.” Restful sleep is graded based on the following parameters: Latency until sleep
onset, wakefulness after sleep onset, and/or the duration of sleep. Sleep has many
important effects on the human body. One of its most important effects is on one’s
memory, where it plays a role in stabilizing perceived information and facilitating
generalized knowledge.
Sleep deprivation is a very common behavior observed, especially in students
during their academic life. The severity of sleep deprivation differs among students, but
the psychological link and behavioral changes seen in patients are very much alarming,
his study shows that 21% of poor sleepers failed 1 or more years at school while similar
problems were observed in just 11% of normal sleepers. General health problems affect
the sleep quality with stress being the most common one. As a medical student when
experiencing such stress, this will eventually cause poor sleep quality, it also will have a
significant influence on one’s cognitive performance. Thus, affecting the academic
performance, which is seen mostly in the students’ attention span, memory
consolidation, and encoding. Physical and psychological health is also compromised
with poor sleep quality and the percentage of disorders increases with the severity of
35
the condition. All students experience stress, but the tremendous amount of knowledge
a medical student is required to obtain in a short time period induces stress leading
eventually to poor sleep quality and late nocturnal sleep associated with daytime
sleepiness. Many hormones, such as growth hormone, are produced in a cyclic manner
correlating with the sleep-wake cycle, suggesting that growth and tissue repair may
occur during sleep. Another hormone produced towards the end of the night is the
stress hormone cortisol, which begins to increase in preparation for the anticipated
stress of the day, usually capped by a particularly large increase (up to 50%) about 20–
30 minutes afer waking, known as the cortisol awakening response. Although sleep is
one of the basic needs of human beings and is important to their health its problem has
a wide range of causes including medical and psychological conditions. Some sleep
problems are caused by restriction of the upper airway, while others are caused by
genetic conditions. Other factors that affect sleep are age, medications, diet, and
environmental factors, such as shif work. Sleep problem covers a broad spectrum of
symptoms and is mostly characterized by one or more of symptoms like fatigue, inability
to fall asleep at night, inability to stay asleep at night, excessive daytime sleepiness,
loud snoring or gasping sounds during sleep, sleep attacks or unintended episodes of
falling asleep, loss of muscle control or inability to move, and unusual behaviors such as
sleep walking. While sleep problems have existed for centuries, it is only within the last
3 to 4 decades that attention has focused on their diagnosis and classifcation, Hiwot
Berhanu, et al (2018).
More than 30 years ago, Rechtschaffen et al1 demonstrated that sleep is just as
necessary as food for bodily survival. Yet, as recently as 2005, Hobson has argued that
36
“sleep is of the brain, by the brain, and for the brain.” In 2007, systems biologist Van
Savage and theoretical physicist Geoffrey West concluded that the reason why small
mammals with a high metabolic rate like the mouse sleep so much longer,
approximately 14 hours per day, than large mammals with a low metabolic rate like the
elephant, which sleeps only 3.5 hours per day, is that the core function of sleep is to
repair, reorganize, and maintain the brain's neurons, which burn more energy per unit
mass than any other tissue.The landmark discovery that sleep facilitates the clearance
of toxic metabolic debris, including amyloid β, that is generated by neural activity and
accumulates during wakefulness, supports and extends that theory. Evidence of the
crucial role that sleep plays in brain development, synaptic pruning, plasticity, rehearsal,
memory consolidation, learning, and insight further supports the conclusion that sleep is
critical for brain functioning, rather than simply serving to keep us out of trouble at night.
Moreover, in the 15 years since Eve Van Cauter and her colleagues at the University of
Chicago discovered that sleep deficiency adversely impacts metabolic and endocrine
functions, it has been demonstrated unequivocally that the duration, timing, and quality
of sleep also critically affect physical health, mental health, performance, and safety.
Thus, it is clear that sleep is critical not just for optimal brain functioning but also for
optimal functioning of the body as well. Recent data indicate that 28% of Americans
report obtaining insufficient sleep on most nights, and only 31% of Americans report
consistently obtaining sufficient sleep. In fact, 30% of civilian workers and 44% of night
shift workers in the United States are sleeping less than 6 hours per night and this
fraction is only likely to rise. Rigorous physiological studies have demonstrated that just
a week or two of sleep curtailment increases appetite and food intake decreases insulin
37
sensitivity and glucose tolerance, even in adipose tissue removed from sleep-deprived
participants, impairs the immune response to vaccination, degrades the ability to resist
infection, disturbs mood, increases the vulnerability to attentional failures and, when
combined with prior chronic circadian disruption, impairs pancreatic β-cell
responsiveness. Concurrently, epidemiologic studies have revealed that habitually short
sleepers have an increased prevalence of obesity; that short sleep duration in young
children confers an increased risk of obesity in older children and adults and that
habitually short and habitually long sleepers are at increased risk for incident
calcification of the coronary arteries incident coronary heart disease incident type 2
diabetes, incident stroke and death, Charles A Czeisler, et al (2015).
One of the important physiological processes in humans is sleep. The study of
sleep quality includes measurement of both quantitative and qualitative components.
Quantitative components of sleep measures the duration of sleep whereas qualitative
component assesses the subjective measure of the depth and feeling of restfulness
upon awakening. Studies have shown that sleep deprivation causes serious health
hazards. Some studies have linked reduction in sleep duration and sleep quality to
changes in life style, increased work and social demands and also excess use of
technology.
Studies done on university students have reported that stress, anxiety and
depressive symptoms are common psychological correlates found among them and
there is a direct relationship between sleep quality and academic performances. Studies
have shown sufficient, sleep and shorter sleep latency lead to higher academic
38
performances and insufficient sleep lead to fatigue, concentration and attention
disturbances. Sleep deprivation also results in school absenteeism and suppression of
other cognitive functions like abstraction and problem solving. Medical students are a
group who have high risk for sleep deprivation because of demanding clinical duties and
academic expectations. Along with this they have to accept the change in their living
style like poor housing, staying away from their family. The above mentioned factors put
them at a greater risk of reduced sleeping and affect their physical and mental activities,
Renu Lohitashwa, et al (2015). Sleep-associated problems cause morbidity, increase in
mortality, and decreased life quality. Sleep problems are important for patients with
psychiatric disorders as for all hospitalized individuals. Epidemiological studies
conducted in the general population indicate a positive correlation between
psychopathology and sleep disorders. It is stated that the incidence of a sleep disorder
in patients with psychiatric diagnoses varies between 50% and 80%. Sleep disorders
are quite common in patients with anxiety, depression, bipolar disorder, and
hyperactivity. Insufficiency of sleep quality in individuals with psychiatric disorders may
cause an occurrence of signs such as tiredness, concentration loss, hallucination,
delusion, and loss of interest. Additionally, inpatients receiving treatment in psychiatric
clinics often complain about sleep disorders. These patients usually mention subjective
sleep complaints such as shortened duration of sleep duration, increased duration of
falling asleep, frequent awakening, and failure of having deep sleep. It is known that
inpatients have a variety of sleep disorders because of both environmental and personal
reasons. Common environmental factors leading to sleep disorders are noise, bright
39
light, and recurrent staff interventions. Moreover, endogenous factors for these patients
are delirium, depression, stress, and pain, Birgül Özkan, et al (2015).
Sleep problems are frequently seen in patients having psychiatric disorders, and
decrease in sleep duration, frequent awakening, and change in sleep stages are
indicated in objective sleep assessment. These sleep disorders added to their chronic
diseases further lowers the functional living and life qualities of the patients.
In a study by Sayyeda Sakina Maryam, et al (2017), undertaken at a specialized
women's health service at a teaching hospital located in Campinas (SP), the author
observed that the main factors patients mentioned as being responsible for the
interruption of their night sleep were environmental factors, such as the care health
professionals provided to them (92%) and their fellow patients (84%). In addition to
these factors, among female patients, 44% referred to the noise caused by equipment
placed near the bed, the noise caused by patients who were generally in poor health or
who were agitated and the need to use the bathroom or the urinal. Excessive lighting
was cited as an influential factor by 52%, and environment noises were cited by 36%.
Many patients experience sleep disturbances and a reduced quality of sleep
while hospitalized. Studies have shown that a person with a disease and/or a bodily
injury has an increased need for sleep. Patients’ experiences of sleep should govern
how sleep disturbances should be managed. Studies describe how nursing staff often
wake patients to assess vital signs and to perform other important procedures that are
necessary for the patients’ care. Little regard, however, is given to the patients’ sleep.
40
Some studies suggest that nursing care should be based on the patient’s perspective,
Linda Gellerstedt, et al (2014).
Lack of restorative sleep and altered sleep-wake cycle is a frequent problem
among patients admitted to the Intensive Care Unit (ICU). This study was conducted to
estimate the prevalence of poor sleep and patient’s perspective of factors governing
poor sleep in the ICU. A cross-sectional study was performed in medical ICU of a
tertiary care hospital. A total of 32 patients admitted to the ICU for at least 24 h were
recruited. A 72-h actigraphy was done followed by a subjective assessment of sleep
quality by the Richards-Campbell Sleep Questionnaire (RCSQ). Patient’s perspective of
sleep quality and quantity and possible risk factors for poor sleep were recorded. Sleep
is an indispensable physiological need often underestimated and disregarded especially
in critically ill patients. Sleep in them is highly fragmented; therefore, they lack deep
restorative REM sleep. Around 38.5% of the patients who survived critical illness and
were on mechanical ventilation (MV) for at least 48 h reported not being able to sleep
well, 40% of the study group remembered frequent awakenings in the night, and 35%
recalled having had difficulty falling asleep during their Intensive Care Unit (ICU)
admission. Sleep deprivation has been associated with the release of inflammatory
cytokines, worse cardiovascular outcomes, poorer immunological response, etc. Sleep
disruption induces a catabolic state, impairs cellular and humoral immune response,
and causes respiratory dysfunction due to muscle fatigue and central respiratory. Sleep
disturbances are known to impair consolidation of memory and cognitive function,
Ramavath Devendra Naik, et al (2018).

