Effectiveness of the Stimulation of Endorphin, Oxytocin, and Serotonin (SPEOS) Method in Improving Sleep Quality among Postpartum Women: A Quasi-Experimental Study in Primary Maternal Healthcare in Gorontalo, Indonesia

Ani Retni; Fatmah M Abdullah

doi:10.56303/jhnresearch.v5i2.1469

Authors

Ani Retni Department of Nursing, Universitas Muhammadiyah Gorontalo, Indonesia
Fatmah M Abdullah Department of Nursing, Universitas Muhammadiyah Gorontalo, Indonesia

Keywords:

Postpartum Women, Sleep Quality, SPEOS, Oxytocin Massage, Maternal Care, Non-Pharmacological Intervention

Abstract

Postpartum sleep disturbance is a clinically relevant maternal health problem because it may weaken physical recovery, emotional regulation, breastfeeding continuity, and early mother infant adaptation. This study analyzed the effectiveness of the Stimulation of Endorphin, Oxytocin, and Serotonin (SPEOS) method in improving sleep quality among postpartum women in the working area of Telaga Primary Health Center, Gorontalo, Indonesia. A quasi-experimental pretest and posttest control group design using consecutive sampling and convenience sub-district cluster allocation was used. Sixty-two postpartum women were allocated into an intervention group and a control group (n = 31 per group). The intervention group received the home-based SPEOS method for seven consecutive days, whereas the control group received routine postpartum care. Sleep quality was measured using the Pittsburgh Sleep Quality Index. Because the data were not normally distributed, the Wilcoxon Signed Rank Test and Mann Whitney U Test were applied. After the intervention, mild sleep disturbance in the intervention group increased from 16.1% to 83.9%, while severe sleep disturbance was no longer observed. Wilcoxon tests revealed significant PSQI reductions in the intervention group (Z = -4.564; p < 0.001; r = 0.82). The Mann Whitney U Test also demonstrated a significant difference in score change between groups (U = 118.500; Z = -4.921; p < 0.001; r = 0.62). These findings indicate that SPEOS provides a statistically and clinically meaningful non-pharmacological approach for postpartum sleep restoration. Its effect is hypothesized to be linked to pathways involving tactile relaxation, oxytocinergic activation, endorphin release, reduced stress response, and increased maternal comfort. SPEOS is recommended as a feasible midwife-led community-based intervention in postpartum nursing and midwifery care.

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References

Nastiti AA. Postpartum Fatigue: A Critical Challenge for New Mothers. Pediomaternal Nursing Journal. 2024;10(2):48–50. doi:10.20473/pmnj.v10i2.62604

Ruan H, Zhang Y, Tang Q, Zhao X, Zhao X, Xiang Y, et al. Sleep duration of lactating mothers and its relationship with feeding pattern, milk macronutrients and related serum factors: A combined longitudinal cohort and cross-sectional study. Frontiers in Nutrition. 2022;9. doi:10.3389/fnut.2022.973291

WHO. WHO recommendations on maternal and newborn care for a positive postnatal experience [Internet]. 2022 [cited 2026 Jul 16]. Available from: https://www.who.int/publications/i/item/9789240045989

Imamura M, Robertson C, Hudson J, Whibley D, Auco L, Gillie K, et al. Effects of pharmacological and non-pharmacological interventions for the management of sleep problems in people with fibromyalgia: a multi-methods evidence synthesis. Health Technology Assessment. 2025;29(20). doi:10.3310/GTBR7561 PubMed PMID: 40454897.

Nguyen CTT, Chiu HY, Lin-Lewry M, Bei B, Tsai SY, Kuo SY. Comparative effectiveness of nonpharmacological interventions on postpartum maternal sleep quality: a systematic review and network meta-analysis. J Clin Sleep Med. 2025 Nov 1;21(11):1957–67. doi:10.5664/jcsm.11814 PubMed PMID: 40745901; PubMed Central PMCID: PMC12582195.

Dewi LA, Armini NW, Sriasih NGK. Perbedaan Kepuasan Ibu Menyusui dengan Pemberian Metode SPEOS (Stimulasi Pijat Endorphin, Oksitosin dan Sugestif) di Wilayah Kerja Puskesmas Tejakula I Tahun 2022. Jurnal Ilmiah Kebidanan (The Journal Of Midwifery). 2023 Jun 12;11(1):95–104. doi:10.33992/jik.v11i1.2442

Nugraheni DE, Heryati K. Metode Speos (Stimulasi Pijat Endorphin, Oksitosin dan Sugestif) Dapat Meningkatkan Produksi ASI dan Peningkatan Berat Badan Bayi. Jurnal Kesehatan. 2017 Apr 30;8(1):1–7. doi:10.26630/jk.v8i1.384

Puspitasari D, Setyowati Esti Rahayu H, Wijayanti K, Rohmayanti. Effectiveness SPEOS Method (Endorphin, Oxytocin, and Suggestive Massage Stimulation) on Breast Milk Production in Postpartum Mothers: A Systematic Literature Review. Gaster. 2025;23(2):211–25. doi:10.30787/gaster.v23i2.1578

Neumann ID, Landgraf R. Balance of brain oxytocin and vasopressin: implications for anxiety, depression, and social behaviors. Trends Neurosci. 2012 Nov;35(11):649–59. doi:10.1016/j.tins.2012.08.004 PubMed PMID: 22974560.

