Qigong Used for Insomnia Therapy in Menopausal Women
Advisor: Ms. Mariam Abodouma
Internship Location: San Francisco State University
Onsite Mentor: Wen-Wen Li
Menopause, a natural decline in reproductive hormones, occurs twelve months after a woman’s last menstrual cycle. Perhaps one of the most frustrating effects of menopause is insomnia, persistent problems falling and staying asleep. When this occurs, women often resort to pills or other products like antidepressants or melatonin medication to sleep. On the other hand, there are more natural approaches to improving sleep quality. In this project, I hope to uncover how Qigong, a form of exercise to optimize energy within the body, can reduce insomnia symptoms in menopausal women. Using the Pittsburgh Sleep Quality Index, participants will rate their sleep quality before and after performing Qigong twice daily for four weeks. With the help of Professor Li at SFSU, I will also conduct a 20-minute interview with each participant to measure their reaction to using Qigong and their ability to perform it successfully. My ultimate goal is to find how this form of self-treatment can provide a more productive and less labor-intensive approach to support menopausal women in managing insomnia. If proven effective, it may be utilized across many clinical settings to reach women who could use this form of self-support.
Project Blog
Week 0: An Introduction
Hi everyone! My name is Joleen, and welcome to the first blog post of my senior project. In this post, I will discuss some background information and show everyone the connection between Qigong, insomnia, and menopause.
Background: Qigong is a form of calming exercise to optimize energy within the body. When I was young, my parents constantly took classes with a Qigong master at his clinic. They still actively practice Qigong, whether at 7 AM before sending me off to school or when shopping at Costco. Whenever I had trouble sleeping, they would perform Qigong to help us. I can recount several times where Qigong has effectively helped me to decrease insomnia and other health-related problems. I found that every time my parents performed Qigong, I could fall asleep much more quickly than if they didn’t. Thus, I became curious if Qigong could help decrease insomnia in various people. At the same time, many women around me are currently going through menopause, the time that marks the end of a woman’s menstrual cycle, and thus struggle with hot flashes and difficulty sleeping. Through my project, I hope to dive deeper into a practice I grew up with. Please join me on this journey as I research how Qigong can help decrease insomnia symptoms in menopausal women!
Recent estimates of the prevalence of insomnia in women with menopause range from 40 to 50%. Insomnia impacts both mental health and physical health, including cardiometabolic and neurocognitive diseases, and significantly increases medical expenses. Although there is previous research on how Qigong helps to improve insomnia symptoms, there is limited research done on the correlation between Qigong and menopause. Self-management using Qigong can provide a less labor-intensive approach to help menopausal women achieve better management of their insomnia, especially given the heavy work burden on healthcare providers. Since Qigong can be easily self-practiced at home, my project is a feasible option for many women.
My project: Qigong can be easily self-practiced at home. My project is a feasible option for many women. I will use Bai Dua Jin Gigong, which has eight easy-to-learn movements (the entire set can be done in 10 minutes) to improve sleep quality in menopausal women. The theory behind the therapeutic effect of qigong is its promotion of circulation in the entire body, including the brain, which can enhance sleep quality. My goal is to have participants practice qigong-based intervention daily, which may help to reduce morbidity in women with menopause. My study is innovative in the following ways: 1) Qigong is an easy-to-follow qigong-based intervention for insomnia; 2) Qigong is low cost because it does not depend on intensive clinician time or medications. By the end of the project, I hope to gain a thorough understanding of the psychology behind Qigong and its positive influences on the human body. Join me next week as we take a deeper dive into my project!
Week 1: Setting Up My Project
Hello everyone! This is the one and only Joleen and I am back with another blog post! In today’s post, I will cover everything from gathering participants for my research project to explaining key terms necessary to understand the content of my project.
Before people begin any research, they need to gather participants. In this research project, I am looking to connect with about 30 women who are premenopausal or menopausal as participants. First, I designed flyers using Google Docs to put in public chats (such as WhatsApp and WeChat). My flyer includes my project's purpose, goal, eligibility requirements, and benefits of my project. I sent them into multiple chats and gathered participants around the school. Next, I request that people interested fill out a Google Form to give me their contact information with the preferred time and location of the interview. Each of my participants will perform Qigong 5 days per week for a month. They will also be interviewed once before and after the study for approximately 30 minutes. Finally, I created a separate spreadsheet to keep track of all my participants and the times I am interviewing them. This way, I will know when to interview each participant for the second time.