41
Sleep disturbance in the clinical environment has been attributed to several
extrinsic factors such as ambient noise, exposure to artificial lighting and clinical
interactions. Noise has been the most studied sleep disturbing factor with reported
noise levels frequently exceeding the World Health Organization (WHO) recommended
nocturnal noise levels of less than 30 dB (A) in the clinical environment. Studies report
ambient noise levels ranging from 50 to 60 dB(A) in intensive care, and 40 to 55 dB(A)
in the general ward environment. The clinical environment may also influence the
circadian rhythm of sleep as artificial lighting can suppress melatonin production.
Melatonin plays an important regulatory role in sleep–wake patterns, and exposure to
artificial light during the sleep phase can adversely affect patients’ perceptions of the
quality of their sleep. Environmental temperature has also been identified as a factor
that can induce misalignment of sleep–wake cycles, which can affect the restorative
sleep phases of slow wave and rapid eye movement sleep, Lori J. Delaney, et al (2018).
Most patients admitted into the intensive care unit (ICU) experience more severe
symptoms and a higher likelihood of death. This increases their nursing needs and
requires the patient to undergo continuous and intensive observation. The ICU is
surrounded by medical teams and a variety of mechanical devices. The fear of being an
ICU patient, uncertainty about the future, isolation from family, financial pressure, and
exposure to an unfamiliar environment results in severe emotional imbalances in
patients. In the ICU, a hospital’s entire medical capacity is concentrated on providing
patients with life-threatening illnesses with a chance at recovery. In the ICU
environment, most patients experience stress due to anxiety about their prognosis; the
unfamiliarity of the ICU and its treatment; limited visiting hours; the pressure of the
42
inspection process; and cognitive, emotional, and behavioral stress depending on the
dispositions of medical team members. This can cause the patient to resort to
inappropriate coping methods. Relatives of ICU patients report high levels of anxiety,
depression, and feelings of panic, chaos, and a need for constant vigilance.
Psychological instability typically occurs when exhaustion starts to accumulate from
stress, and the sympathetic nervous system, which maintains the body’s state of
equilibrium, is activated, Eun Hee Cho, et al (2017).
Aside from the stress that accompanies illness, hospitalization is a stressful life
event that brings about changes in one’s daily life and the activities that they engage in,
having good quality of sleep is important it affects each and every part of our activity
exhaustion itself is deadly when left uncheck it could boom into different types of other
disorders.
43
Synthesis
This chapter is composed of the conceptual and research literature to give
background information to this study. The main focus is to determine the effects of
sedative music on the quality of sleep of breast cancer patients.
Based on the review of literature, several studies have been conducted that
prove the effectivity of sedative music. As Angela Shum, et al. (2014) utilized guided
sedative music in order to decrease symptoms associated with the quality of sleep and
provide relief of elders from anxiety and worry associated with illness. Additionally,
Chih-Kuang Chen, MD， et al. (2014) investigated the effect of sedative music on the
different stages of the sleep cycle in young adults with various sleep latencies.
According to Samuel Ken-En Gan， et al. (2015) utilized medication with audio
simulation in reducing anxiety of significant others of students in James Cook
University, Singapore. Neda Mirbagher Ajorpaz ， et al. (2015), music (especially
sedative music, those slow and calming songs) influences the pain signs, stress and
anxiety levels of postoperative patients. It helps reduce postoperative pain.
This study, familiar to those previously conducted utilized sedative music therapy
to determine any response brought about by the said interventions. The respondents
with breast cancer and even taking analgesic &/or anesthetic medicine still have poor
sleep, which will measure using PSQI, the score above 5 means poor sleep. The
intervention of sedative music will utilize improve the quality of sleep. And in mental
area, sedative music can reduce the risk of depression for patients.
44
This study focuses only in the breast cancer patient, who is taking analgesic &/or
anesthetic medicine still with poor sleep. other medical conditions are not taken into
consideration, rather the respondents are purposively chosen, basing from the given
criteria, particularly for this study. The results yield, therefore, do not encompasses
other medical conditions.
In general, based on historical background and numerous studies sedative music,
in this study, the results of the study will show empirical evidence of the positive effect
of sedative music on the quality of sleep of breast cancer patient.

