Laughter Yoga and Sleep Hygiene Training for College Students With Premenstrual Syndrome (LYSHPMS)

The Effect of Laughter Yoga and Sleep Hygiene Training on Premenstrual Syndrome Levels, Perceived Stress Levels, and Sleep Quality Among University Students

This study aims to evaluate the effects of laughter yoga and sleep hygiene training on premenstrual syndrome (PMS) symptoms, perceived stress levels, and sleep quality among nursing students.Premenstrual syndrome is a common health issue characterized by physical symptoms as well as emotional fluctuations, anxiety, depressive mood, and behavioral changes, which can negatively impact quality of life. Additionally, it is known that stress is a significant risk factor that exacerbates PMS symptoms, and that healthy lifestyle behaviors may be effective in alleviating these symptoms. In this context, it has been reported that yoga and similar relaxation-based practices support mental well-being by reducing stress levels.The intervention consists of laughter yoga and sleep hygiene education, implemented as non-pharmacological methods over a 4-week period.Participants were assessed at baseline, immediately following the intervention, and during the 1-month follow-up period. The primary objective is to observe improved sleep quality alongside reductions in PMS symptoms and stress levels in participants as a result of the intervention. The findings are expected to contribute to the effectiveness of non-pharmacological, low-cost, and feasible approaches in managing PMS symptoms, as well as addressing stress and sleep quality.

Study Overview

• Status: Completed
• Conditions: Stress; Sleep Quality; Laughter Yoga; Premenstrual Syndrome-PMS
• Intervention / Treatment: Behavioral: Supportive Care

Detailed Description

Premenstrual syndrome (PMS) is a common health issue characterized by emotional fluctuations, anxiety, depressive mood, and behavioral changes, in addition to physical symptoms that can negatively impact quality of life. PMS can lead to a decline in quality of life by negatively affecting an individual's social life, psychological well-being, emotional balance, and dietary habits; in some individuals, it can develop into a severe condition that significantly restricts daily life. Within the multifaceted nature of PMS, stress emerges as a significant risk factor; it is noted that stress can increase symptom severity, elevate the frequency of traumatic life experiences, and underlie sleep disturbances in individuals. Deterioration in sleep quality further exacerbates this process, being associated with fatigue, emotional fluctuations, and a decline in overall well-being. While non-pharmacological methods are used to mitigate or prevent these effects on the individual, laughter yoga-based interventions remain limited. This study evaluates laughter yoga-a low-cost, feasible non-pharmacological method that incorporates simulated laughter, rhythmic breathing, gentle movements, and meditation-examining its effects on PMS management, stress-related hormone (cortisol) levels, and sleep quality.The intervention consisted of laughter yoga and sleep hygiene training administered over a 4-week period. Sleep hygiene training was provided during the first session of laughter yoga. Participants were assessed at different time points: at baseline, immediately following the intervention, and at the 1-month follow-up. The primary objective of the study is to assess changes in PMS levels, stress, and sleep quality over time among university students and to determine the sustainability of the intervention's effects during the follow-up period. This study contributes to the literature on nonpharmacological methods used to evaluate the effectiveness of interventions on PMS levels, stress, and sleep quality.

• Study Type: Interventional
• Enrollment (Actual): 45
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Turkey (Türkiye)
  • Ankara
    • Ankara, Ankara, Turkey (Türkiye), 06000
      • Gazi University Institute of Health Sciences

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

Inclusion criteria for the study:

• Female, 18 years of age or older
• Second-year nursing student (who has not yet taken the Women's Health and Diseases Nursing course)
• Having a regular menstrual cycle
• Scoring 45 or higher on the Premenstrual Syndrome Scale (PMS level is mild)
• Using the WhatsApp® app

Exclusion criteria for the study:

• Having any communication difficulties (mental, auditory, visual, etc.)
• Having previously participated in a stress management program
• Using pharmacological or non-pharmacological methods to manage PMS symptoms
• Having a chronic or neuropsychiatric condition

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Supportive Care
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Participants were enrolled in a 4-week laughter yoga program.They received training on sleep hygiene; intervention group	Behavioral: Supportive Care; University students participated in 45-minute laughter yoga sessions held once a week for four weeks. During the first session, participants received training on sleep hygiene and were given a brochure on the topic. The sleep hygiene training covered the following topics: sleep, the importance of sleep, factors affecting sleep (circadian rhythm, sleep-wake cycle, nutrition, physical activity), factors causing poor sleep, sleep deprivation, and sleep hygiene.
No Intervention: No interventions were made regarding the participants.; control grup