My external advisor and I met to design two sets of interview questions that my participants will be answering. These are related to demographics and quality of sleep. Instead of creating these questions all from scratch, we copied and edited questions from existing research, such as the Fatigue Assessment Scale or the Pittsburg Sleep Index. However, for the questions specifically geared toward the project, we came up with questions to improve the study. After my participants answer these questions, I will analyze this data to draw conclusions.
My external advisor and I also compiled documents for participants to sign. These are legal documents and will ensure that collected data may be released. We obtained the Health Insurance Portability and Accountability Act authorization, written informed consent, and documents affirming the formal release of certain medical records in data collection. These documents are necessary to conduct research in an ethical setting.
That’s it for this week! Next week, I will show everyone the interviews and how I will do them!
Week 2: Interviews Part 1
Hello everyone! This is the one and only Joleen, and I am back with another blog post! Today, I will discuss my interviews and the steps I used to gather my data for this project!
As I mentioned last week, my external advisor and I designed a series of questions to ask our participants. I will interview all my participants this week and next week using these questions. Before the interview begins, I have my participants fill in the confidentiality and IRB approval documents according to the research protocol. If they have any questions regarding my research process or data privacy, I explain to them in concrete detail. Next, I begin recording information about the meeting, such as the date, participant name, and interview time. Then, I took the participants' blood pressure and gave them a form to fill out. These forms include information such as name, email, and date of birth. These data points are crucial to ensure that I can communicate with all participants and that they meet the age requirements of my project. Finally, I reminded all participants to practice Qigong consistently five days a week and schedule a second interview with me four weeks later.
And that’s the interview process! Many people ask me what the blood pressure machine numbers mean, so let’s look into that. The top number is the systolic blood pressure, which measures the pressure in the arteries when the heart beats. In other words, it is the maximum blood pressure when the organ ventricles contract. The bottom number is the diastolic blood pressure, which represents the pressure in the arteries when the heart rests between beats. It measures the arteries' resistance to stretch when the heart relaxes. Many outside factors can impact your blood pressure temporarily or permanently, such as stress levels, smoking or drinking, and eating diets low in potassium or sodium. Blood pressure is written in the form of systolic/diastolic and normal blood pressure should be below 120/80. Check out the first chart in this link to learn more: https://www.heart.org/en/health-topics/high-blood-pressure/understanding-blood-pressure-readings
Sources: https://www.cdc.gov/bloodpressure/prevent_manage.htm
Week 3: Interviews Part 2
Hello everyone! This is the one and only Joleen, and I am back with another blog post! This week, I did interviews with the second half of my participants and prepared myself for some data entry. Instead of going into the interview process, which is similar to last week’s post, I will explain more about Qigong and its history.
Many of you might still be wondering: what exactly is Qigong? It combines movement, breathing, meditation, and body posture. It is used mainly for purposes related to health and medicine. People across the world practice Qigong for health benefits, recreation, and spirituality. Now, let’s break down the word. “Qi” means air or energy. “Gong” means work or to achieve something through effort. Combined, the two words mean to use effort and balance life energy, especially for well-being. Although there is evidence of Qigong dating back to over 2000 years ago, this practice did not become well known until the 1950s, when the Chinese government integrated various Qigong approaches into one system. In addition, many people wanted to prove from research that Qigong brings positive benefits to the human body. The practice of Qigong grew rapidly in the 1990s, with over 60 million people across the world practicing it.
There are many types of Qigong, ranging from dynamic to static to meditative practice, with each type of practice emphasizing one specific focus. Qigong also has many forms and purposes, such as medical Qigong, intellectual Qigong, and life-nourishing Qigong. Some principles are in place no matter the practice or form one chooses. All forms of Qigong involve intentional movement, rhythmic breathing, and awareness to produce a calming and relaxing effect. Because of this, Qigong is often viewed as more than just a common physical exercise. Many believe that it produces specific psychophysiological benefits.
According to research done in 2013, qigong has numerous physiological effects, such as improved respiratory and cardiovascular function. Some studies have been done using randomized controlled trials. Clinical research has been conducted for conditions ranging from quality of life to immunization. Various studies have also indicated that Qigong practice decreases cortisol levels. However, research is limited because there is little financial and medicinal incentive to research in this field. I wanted to do research involving Qigong to learn more about the positive benefits it brings to us.