45
Chapter 3
This chapter deals with the research procedure that is utilize in this study. These are
presenting in the following sections: (a) Research Design (b) Research Locales (c)
Respondents of the Study and Sampling Technique (d) Research Instruments (e) Data
Gathering Procedures (f) Statistical Treatment of Date
METHODOLOGY
Research Design
This study utilized the quasi experimental design specifically the nonequivalent
control group design or the pretest-posttest control group design. Participants listened
on hours of sleep with the duration of 4 hours at night to sedative music (experimental
group) at bedtime for 1 week.
The research design is illustrated as follows:
Treatment O1 X O2 X O3 X O4 X O5 X O6 X O7
Comparison O8 O9 O10 O11 O12 O13 O14

46
Table 1 The illustrated of Legend/Where of the research design.
Legend/Where
O1= Treatment group pre-test 08= Comparison group pre-test
O2= Treatment group post-test O9= Comparison group post-test
X= Sedative music Intervention
Research Locales
This study was conducted at the department of hospitals in China
Respondents of the Study and Sampling Technique
Perla A. Vargas, et al. were illustrated that the PSQI > 5 can be identified that
people have problem of sleep in 2014. This study involved 40 respondents aged 18 and
above, will be divided to two group, each group in a special department of hospital, one
group combine 20 breast cancer patients with the problem of quality of sleep (PSQI> 5)
with sedative music intervention, while another group also has 20 breast cancer patients
with sleep problem with sedative music intervention. 20 breast cancer patients were
47
assigned as the treatment group and the others were assigned as the comparison
group.
Probability sampling will be use in the study in which the researcher deliberately
chose that include patients with breast cancer, then using PSQI exam patients’ quality
of sleep (PSQI> 5), after that choosing the respondents from those patients who are
willing attend this study.
In this sampling plan, the total population is divided into these groups (known as
clusters) and the patients with Breast Cancer Stage 3 taking analgesic &/or anesthetic
medicines who still only will be selected. The elements in each cluster are then sampled
( Tim Guetterman, 2015). In this study, I’m going to recruit participants who across the
requirements of standards of patients and who both have sleep problem based on the
survey of PSQI (PSQI> 5).
Research Instruments
The following research instruments were used in the study:
1. Participant’s Date Sheet. This was originally drafted by the researcher and the first
part of the tool that was used to gather the demographic data of the respondents: age,
civil status, length of time lack of sleep since Breast Cancer, education & environment,
history check of medical concerns and the respondents ID number to determine
whether the particular participant is in the comparison or control group based.

48
2. Pittsburgh Sleep Quality Index [PSQI]. Bianchi (2013) defines PSQI is a self-rated
questionnaire which assess sleep quality and disturbance over a 1-month time interval.
Nineteen individual items generate seven “component” scores: subjective sleep quality,
sleep latency, sleep duration, habitual sleep efficiency, sleep disturbance, use of
sleeping medication, and daytime dysfunction. The sum of scores for these seven
components yields one global score. Each item is weighted on a 0–3 interval scale. The
global PSQI score is then calculated by totaling the seven component scores, providing
an overall score ranging from 0 to 21, where lower scores denote a healthier sleep
quality.
Data Gathering Procedures
The following steps were undertaken for the data gathering:
Phase I: Social Preparation:
Prior to the initiation of the study, the researcher secured a letter regarding the
ethical consideration and research approval from the Independent Ethics. Committee of
De La Salle Health Sciences Institute
Phase II: Data Gathering:
The actual data gathering was further divided into four phases which includes:
Coordination Phase, Facilitation Phase, Application of the Intervention and Post
Intervention Phase
49
Coordination Phase
1. The researcher coordinated with the officer-in- charge of the involved
institution regarding the nature and purpose of the study, the flow of the research
was coordinated with the concerned officials and personnel of the institution.
2. The researcher then made a survey and a list of the patients that were
qualified to be participant in the study.
The inclusion criteria were:
 volunteered to participate in the research,
 Hospitalization for a week
 Able to communicate,
 not having any auditory or speech problem,
 not taking any sleeping pills before or during the procedure of music-
therapy,
 aged ≥ 18 (adult age group),
 not having any psychiatric disorder diagnosis (Alzheimer, Parkinson etc),
 Not being drug – addicted.
3. The qualified list of participants will be forward to the office-in-charge for
reference and approval.
Facilitation Explanation of the Study and Pre-intervention Phase
This was where the researcher conducted his data gathering. Prior to the
administration of intervention, a series of steps were undertaken in BCP to generate

50
relevant data from the respondents and determine their qualifications as respondents in
the study.
The researcher introduced himself and facilitated the explanation of the scope of
the study to the respondents using the written informed consent.
5. When the respondents agreed, the written informed consent, which the
researcher for the purpose of this study made, was given to the client to sign indicating
that she is willing to participate in the study.
6. After signing the written informed consent, this was followed by filling-out of
the Participant’s Data Sheet for the determination of the client's profile and the adapted
PSQI to determine if respondents have sleep problem.
7. Once finished, the researcher prepared the materials needed for the
intervention.
Treatment Group:
Application of Treatment
8. The intervention consisted of the following:
a. Participants listened on hours of sleep with the duration of 4 hours at night to
sedative music (experimental group) at bedtime every night for 1 week.
b. Participants would be asked to listen, especially the advised sedative music
and would be also encouraged not to use relaxation techniques or do physical
activity in bedtime.
51
9. On day two to seven, the above activity will be followed.
Post Intervention
10. After the application of every intervention, the researcher assisted the
participants in filling-out the Pittsburgh Sleep Quality Index [PSQI] on the
following morning.
Comparison Group
All the phases in data gathering for the treatment group will be used in the
comparison group except phase Ill, which is the intervention phase wherein the
participant will undergo listening to sedative music.
Statistical Treatment of Date
The following statistical treatments were used to answer the specific problems
and to test the hypothesis of the research. (a) Percentage Distribution, (b) Mean, (c) T-
test for independent variables, and (d) Percentage Change
a.) Percentage Distribution --- This is a statistic that represents the proportion of a
sub-group, expressed as a percentage ranging from 0 to 100. A percentage
distribution is the number of parts per hundred that a certain portion (Susan M.
Brookhart, 2016). In this study, the percentage distribution can be used
determine the profile of the respondents in the terms of age, civil status, length of
time lack of sleep since BC and the respondents’ educational background &
occupation.
52
b.) Mean --- Mean the mean, sometimes abbreviated as M, is the average sum of a
set of values found by adding all values and dividing by the total number of
values (Susan M. Brookhart, 2016). In this study, the mean can be used to
analyze the effect of sedative music on the quality of sleep of breast cancer
patients before and after and those who are exposed and not exposed to the
intervention.
c.) T-test for independent Means --- A common research situation is the comparison
of two groups of subjects with regard to the dependent variable. The appropriate
analytic procedure for testing the statistical significance of the difference between
the means of two groups is the parametric test known as the t-test (Amir Tiyuri, et
al. 2018). Thus, this statistical treatment can be used to compare the differences
on the quality of performance of sleep of daily living before and after between
those who are exposed and not exposed to sedative music. In this study, it also
can be used to determine the degree of effectiveness of SM to the quality of
sleep of respondents combined with the data of PSQI