Takayanagi Y, Onaka T. Roles of Oxytocin in Stress Responses, Allostasis and Resilience. Int J Mol Sci. 2021 Dec 23;23(1):150. doi:10.3390/ijms23010150 PubMed PMID: 35008574; PubMed Central PMCID: PMC8745417.

Saper CB, Scammell TE, Lu J. Hypothalamic regulation of sleep and circadian rhythms. Nature. 2005 Oct 27;437(7063):1257–63. doi:10.1038/nature04284 PubMed PMID: 16251950.

Boccalaro IL, Rillosi E, Ramirez-Plascencia ODD, De Luca R, Mahoney CEE. A narrative review on oxytocin at the intersection of sleep, stress, and social behavior. Front Neurosci. 2026 Apr 21;20. doi:10.3389/fnins.2026.1745281

Mollayeva T, Thurairajah P, Burton K, Mollayeva S, Shapiro CM, Colantonio A. The Pittsburgh sleep quality index as a screening tool for sleep dysfunction in clinical and non-clinical samples: A systematic review and meta-analysis. Sleep Med Rev. 2016 Feb;25:52–73. doi:10.1016/j.smrv.2015.01.009 PubMed PMID: 26163057.

Setyowati A, Chung MH. Validity and reliability of the Indonesian version of the Pittsburgh Sleep Quality Index in adolescents. Int J Nurs Pract. 2021 Oct;27(5):e12856. doi:10.1111/ijn.12856 PubMed PMID: 32632973.

Kadek Widiantari, Dewianti NM, Ni Luh Wayan Adi Arsani. The Effect Application of the SPEOS Method (Endorphin, Oxytocin, Suggestive Massage Stimulation) with Essential Oil Aromatherapy on Breast Milk Production in Postpartum Mothers. Babali Nursing Research. 2023;4(4):785–95. doi:10.37363/bnr.2023.44316

Sari LP, Salimo H, Budihastuti UR. Optimizing the Combination of Oxytocin Massage and Hypnobreastfeeding for Breast Milk Production among Post-Partum Mothers. Journal of Maternal and Child Health. 2017 Jun 29;2(1):20–9.

Sihaloho E, Dalimunthe SY, Simamora MK, Ristiani R. Effectiveness of Slow Stroke Back Massage Therapy on the Sleep Quality of Postpartu Mother. Proceedings of the International Conference on Nursing and Health Sciences. 2022;3(1):299–306. doi:10.37287/picnhs.v3i1.3688

Ko YL, Lee HJ. Randomised controlled trial of the effectiveness of using back massage to improve sleep quality among Taiwanese insomnia postpartumwomen. Midwifery. 2014 Jan;30(1):60–4. doi:10.1016/j.midw.2012.11.005 PubMed PMID: 23410501.

Ko YL, Lin SC, Lin PC. Effect of auricular acupressure for postpartum insomnia: an uncontrolled clinical trial. J Clin Nurs. 2016 Feb;25(3–4):332–9. doi:10.1111/jocn.13053 PubMed PMID: 26612319.

Nakakita Kenyon M. Randomized controlled trial on the relaxation effects of back massages for puerperants on the first post-partum day. Jpn J Nurs Sci. 2015 Apr;12(2):87–98. doi:10.1111/jjns.12053 PubMed PMID: 24962143.

Sumiaty, Suryani L, Sundari, Usman AN. Traditional and complementary health care during pregnancy, labor, and postpartum in the Kaili ethnic culture. Enfermería Clínica. 2020 Mar 1;International Conference on Women and Societal Perspective on Quality of Life (WOSQUAL-2019)30:597–601. doi:10.1016/j.enfcli.2019.07.169

Mato R, Ariyana A. The Relationship Between Cultural Beliefs in Postpartum Care and Maternal Mental Health in Traditional Communities in Makassar City. Journal of Applied Health Science (JAHS). 2025 Nov 30;1(1):18–24.

Toomey E, Hardeman W, Hankonen N, Byrne M, McSharry J, Matvienko-Sikar K, et al. Focusing on fidelity: narrative review and recommendations for improving intervention fidelity within trials of health behaviour change interventions. Health Psychol Behav Med. 8(1):132–51. doi:10.1080/21642850.2020.1738935 PubMed PMID: 34040865; PubMed Central PMCID: PMC8114368.

Begum S, Yada A, Lorencatto F. How Has Intervention Fidelity Been Assessed in Smoking Cessation Interventions? A Systematic Review. J Smok Cessat. 2021 Jan 15;2021:6641208. doi:10.1155/2021/6641208 PubMed PMID: 34306228; PubMed Central PMCID: PMC8279202.

WHO. Adolescent pregnancy [Internet]. World Health Organization; 2024 [cited 2026 Jul 16]. Available from: https://www.who.int/news-room/fact-sheets/detail/adolescent-pregnancy

Backhaus J, Junghanns K, Broocks A, Riemann D, Hohagen F. Test–retest reliability and validity of the Pittsburgh Sleep Quality Index in primary insomnia. Journal of Psychosomatic Research. 2002 Sep 1;53(3):737–40. doi:10.1016/S0022-3999(02)00330-6