Thats it! I hope you learned more about Qigong in this week’s blog. Next week, we will look at how I input my data and analyze some previous research on how Qigong impacts insomnia symptoms. Stay tuned!
Sources:
https://web.archive.org/web/20111017031024/http://www.literati-tradition.com/qi_gong_origins.html
https://www.nccih.nih.gov/health/complementary-alternative-or-integrative-health-whats-in-a-name
https://web.archive.org/web/20140201235840/http://sactaichi.com/what-is-qi-gong/
https://www.webmd.com/fitness-exercise/a-z/tai-chi-and-chi-gong
Week 4: Reading and Data Entry
Hello everyone! This is the one and only Joleen, and I am back with another blog post! Last week, I finished gathering data from my interviews and surveys. This week, I decided to read some current research on how exercise impacts insomnia symptoms in menopausal women to gain a stronger understanding of knowledge in the field. I read six different research papers, took notes, and compiled them into one document detailing the findings. I will explain two of the research papers I read, their results, and why this paper will help me with my research.
The first paper I read was “The Effect of Qigong on Menopausal Symptoms and Quality of Sleep for Perimenopausal Women”. The article explained that over half of women who are menopausal suffer from some sort of sleep disorder and that sleep problems are the most frequent complaint. Their research found that low exercise is a main factor in poor sleep quality. Another important piece of information the researchers reaffirm is women have higher anxiety than men because there are hormonal changes that affect women’s psychological state.
The second paper I read was “Effects of Exercise on Sleep in Perimenopausal Women”. This research paper discussed how exercise reduces anxiety and depression, allowing people to have better sleep quality. Similar to the first paper I read, this paper also explains how estrogen changes and neurotransmitter imbalances cause people to take a longer time falling asleep. In a separate section on Qigong, the authors wrote that Qigong had a significant effect on sleep improvement in perimenopausal women because it can regulate negative emotions and improve the body’s immunity functions. When practicing Qigong, people are in a state of deep physical and mental relaxation because they regulate their breathing. This way, stress naturally decreases, and emotions are stabilized.
In addition to reading research papers, I also began to input some data into the SPSS software, which looks like an extra complicated Google Sheets file. You may wonder how I transfer information from the interview into this software. Even though I hold in-person interviews, they are not formal interviews where I ask questions and participants answer. Instead, I take their blood pressure and give them a paper to fill out. This paper contains questions that have numerical values as answers. I input numbers from the paper into each cell in the software. Each question corresponds to one column in the sheet. The process might seem simple, but I have yet to explain windows and variables next week.
Remember to come back and read next week’s blog to uncover the mystery behind using the SPSS software for statistical analysis!
Sources: https://www.researchgate.net/publication/224853822_The_Effect_of_Qigong_on_Menopausal_Symptoms_and_Quality_of_Sleep_for_Perimenopausal_Women_A_Preliminary_Observational_Study#:~:text=Ping%20Shuai%20Qigong%20improved%20climacteric,sleeping%20quality%20and%20climacteric%20symptoms.
Week 5: Introduction and Literature Review
Hello everyone! This is the one and only Joleen, and I am back with another blog post! This week, I focused on emailing and calling my participants to ensure they were on track. I also answered any questions they had and asked them if they felt any changes in their sleep from the Qigong. After, I began to write the introduction and literature review sections of my paper using both the notes I took last week and some new notes. I know that last week I said I would talk about the SPSS program and how I input my data for it to be analyzed, but then I realized that I never discussed menopause in great detail. So today, I will explain more about menopause, its causes, effects, and its relationship to insomnia and Qigong.
Menopause occurs twelve months after a woman’s period stops. It usually begins around the age of 50 but this varies for everyone. Even though this process happens to all women, its effects may disturb everything from sleep to everyday behavior. A woman knows that she is about to enter menopause when she experiences some of its symptoms, such as irregular periods, hot flashes, chills, night sweats, and mood changes. Irregular periods are the most common symptom and are a positive sign that a woman is in the perimenopausal stage. This is also when the body begins to use energy differently. Hot flashes are sudden feelings of heat in the body and are usually accompanied by becoming flushed red blotches, and heavy sweating.