53
Reference
Bianchi, Matt T. 2013. “Preface.” Sleep Deprivation and Disease: Effects on the Body,
Brain and Behavior (February): vii.
Fortner, Barry V. et al. 2002. “Sleep and Quality of Life in Breast Cancer Patients.”
Journal of Pain and Symptom Management 24(5): 471–80.
Galway, Lp et al. 2012. “A Two-Stage Cluster Sampling Method Using Gridded
Population Data, a GIS, and Google Earth(TM) Imagery in a Population-Based
Mortality Survey in Iraq.” International journal of health geographics 11: 12.
http://www.ncbi.nlm.nih.gov/pubmed/22540266 (March 26, 2019).
Kuo, Hsiao Hsuan, Ming Jang Chiu, Wen Chun Liao, and Shiow Li Hwang. 2006.
“Quality of Sleep and Related Factors during Chemotherapy in Patients with Stage
I/II Breast Cancer.” Journal of the Formosan Medical Association 105(1): 64–69.
http://dx.doi.org/10.1016/S0929-6646(09)60110-8.
Lafçi, Diğdem, Gürsel Öztunç, and Professor Cukurova. 2015. “The Effect of Music on
The Sleep Quality of Breast Cancer Patients.” International Journal of Caring
Sciences 8(3): 633–40. www.internationaljournalofcaringsciences.org.
Roche. “Breast Cancer A Guide for Journalists On.”
“World Health Organization, Yearly, 8.8 Million People Die from Cancer.” 2017.
SEARO.
“54 Shocking Sleep Statistics, Data and Trends Revealed for 2019.”
https://www.sleepadvisor.org/sleep-statistics/ (September 8, 2019).
“A Comprehensive Guide to Music Therapy: Theory, Clinical Practice, Research ... -
Lars Ole Bonde, Tony Wigram - Google 图书.”
https://books.google.com.ph/books?hl=zh-
CN&lr=&id=iWWYrTf0_VkC&oi=fnd&pg=PA1&dq=clinical+psychology+music+thera
py+theories&ots=PzAoDCHSHM&sig=CLlTZXtXMNoy4_2rgmovVbR1F7g&redir_es
c=y#v=onepage&q=clinical psychology music therapy theories&f=false (September
8, 2019).
Abedi, Behzad et al. 2017. “The Effect of Traditional Persian Music on the Cardiac
Functioning of Young Iranian Women.” Indian Heart Journal 69(4): 491–98.
http://dx.doi.org/10.1016/j.ihj.2016.12.016.
Amin, Hussein et al. 2016. “Effect of Sleep Deprivation on the Attitude and Performance
of Medical Students, Riyadh, Saudi Arabia.” International Journal of Medical
Science and Public Health 5(3): 575.
Beverly, Chloe M. et al. 2018. “Change in Longitudinal Trends in Sleep Quality and
Duration Following Breast Cancer Diagnosis: Results from the Women’s Health
54
Initiative.” npj Breast Cancer 4(1).
“Breast Cancer | World Cancer Research Fund International.”
https://www.wcrf.org/dietandcancer/breast-cancer (September 8, 2019).
Bunney, P. E., Zink, A. N., Holm, A. A., Billington, C. J., & Kotz, C. M. 2017. “乳鼠心肌
提取 HHS Public Access.” Physiology & behavior 176: 139–48.
Chen, Chih Kuang et al. 2014. “Sedative Music Facilitates Deep Sleep in Young Adults.”
Journal of Alternative and Complementary Medicine 20(4): 312–17.
Chen, Wanqing et al. 2016. “Cancer Statistics in China, 2015.” CA: A Cancer Journal for
Clinicians 66(2): 115–32.
Courneya, Kerry S. et al. 2014. “Effects of Exercise Dose and Type on Sleep Quality in
Breast Cancer Patients Receiving Chemotherapy: A Multicenter Randomized Trial.”
Breast Cancer Research and Treatment 144(2): 361–69.
Czapiewska, Gabriela. 2016. “Organic Farming Development in Northern Poland in
Context of Environmental Conditions and Financial Support System.” Proceedings
of the International Multidisciplinary Scientific GeoConference SGEM 1(8): 957–64.
http://www.redi-
bw.de/db/ebsco.php/search.ebscohost.com/login.aspx%3Fdirect%3Dtrue%26db%3
Daph%26AN%3D118410620%26site%3Dehost-live.
Fakih, Rami et al. 2018. “Prevalence and Severity of Sleep Disturbances among
Patients with Early Breast Cancer.” Indian Journal of Palliative Care 24(1): 35–38.
“Female Breast Cancer - Cancer Stat Facts.”
https://seer.cancer.gov/statfacts/html/breast.html (September 8, 2019).
Fucci, Davide, Giuseppe Scanniello, Simone Romano, and Natalia Juristo. 2018. “Need
for Sleep: The Impact of a Night of Sleep Deprivation on Novice
Developers' Performance.” IEEE Transactions on Software Engineering:
1–20.
Gan, Samuel Ken En, Keane Ming Jie Lim, and Yu Xuan Haw. 2016. “The Relaxation
Effects of Stimulative and Sedative Music on Mathematics Anxiety: A Perception to
Physiology Model.” Psychology of Music 44(4): 730–41.
Gómez Gallego, M., and J. Gómez García. 2017. “Music Therapy and Alzheimer’s
Disease: Cognitive, Psychological, and Behavioural Effects.” Neurología (English
Edition) 32(5): 300–308. http://dx.doi.org/10.1016/j.nrleng.2015.12.001.
Guetterman, Timothy C. 2015. “Descriptions of Sampling Practices Within Five
Approaches to Qualitative Re...: @ Walden University Library.” Forum: Qualitative
Social Research 16(2). https://eds-a-ebscohost-
com.ezp.waldenulibrary.org/eds/detail/detail?vid=19&sid=e6bdaae9-3fe0-4701-
8e98-
55
9e9d84b3bbdb%40sessionmgr4008&bdata=JnNpdGU9ZWRzLWxpdmUmc2NvcG
U9c2l0ZQ%3D%3D#AN=edsdoj.4128d874665d485b835ea2534227d5a4&db=edsd
oj.
“How Cancer Can Affect Sleep | Dana-Farber Cancer Institute.” https://blog.dana-
farber.org/insight/2014/03/how-cancer-can-affect-sleep/ (September 8, 2019).
Karageorghis, Costas I. et al. 2018. “Psychological and Psychophysiological Effects of
Recuperative Music Postexercise.” Medicine and Science in Sports and Exercise
50(4): 739–46.
Kashani, Fahimeh, and Parisa Kashani. 2014. “The Effect of Massage Therapy on the
Quality of Sleep in Breast Cancer Patients.” Iranian journal of nursing and
midwifery research 19(2): 113–18. http://www.ncbi.nlm.nih.gov/pubmed/24834078
(September 8, 2019).
Klumpers, Ursula M.H. et al. 2015. “Neurophysiological Effects of Sleep Deprivation in
Healthy Adults, a Pilot Study.” PLoS ONE 10(1): 1–16.
Korhan, Esra Akin et al. 2014. “The Effects of Music Therapy on Pain in Patients with
Neuropathic Pain.” Pain Management Nursing 15(1): 306–14.
Liu, Jean C.J., Silvan Verhulst, Stijn A.A. Massar, and Michael W.L. Chee. 2015. “Sleep
Deprived and Sweating It Out: The Effects of Total Sleep Deprivation on Skin
