Effect of the 4-7-8 Breathing Technique on Sleep Quality in University Students: A Quasi-Experimental Controlled Study

Abstract

Background: University students are at high risk of poor sleep quality due to academic demands, psychological stress, and irregular sleep schedules. Non-pharmacological relaxation strategies, such as the 4-7-8 breathing technique, have been proposed to improve sleep quality by promoting autonomic regulation and relaxation.
Objective: This study aimed to examine the effect of the 4-7-8 breathing technique on sleep quality among university students.
Methods: A quasi-experimental pretest–posttest controlled study was conducted involving 110 undergraduate physiotherapy students. Participants were allocated into an intervention group (n = 55) and a control group (n = 55). The intervention group performed the 4-7-8 breathing technique twice daily for 14 consecutive days, while the control group received no intervention. Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI). Within-group changes were analyzed using paired t-tests, and between-group differences were evaluated using independent t-tests, with a significance level of α = 0.05.
Results: The intervention group demonstrated a significant reduction in PSQI scores from 9.5 ± 3.5 at baseline to 5.7 ± 2.9 post-intervention (t = 7.108, p < 0.001; 95% CI: 4.9–6.5), with a large effect size (Cohen’s d = 0.95). No significant change was observed in the control group. Post-intervention comparisons showed significantly better sleep quality in the intervention group compared with the control group (t = 3.910, p < 0.001; Cohen’s d = 0.75).
Conclusion: The 4-7-8 breathing technique significantly improves sleep quality among university students and may serve as an effective, safe, and accessible non-pharmacological intervention.