There are several causes of menopause. The first is when reproductive hormones naturally begin to decline. In a woman’s late 30s, her ovaries start to produce less estrogen, and fertility declines. In the late 40s, period frequencies start to fluctuate and the period of the period will vary each time a woman is on her cycle. This occurs until the ovaries stop producing eggs and the woman has no more periods. During menopause, doctors often recommend women avoid caffeine, exercise, and maintain a healthy diet by eating more fruits and vegetables.
Hot flashes are also part of the main reason why many women struggle with having good sleep quality. Some hot flashes are so strong that they can force a woman to wake up. Night sweats keep women up and they often struggle to fall back asleep after waking up.
The effects of menopause vary for every woman. While most women simply exercise more and stay in cooler environments, some women need treatment for severe symptoms. Treatment comes in many forms, but the most common is hormone therapy, which helps to make up for lost hormones. Estrogen Progesterone Hormone Therapy uses doses of estrogen and progesterone to help decrease the severity of hot flashes and prevent osteoporosis. However, there are some risks associated with hormone therapy, such as blood clots, increased chance of strokes, and even cancer. Thus, hormone therapy should only be used when necessary and under the supervision of a doctor.
Whew! That was kind of long, wasn’t it? Since exercise has been shown to decrease the severity of such symptoms, I hope that my research on Qigong will help many of my participants. Next week, I promise we will discuss SPSS and how I use it to enter my data. Until next time!
Sources:
https://www.mayoclinic.org/diseases-conditions/menopause/symptoms-causes/syc-20353397#:~:text=Menopause%20is%20the%20time%20that,51%20in%20the%20United%20States.
https://www.nia.nih.gov/health/menopause/what-menopause
https://my.clevelandclinic.org/health/diseases/21841-menopause
Week 7: Second Interviews
Hi everyone! This is the one and only Joleen and I am back with the seventh blog post for my senior research project! This week, I will be discussing my interviews for the second round. This blog will be shorter and more straightforward because everything is pretty much the same as last week and as the first round of interviews that I conducted four weeks ago.
The second interview is different from the first for a couple of reasons. First, we do not need to ask questions relating to participants’ age, income, etc because we already entered that information into the SPSS where it is being processed. We only need to ask questions with answers that we must input into the software. These questions ask about participants’ sleep quality and struggles relating to menopause. After I enter the data from the second interview, I will use data analysis to compare the numbers before and after the participants practice Qigong. This way, I will be able to conclude whether or not Qigong is actually effective in decreasing insomnia symptoms in menopausal women.
Second, my external advisor and I worked together to add another section to the interview. This section involved free-response questions. Examples include: “How easy was it for you to comprehend the video instructions” and “Did you have any difficulties throughout the entire process?” Questions like these will benefit me if I decide to continue my research project in the future. We also asked participants to rank how helpful Qigong was in decreasing insomnia and how likely participants would recommend my project to others. This week’s blog is short, but next week’s will be extra long! Prepare yourselves!
Week 8: Data Analysis
Hi everyone! This is, once again, the only and only Joleen Pan! Today I am back with another blog post! As I promised, today’s blog will be about data analysis using SPSS software. The first thing to know is that SPSS variables are split into two different types: categorical and continuous. Categorical data types have a fixed number of values. An example could be sex, which is limited to two values. Continuous variables, like age, have any value between a set minimum and maximum. Age is set from 0 to any value, usually to 100. Once we have identified the type of variable we are analyzing, we know the method to use. If we are analyzing categorical variables, then we will use the frequency method. If we are analyzing continuous variables, then we will use the descriptive method.
First, let’s discuss descriptive analysis. When we click into the analysis window, we see all the possible variables on the left-hand side of the screen. We need to drag specific variables that we wish to analyze to the right. Then we click enter, and it will create a table with a title, variable options, minimum, maximum, mean, and standard deviation. If we do frequency analysis, we take the same steps, but the generated table has different columns. It will generate frequency, percent, valid percent, and cumulative percent. When analyzing frequencies, we can develop a chart instead of a table. SPSS can create a bar chart, pie chart, or histogram according to your choice.
When analyzing multiple-choice responses, we add one more step because we need to define our variable sets. This time, we drag multiple variables to the right-hand side of the screen. Then, we must add a label and name to this variable set. The second step is to create a frequency table from this set using the same method I mentioned earlier.