Conductance Reactivity to Psychosocial Stress.” Sleep 38(1): 155–59.
Miendlarzewska, Ewa A., and Wiebke J. Trost. 2014. “How Musical Training Affects
Cognitive Development: Rhythm, Reward and Other Modulating Variables.”
Frontiers in Neuroscience 7(8 JAN): 1–18.
Min, Jun Ki et al. 2014. “Toss ‘N’ Turn: Smartphone as Sleep and Sleep Quality
Detector.” Conference on Human Factors in Computing Systems - Proceedings:
477–86.
Mirbagher Ajorpaz, Neda, Abouzar Mohammadi, Hamed Najaran, and Shala Khazaei.
2014. “Effect of Music on Postoperative Pain in Patients Under Open Heart
Surgery.” Nursing and Midwifery Studies 3(3).
Otte, Julie L. et al. 2015. “Systematic Review of Sleep Disorders in Cancer Patients:
Can the Prevalence of Sleep Disorders Be Ascertained?” Cancer Medicine 4(2):
183–200.
Patrick, Yusuf et al. 2017. “Effects of Sleep Deprivation on Cognitive and Physical
Performance in University Students.” Sleep and Biological Rhythms 15(3): 217–25.
Rose, Sumi, and Sonumol Ramanan. 2017. “Effect of Sleep Deprivation on the
Academic Performance and Cognitive Functions among the College Students : A
Cross Sectional Study.” (December): 51–56.
56
Schumacher, Matthew, and Desmond Sipes. 2015. “The Effects of Sleep Deprivation on
Memory , Problem Solving and Critical Thinking.” (May).
Science, Sport, and Rasht Review. 2015. “THE EFFECT OF MUSIC ON MENTAL AND
PHYSICAL PERFORMANCE Nasim Habibzadeh Habibzadeh , H .: The Effect of
Music on Mental and Physical Performance Acta Kinesiologica 9 ( 2015 ) Suppl . 1 :
31 ‐ 34.” 9: 2013–16.
Shobeiri, Fatemeh, Susan Khaledi, Seyedeh Zahra Masoumi, and Ghodratola
Roshanaei. 2016. “The Effect of Music Therapy Counseling on Sleep Quality in
Pregnant Women.” International Journal of Medical Research & Health Sciences
5(9S): 408–16.
Tiyuri, Amir et al. 2018. “Research Self-Efficacy and Its Relationship with Academic
Performance in Postgraduate Students of Tehran University of Medical Sciences in
2016.” Journal of Education and Health Promotion 7(1): 11.
“UAB - News - Improving Sleep Quality for Breast Cancer Survivors.”
https://www.uab.edu/news/health/item/8970-improving-sleep-quality-for-breast-
cancer-survivors (September 8, 2019).
Ye, Ming, ShuHui Tang, Peng Qing, and Guangyuan Liu. 2018. “Effects of Sleep
Deprivation on Brain Functional Network.” Journal of Psychiatry and Psychiatric
Disorders 02(02): 55–64.
Berhanu, Hiwot, Andualem Mossie, Samuel Tadesse, and Daniel Geleta. 2018.
“Prevalence and Associated Factors of Sleep Quality among Adults in Jimma
Town, Southwest Ethiopia: A Community-Based Cross-Sectional Study.” Sleep
Disorders 2018: 1–10.
Bobić, Tatjana Trošt et al. 2016. “The Impact of Sleep Deprivation on the Brain.” Acta
Clinica Croatica 55(3): 469–73.
Bunney, P. E., Zink, A. N., Holm, A. A., Billington, C. J., & Kotz, C. M. 2017. “乳鼠心肌
提取 HHS Public Access.” Physiology & behavior 176(3): 139–48.
Champion, Victoria L. et al. 2014. “Comparison of Younger and Older Breast Cancer
Survivors and Age-Matched Controls on Specific and Overall Quality of Life
Domains.” Cancer 120(15): 2237–46.
Chandwani, Kavita D. et al. 2014. “Randomized, Controlled Trial of Yoga in Women with
Breast Cancer Undergoing Radiotherapy.” Journal of Clinical Oncology 32(10):
1058–65.
Cho, Eun Hee, Mi Young Lee, and Myung Haeng Hur. 2017. “The Effects of
Aromatherapy on Intensive Care Unit Patients’ Stress and Sleep Quality: A
Nonrandomised Controlled Trial.” Evidence-based Complementary and Alternative
Medicine 2017.
57
Czeisler, Charles A. 2015. “Duration, Timing and Quality of Sleep Are Each Vital for
Health, Performance and Safety.” Sleep Health 1(1): 5–8.
http://dx.doi.org/10.1016/j.sleh.2014.12.008.
Datta, Prya, Mandeep Kaur, Satinder Gombar, and Jagdish Chander. 2017. “Early
Administration of Selenium in Patients with Acute Traumatic Brain Injury: A
Randomized Double-Blinded Controlled Trial.” Indian Journal of Critical Care
Medicine 21(2): 75–79.
Delaney, Lori J. et al. 2018. “They Can Rest at Home: An Observational Study of
Patients Quality of Sleep in an Australian Hospital.” BMC Health Services Research
18(1): 1–9.
Gellerstedt, Linda, Jörgen Medin, and Monica Rydell Karlsson. 2014. “Patients’
Experiences of Sleep in Hospital: A Qualitative Interview Study.” Journal of
Research in Nursing 19(3): 176–88.
Ho, Sheau Yan et al. 2015. “A Longitudinal Study of Depression, Fatigue, and Sleep
Disturbances as a Symptom Cluster in Women with Breast Cancer.” Journal of
Pain and Symptom Management 49(4): 707–15.
http://dx.doi.org/10.1016/j.jpainsymman.2014.09.009.
Kohansieh, Michelle, and Amgad N. Makaryus. 2015. “Sleep Deficiency and Deprivation
Leading to Cardiovascular Disease.” International Journal of Hypertension 2015.
Lafçi, Diğdem, Gürsel Öztunç, and Professor Cukurova. 2015. “The Effect of Music on
The Sleep Quality of Breast Cancer Patients.” International Journal of Caring
Sciences 8(3): 633–40. www.internationaljournalofcaringsciences.org.
Lohitashwa, Renu et al. 2015. “Effect of Stress on Sleep Quality in Young Adult Medical
Students: A Cross Sectional Study.” International Journal of Research in Medical
Sciences 3(12): 3519–23.
Maryam S.S., Shaiju B., Neha J. 2017. “Assessment of Quality of Sleep and Perceived
Sleep Distracters among Hospitalised Patients.” International Journal of Health
Sciences and Research 7(4): 317–24.
Modayfer, Omar, Meshail Aamer, Abdulellah Adel, and Laura Olayan. 2017. “Impact of
Sleep Quality and General Health on Academic Performance.” International Journal
of Medical Science and Public Health 6(4): 1.
Palesh, Oxana et al. 2014. “Actigraphy-Measured Sleep Disruption as a Predictor of
Survival among Women with Advanced Breast Cancer.” Sleep 37(5): 837–42.
Bin Tian and James L. Manley. 2008. “基因的改变NIH Public Access.” Bone 23(1): 1–7.
Yang, Guang et al. 2015. “蚊子网状进化HHS Public Access.” 344(6188): 1173–78.