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Changes in premenstrual syndrome levels	PMS levels and associated physical, emotional, and behavioral changes in participants were measured using a validated scale. Changes in PMS levels were assessed by comparing the intervention and control groups.The Premenstrual Syndrome Scale (PSS) was used to evaluate the data.The scale consists of a total of 44 items and 9 subscales, organized on a 5-point Likert scale. The scale is scored as follows: 1 = never, 2 = rarely, 3 = sometimes, 4 = often, and 5 = always. Scores obtained from the scale can be calculated separately for each subscale or evaluated based on the total score. The total scale score ranges from 44 to 220, and the presence of PMS is considered in individuals scoring 132 or higher. Additionally, the severity of PMS is classified as follows: 44 points = no PMS, 45-103 points = mild PMS, 104-163 points = moderate PMS, and 164-220 points = severe PMS.	Baseline, 4 weeks (end of intervention), 1-month follow-up

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Changes in perceived stress levels	Participants' perceived stress levels were measured using a validated scale. Changes in stress levels were assessed by comparing the intervention and control groups. The Perceived Stress Scale (PSS) was used to analyze the data.The scale consists of a total of 14 items, each of which is rated on a 5-point Likert scale (0 = Never, 4 = Very often). The scale consists of two subscales: low self-efficacy perception (items 4, 5, 6, 8, 9, 10, 13) and stress/distress perception (items 1, 2, 3, 7, 11, 12, 14). Items 4, 5, 6, 7, 9, 10, and 13 are reverse-scored. The lowest and highest possible scores a participant can achieve on this scale are 0 and 56, respectively. An increase in the total score from the scale or its subscales indicates an increase in the individual's perceived stress level.	Baseline, 4 weeks (end of intervention), 1-month follow-up
Changes in sleep quality	Participants' sleep quality was measured using a validated scale. Changes in sleep quality were assessed by comparing the intervention and control groups. The assessment was conducted using the Pittsburgh Sleep Quality Index (PSQI). The scale consists of 24 questions. The first 18 questions, which the participant answers themselves, are used to calculate the total score and the subscale scores. The 18 questions on the scale cover 7 components: sleep quality (component 1), sleep latency (component 2), sleep duration (component 3), habitual sleep efficiency (component 4), sleep disorder (component 5), sleep medication use (component 6), and daytime sleep dysfunction (component 7). Each component is scored on a scale of 0-3. The sum of these 7 component scores yields the total score. The total score ranges from 0 to 21. Individuals with a score of 5 or below are assessed as having "good" sleep quality, while those with a score above 5 are assessed as having "poor" sleep quality.	Baseline, 4 weeks (end of intervention), 1-month follow-up

Collaborators and Investigators

• Sponsor: Gazi University
• Investigators: Principal Investigator: Şengül YAMAN SÖZBİR, Gazi University

Study record dates

Study Major Dates

• Study Start (Actual): March 1, 2026
• Primary Completion (Actual): May 1, 2026
• Study Completion (Actual): May 1, 2026

Study Registration Dates

• First Submitted: May 4, 2026
• First Submitted That Met QC Criteria: May 14, 2026
• First Posted (Actual): May 20, 2026

Study Record Updates

• Last Update Posted (Actual): May 20, 2026
• Last Update Submitted That Met QC Criteria: May 14, 2026
• Last Verified: May 1, 2026

More Information

Terms related to this study

• Keywords: Stress; Non-pharmacological method; Sleep Hygiene; Nursing Students; Laughter Yoga; Premenstrual Syndrome
• Additional Relevant MeSH Terms: Nervous System Diseases; Mental Disorders; Pathologic Processes; Sleep Wake Disorders; Sleep Disorders, Intrinsic; Dyssomnias; Menstruation Disturbances; Pathological Conditions, Signs and Symptoms; Behavior; Health Behavior; Sleep Initiation and Maintenance Disorders; Premenstrual Syndrome; Sleep Hygiene; Therapeutics; Patient Care; Health Services; Health Care Facilities Workforce and Services; Palliative Care
• Other Study ID Numbers: EBS

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO
• IPD Plan Description: Data confidentiality and participant privacy will be strictly protected in accordance with applicable laws and regulations. Individual participant data (IPD) will not be shared.

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No