Finally, SPSS is also helpful when calculating cross-tabulation. This shows if there is an association between two categorical variables. We will calculate percentages in the direction of the independent variable and use the chi-squared test to determine if the association is statistically significant. This time we will use an analyzation method called crosstabs. Instead of dragging either row or column titles, this method will allow us to drag variables into both. Under statistics, we will click chi-squared instead of correlation. If p > 0.5, then it is not significant.
The SPSS is much more complicated than what I just explained, but this is the basics of what I will be using for my research. There are many other ways to analyze data, such as comparing means with a t-test or calculating various means and standard deviations. This blog post summarizes how I analyze data, so next week, we will move on to results. Stay tuned!
Week 9: A Setback
Hi everyone! This is the one and only Joleen, and we are here at the second to last blog post of this season. Whew! Today’s blog post contains a very important lesson for all my views. Without further ado, let me tell you a story!
SPSS is a relatively old software, so if someone were to analyze data, they might have to use the newer version available on most modern-day computers. However, I am using an older SPSS data analysis version. Instead of using my daily computer, I use another special computer from the 1990s. At that time, technology was not as advanced, so many tools that we have today on Google Sheets were not made available until after the old SPSS was released.
One day, I woke up when the sky was all blue, the birds were chirping, and I was in a great mood. I went downstairs, had a wonderfully delicious breakfast, and got ready to work on my senior project. First, I check for emails or reminders from my advisors. Then, I finish up my previous blog post and send it over to be published. That day seemed pretty cheerful, but little did I know that it would set me back a couple of weeks. I opened up the old computer from the 1990s to continue my data analysis but ended up staring at the screen with my brows furrowed. My dad comes in and asks me, “Why do you look so confused?” Well, I had just noticed that half of my data was missing. Shock led to sadness, and sadness led to anger. How could I ever forget about that “save” button?
Remember how I mentioned earlier that many tools we have today weren’t available back then? Well, automatic saving is one of them. I tried everything, like undoing some actions and checking previous versions, but all my data was permanently gone. That meant I had to reenter them for 13 participants! Fortunately, I kept the interview papers, so I could enter the data quickly if I focused. So this week, I mainly reentered data and double checked to make sure I was on schedule.
Readers, let this be a lesson to you. If you aren’t using Google Docs, Sheets, or Slides, please double-check to see if you have saved all your work, because not all platforms will automatically save. I have now learned from my mistakes! Next week, I will wrap up my project and do some concluding thoughts. See you for the finale!
Week 10: Concluding Thoughts
Hi everyone! This is the one and only Joleen, and we are here at the last blog for my senior project! If you made it all the way here with me, give yourself a pat on the back. Today, we will be wrapping up my project by discussing qualitative data analysis, the significance of my work, and some future ideas I have.
In week 8, I discussed how I analyzed data quantitatively using the SPSS software. While I got those data points from the questions with numbers as answers, I also used free-response questions to get some qualitative data points. These questions included “Were you able to understand the content of the video” and “What are the strengths and weaknesses of my project?” Many people answered that they understood the video and they thought my project allowed them to relax, get some exercise, and fall asleep quicker. Since many of my participants mentioned these positive results, I noted them and color-coded them. An example looks like this:
Participant | Comprehension ofvideo content | Comprehension of Instructions | Level of helpfulness of QUIT video | Level of helpfulness of QUIT video: If helpful/not helpful, please explain.
1. 04/08/2024 | Understood the content“Yes, it was very useful and I liked it!” | Understood the content“Yes, very clear” | 4/Helpful | Better sleep“Helped me to fall asleep quickly and deeply..”
In this case, we can infer a correlation between performing Qigong and getting a good night’s sleep. However, we cannot say it is causation because we are unsure what other options participants use to decrease their insomnia symptoms. We can only say that Qigong does, in some way, improve sleep quality.
Many women resort to pills, melatonin, and antidepressants to fall asleep, which can disturb hormonal processes and cause more bodily problems. My project helps to raise awareness of using more natural ways for menopausal women to decrease insomnia symptoms and improve sleep quality. Exercise is effective, healthy, and less costly. In addition, exercise like Qigong may help with improving mental health by reducing anxiety or depression linked to insomnia.
Readers! I hope that you enjoyed reading about the journey of my senior project. I will be writing a paper to discuss my findings which will be published in a journal this summer, so stay tuned. Remember: exercise has many positive impacts on physical and mental health! Thank you and this is the one and only Joleen signing out.