58
National Comprehensive Cancer Network (NCCN)

(http://www.nccn.org/professionals/physician_gls/pdf/Survivorship.pdf).
APPENDIX A
SLEEP-QUALITY QUESTIONNAIRE
This sleep-quality questionnaire—the Sleep Condition Indicator—was developed
by Colin Espie, professor of sleep medicine at the University of Oxford and a cofounder
of the sleep-education app Sleepio. Consider it a helpful, science- backed tool to start a
conversation with yourself, your family, and your friends, and a useful reference as you
take steps to renew or sustain your relationship with sleep.
To start, circle the most accurate response for each question. At the end, add up
your points to get your sleep assessment, along with tips for improvement.
59
Thinking about a typical night in the last month . . .
1. How long does it take you to fall asleep?

0–15 min. 4 points
46–60 min. 1 point
>60 min. 0 points
2. If you then wake up one or more times during the night, how long are you awake
in total? (Add up all the time you are awake.)
46–60 min. 1 point
>60 min. 0 points
3. If your final wake-up time occurs before you intend to wake up, how much earlier
is this?
I don’t wake up too early/Up to 15 min. early 4 points
16–30 min. early 3 points
31–45 min. early 2 points
46–60 min. early 1 point
>60 min. early 0 points
4. How many nights a week do you have a problem with your sleep?
0–1 4 points
2 3 points
3 2 points
4 1 point
60
5–7 0 points
5. How would you rate your sleep quality?
Very good 4 points
Good 3 points
Average 2 points
Poor 1 point
Very poor 0 points
Thinking about the past month, to what extent has poor sleep . . .
6. affected your mood, energy, or relationships?
Not at all 4 points
A little 3 points
Somewhat 2 points
Much 1 point
Very much 0 points
7. affected your concentration, productivity, or ability to stay awake?
Not at all 4 points
A little 3 points
Somewhat 2 points
Much 1 point
Very much 0 points
8. troubled you in general?

Not at all 4 points
A little 3 points
Somewhat 2 points
Much 1 point
Very much 0 points
61
Finally . . .
9. How long have you had a problem with your sleep?

I don’t have a problem/<1 month 4 points
1–2 months 3 points
3–6 months 2 points
7–12 months 1 point
>1 year 0 points
Now add up your total score and enter it here:

Use the following as a guide:
0–9 Your sleep problems seem to be severe. You should definitely try to get
some help.
10–18 You have some sleep problems. It’s important to examine your sleep
habits and see how you can make changes.
19–27 Your sleep is in good shape, but there are still many steps you can take to
make it even better.
28–36 Your sleep is in great shape. Keep doing what you’re doing and spread
the word!
62
Appendix - B
PITTSBURGH SLEEP QUALITY INDEX (PSQI)
INSTRUCTIONS: The following questions relate to your usual sleep habits during
the past month only. Your answers should indicate the most accurate reply for
the majority of days and nights in the past month. Please answer all questions.
1. During the past month, when have you usually gone to bed at night?
USUAL BED TIME
2. During the past month, how long (in minutes) has it usually take you to fall
asleep each night?
NUMBER OF MINUTES
63
3. During the past month, when have you usually gotten up in the morning?
USUAL GETTING UP TIME
4. During the past month, how many hours of actual sleep did you get at night?
(This may be different than the number of hours you spend in bed.) HOURS
OF SLEEP PER NIGHT
INSTRUCTIONS: For each of the remaining questions, check the

one best response. Please answer all questions.
5. During the past month, how often have you had trouble sleeping because
you...
Not during the less than once or three or more

past month once a week twice a week times a week
..cannot get to sleep within 30
minutes
(b) ..wake up in the middle of the night or early morning
(c)...have to get up to use the bathroom
(d)...cannot breathe comfortably
...cough or snore loudly
( ) ...feel too cold
(g) ...feel too hot
.had bad dreams
...have pain
(j) Other reason(s), please describe
64
How often during the past month
have you had trouble sleeping
because of this?
very good Fairly good Fairly bad very bad
6. During the past month, how would

you rate your sleep quality overall?
Not during Less than Once or Three or

the past once a twice a more
month week week times a
week
7. During the past month, how often
have you taken medicine
(prescribed or
"over the counter") to help you sleep?
8. During the past month, how often

have you had trouble staying awake
while driving, eating meals, or
engaging in social activity?
No problem Only a very Somewhat A very

at all slight of a big
problem problem problem
9. During the past month, how
much of a problem has it been
for you to keep up enough
enthusiasm to get things done?
No bed Partner/ Partner in same
partner or roommate in room, but not Partner in
65
roommate other room same bed same bed
10. During the past month, how

much of a problem has it been
for you to keep up enough
enthusiasm to get things done?
If you have a roommate or bed partner, ask him/her how often in the past month
you have had..
Three or
Not during the Less than Once or more
past month once a week twice a week times a
week
...loud snoring
(b) ...long pauses between breaths while asleep

(c) ...legs twitching or jerking while you sleep
(d) ...episodes of disorientation or confusion during
sleep
(e) Other restlessness while you sleep; please
describe
66
Appendix – C
SCORING INSTRUCTIONS FOR THE PITTSBURGH SLEEP QUALITY INDEX
The Pittsburgh Sleep Quality Index (PSQI) contains 19 self-rated questions and 5
questions rated by the bed partner or roommate (if one is available). Only self-rated
questions are included in the scoring. The 19 self-rated items are combined to form
seven "component" scores, each of which has a range of 0-3 points. In all cases, a
score of '1 0" indicates no difficulty, while a score of "3 11 indicates severe difficulty. The
seven component scores are then added to yield one "global" score, with a range of 0-
21 points, "0" indicating no difficulty and "21 " indicating severe difficulties in all areas.
Scoring proceeds as follows:

67
Component 1: Subjective sleep quality
Examine question #6, and assign scores as follows:
Component 1
Response score
"Very good" 0
"Fairly good" 1
"Fairly bad" 2
"Very bad" 3
Component 1 score:
Component 2: Sleep latency
1. Examine question #2, and assign scores as follows:
Response Score
S15 minutes 0
16-30 minutes 1
31-60 minutes 2
> 60 minutes 3
Question #2 score:
2. Examine question #5a, and assign scores as follows:

68
Response Score
Not during the past month
Less than once a week 1
Once or twice a week 2
Three or more times a week 3
Question #5a score:
3. Add #2 score and #5a score
Sum of #2 and #5a:
4. Assign component 2 score as follows:
Sum of #2 and #5a Component 2 score
0 0
1-2 1
3-4 2
5-6 3
Component 2 score:
Component 3: Sleep duration
Examine question #4, and assign as follows:
Component 3
Response score
69
> 7 hours
6-7 hours 1
5-6 hours 2
< 5 hours 3
Component 3 score:
Component 4: Habitual sleep efficiency
1. Write the number of hours slept (question #4) here:
2. Calculate the number of hours spent in bed:
Getting up time (question #3):
Bedtime (question #1
Number of hours spent in bed:
3. Calculate habitual sleep efficiency as follows:
(Number of hours slept/Number of hours spent in bed) X 100 = Habitual sleep
efficiency (%)
) x 100 = %
Component 4
Habitual sleep efficiency % score

70
> 85%
75-84% 1
65-74% 2
< 65% 3
Component 4 score:
Component 5: Step disturbances
1 . Examine questions #5b-5j, and assign for each question as follows:
Response Score
Less than once a week 1
Once or twice a week 2
5b score:
5c score:
5d score:
5e score:
5f score:
5g score:
5h score:
5 i score:
71
5 j score:
2. Add the scores for questions #5b-5j:
Sum of #5b-5j:
Sum of #5b-5j Component 5 score
0 0
1-9 1
10-18-4 2
19-27 3
Component 5 score:
Component 6: Use of sleeping medication
Examine question #7 and assign scores as follows:
Component 6
Response score
Less than once a week 1 Once or
twice a week 2
Component 6 score:
72
Component 7: Daytime dysfunction
1. Examine question #8, and assign as follows:
Response Score
Never 0
Once or twice 1
Once or twice each week 2
Three or more times each week 3
Questionß8 score:
2. Examine question #9, and assign scores as follows:
Response Score
No problem at all 0
Only a very slight problem 1
Somewhat of a problem 2
A very big problem 3
Question #9 score:
3. Add the scores for question #8 and #9:
Sum of #8 and #9:
Sum of #8 and #9 Component 7 score
0 0
73
1-2 1
5-6 3
Component 7 score:
Global PSQI Score
Add the seven component scores together:
Global PSOI Score:
Appendix - D
Sleep Questionnaire
Name: ___________________ Sex: ________ Age: _____ Date: ________
Date of birth: __________ Height: ________ Weight: _______ Neck size: ________
Referring Physician: ___________________ Primary Car e MD: _______________
MAIN SLEEP COMPLAINT(S)
❑ Trouble falling asleep ❑ Trouble remaining asleep
❑ Excessive sleepiness during the day

74
❑ Snoring
❑ Unwanted behaviors during sleep, such as __________________________
❑ Other, explain ________________________________________________
❑ How long? ________________________________________________
PRIOR SLEEP DISORDER DIAGNOSIS OR STUDIES
❑ I have a prior sleep diagnosis of __________________________________

Prior sleep studies (where, when) __________________________________
I am currently prescribed ❑ CPAP or ❑ Bilevel pressure. Settings __________
Oxygen during the ❑ day or ❑ night _________ liters per minute.
❑ Yes ❑ No I have had surgery for a sleep disorder ❑ UPPP ❑ Tonsillectomy.
❑ Other __________________________________________________________
❑ Yes ❑ No I use a dental device for sleep disordered breathing.
SLEEP PATTERN
Typical bedtime: __________ weekday __________ weekend
Typical awakening time: __________ weekday __________ weekend
Typical hours in bed: __________ hours.
Typical hours of sleep: __________ hours
Typical amount of time it takes to fall asleep __________ hours
Typical number of awakenings per night __________
Time it takes to fall back asleep after awakening __________

75
❑ Yes ❑ No My sleep pattern is irregular.
❑ Yes ❑ No I awaken early in the morning still tired but unable to return to sleep.
SLEEP ENVIRONMENT HABITS
Typical sleep position(s) ❑ back ❑ side ❑ stomach ❑ head elevated ❑ in a chair
❑ I sleep alone. ❑ I share a bed with someone.
My bedroom is ❑ comfortable ❑ noisy ❑ too warm ❑ too cold
❑ Yes ❑ No I have pets in the bedroom.
❑ Yes ❑ No I watch TV in bed prior to sleep.
❑ Yes ❑ No I read in bed prior to sleep.
❑ Yes ❑ No I work or study in bed.
❑ Yes ❑ No I drink alcohol prior to bedtime.
❑ Yes ❑ No I smoke prior to bedtime or when I awaken during the night.
❑ Yes ❑ No I eat a snack at bedtime.
❑ Yes ❑ No I eat if I awaken during the night.
BREATHING
❑ Yes ❑ No I have been told that I snore ❑ loudly.
❑ Yes ❑ No I have been told that I stop breathing while asleep.
❑ Yes ❑ No I have been told that I snore only when sleeping on my back.
❑ Yes ❑ No I have been awakened by my own snoring.

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❑ Yes ❑ No I awaken at night choking or gasping for air.
❑ Yes ❑ No I awaken short of breath.
❑ Yes ❑ No I have trouble breathing when flat on my back.
❑ Yes ❑ No I have trouble breathing through my nose.
❑ Yes ❑ No I have morning headaches.
❑ Yes ❑ No I sweat a great deal at night.
DAYTIME SLEEOINESS
❑ Yes ❑ No I often feel drowsy during the day, more than I expect is normal.
❑ Yes ❑ No I feel unrefreshed or tired in the morning despite sleeping at night.
❑ Yes ❑ No I take I daytime naps. How many? ________
❑ Yes ❑ No I have uncontrollable urges to fall asleep during the day.
❑ Yes ❑ No I have experienced lapses in time or blackouts.
❑ Yes ❑ No I have fallen asleep while driving.
❑ Yes ❑ No I performed poorly in school or work because of sleepiness.
EPWORTH SLEEPINESS SCALE
How likely are you to doze off or fall asleep in the following situations, in contrast to
feeling just tired? Use the following scale and indicate the most appropriate number
for each situation.
0 = would never doze
1 = slight chance of dozing

77
2 = moderate chance of dozing
3 = high chance of dozing
Situation ..........................................................................................Chance of dozing
Sitting and reading

......................................................................................................______
Watching TV
..............................................................................................................______
Sitting, inactive in a public place (e.g., a theater or meeting) .......................... ______
As a passenger in a car for an hour without a break .........................................______
Lying down to rest in the afternoon when circumstances permit ................... ______
Sitting and talking with someone .................................................................... ______
Sitting quietly after lunch without alcohol........................................................... ______
In a car, while stopped for a few minutes in traffic .............................................______
TOTAL (Range of 0 to 24) ............. ______
RLS
❑ Yes ❑ No I kick or jerk my legs excessively during sleep. ❑ This bothers my bed
partner.
❑ Yes ❑ No I experience a creeping-crawling or tingling sensation in my legs when

I try to fall asleep.
❑ Yes ❑ No I experience an inability to keep my leg still prior to falling asleep.
❑ Yes ❑ No I experience the feeling of restlessness in my legs at night.
orexin related
78
❑ Yes ❑ No I experience sudden muscle weakness in response to emotions such

as laughter, anger or surprise.
❑ Yes ❑ No I experience an inability to move while falling asleep or when waking

up.
❑ Yes ❑ No I have experienced hallucinations or dreamlike images when falling

asleep or waking up.
❑ Yes ❑ No I frequently dream during daytime naps.
PARASOMNIAS
❑ Yes ❑ No I act on my dreams while asleep.
❑ Yes ❑ No I have frequent nightmares.
❑ Yes ❑ No I talk in my sleep.
❑ Yes ❑ No I have sleep walked as an adult.
MISCELLANEOUS (Circadian, GERD, Depression, Enuresis, Bruxism, Pain)
❑ Yes ❑ No I frequently travel across two or more time zones.
❑ Yes ❑ No I am more alert in the morning than evening.
❑ Yes ❑ No I am more alert in the evening than morning.
❑ Yes ❑ No I awaken alert in the morning earlier than it is time to get up.
❑ Yes ❑ No I frequently have heartburn or acid reflux at night.
❑ Yes ❑ No I feel depressed.
❑ Yes ❑ No Chronic pain interferes with my sleep.

79
❑ Yes ❑ No The need to urinate frequently interrupts my sleep.
❑ Yes ❑ No I grind my teeth in my sleep.
❑ Yes ❑ No I have bedwetting (enuresis).
INSOMNIA
❑ Yes ❑ No I have trouble falling asleep.
❑ Yes ❑ No Thoughts start racing through my mind when I try to fall asleep.
❑ Yes ❑ No I have trouble remaining asleep.
❑ Yes ❑ No I awaken frequently during the night.
❑ Yes ❑ No I have difficulty returning to sleep if I awaken during the night.
HABITS
❑ Yes ❑ No I smoke cigarettes (or other tobacco). If yes, how much?
❑ Yes ❑ No I drink alcohol. If yes, how much and how often?
❑ Yes ❑ No I drink caffeinated beverages during the day ______cups/bottles/cans
❑ tea ❑ coffee ❑ soda per day
SOCIAL HISTORY
Marital status ❑ Single ❑ Married ❑ Separated ❑ Divorced ❑ Widowed
Employment status: ❑ Employed: Occupation
❑ Unemployed ❑ Disabled ❑ Student ❑ Retired
❑ Yes ❑ No I regularly work night shifts.
❑ Yes ❑ No I work rotating shifts, including nice shiftwork.

80
PAST MEDICAL HISTORY
❑ Hypertension ❑ Coronary artery disease ❑ Congestive heart failure
❑ Stroke ❑ Seizures ❑ COPD/asthma ❑ Diabetes ❑ Cancer
❑ Thyroid problems ❑ Depression or anxiety
❑ Alcoholism or chemical dependency ❑ Sinus disease
❑ Allergic rhinitis/nasal congestion ❑ Nasal fracture ❑ Reflux (GERD)
❑ Stomach or colon problems ❑ Fibromyalgia ❑ Back or joint problems (arthritis)
❑ Other_____________________________________________________________
Female ❑ Premenstrual syndrome ❑ Menopause
Male ❑ Prostate problems ❑ Erectile dysfunction
Prior surgeries _________________________________________________________
Weight change during the past year ❑ gained ______ pounds ❑ lost _____ pounds
CURRENT MEDICATIONS (OR ❑ LISTED ON SEPARATE SHEET)
Medication Dose Times Per Day

81
Allergies: _____________________________________________________________
FAMILY HISTORY
Has an immediate blood relative had any of the following?
❑ Obstructive sleep apnea ❑ Narcolepsy ❑ Other sleep disorders?
_____________________________________________________________________

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EFFECTS OF SEDATIVE MUSIC ON THE QUALITY OF SLEEP OF BREAST CANCER

specialization in Medical-Surgical Nursing, has be examined and is recommended for

acceptance and approval for colloquium.

MA. LOVELLA M. MONDERIN-AURE RN, MAN

THESIS REVIEW PANEL

Approved by the Committee on Colloquium with a grade of __________.

DAISY H. ALBERTO, RN, MAN, PhD MERCEDITA A. QUIAMBAO, RN, MAN

ALVIN D. CRUDO, RRT, EdD

Master of Arts in Nursing Major in Medical-Surgical Nursing.

ALELY S. REYES, RN, MAN, PhD

RESTITUTA C. TAN, PhD, RM, RN, RGC

1. THE PROBLEM AND ITS BACKROUND 6

1. The illustrated of Legend/Where of the research design.

2. The Quality of Sleep of Breast Cancer Patients among tumor

departments in hospitals in Henan Province in China in the Control

Group Before and After Sedative Music

3. The Quality of Sleep of Breast Cancer Patients among tumor

departments in hospitals in Henan Province in China in the Treatment

Group Before and After Sedative Music

4. Comparison on the Quality of Sleep of Breast Cancer Patients among

tumor departments in hospitals in Henan Province in China before

5. Comparison on the Quality of Sleep of Breast Cancer Patients among

tumor departments in hospitals in Henan Province in China after

6. Comparison on the Quality of Sleep of Breast Cancer Patients among

tumor departments in hospitals in Henan Province in China before

and after Sedative Music

9.1 The Independent Variable and the Dependence

Variable of Breast Cancer Patients in Hospitals in

9.2 Enriching the Quality of Sleep of Breast Cancer

Patients among tumor departments in hospitals in

Henan Province in China Through Sedative Music

9.3 Profile of the Respondents According to Age

9.4 Profile of the Respondents According to civil status

9.5 Profile of the Respondents According to length of time

lack of sleep since Breast Cancer

9.6 Profile of the Respondents According to respondents’

educational background & occupation.

9.7 Profile of the Respondents According to respondents’

THE PROBLEM AND ITS BACKGROUD

― Ernest Hemingway (1899-1961)

Cancer is a serious issue in today’s World health Organization South-East Asia

(Jin-Li Lou. 2017).

occur independently or in combination. From one article of Sleep Medicine Research,

treatment, while undergoing chemotherapy or radiation therapy, and after the

side effects of treatment, undergoing chemotherapy or radiation therapy, and fear of

The next classification system was the International Classification of Sleep

Insomnia is defined as a persistent difficulty with sleep initiation, duration, consolidation,

breast cancer patients caused by chemotherapy, radiation therapy, length of time

reaction during treatment and diagnosis of cancer, environment, age, education,

more types of sleep disorders were observed. (Koopman C et al.,2002) Furthermore, in

including medications (e.g. benzodiazepines or melatonin receptor agonists) and non-

pharmacological treatments is also effective (Gregory M. Asnis et al. 2016). However,

hypotension, weakening of vital functions, drowsiness, nausea, vomiting, and even

use in the treatment of insomnia, in the absence of psychiatric disorders, particularly in

light of its potential side-effects.

In addition, reported by an article, 80% of the populations of third-world countries

has been increasing emphasis on exploring the effectiveness of non-pharmacological

interventions to promote sleep, such as minimizing nighttime disturbances, reducing

techniques. One research based on 13 intervention studies with 1,154 participants,

to 80 beats per minute, without accents, percussiveness, rhythmic complexity, or

subjective and objective assessments (Chih-Kuang Chen et al. 2014). According to

genres comprising 545 artists (Tabitha Trahan, et al. 2018).

According to my aunt’s experience, she suffered BC 6 years ago, I still remember