Do you have sleep issues?

Please answer the following questions and include an explanation where applicable.

  • Do you have difficulty falling asleep at night?
  • Do you find it difficult to stay asleep?
  • Do you sleep less than 7 hours a night?
  • Do you require noise to fall asleep? (television, radio, “white” noise)
  • Do you require absolute silence in order to fall/stay asleep?
  • Do you wake up easily? (i.e., are you noise-sensitive)
  • Do you often wake up at the same time(s) during the night?
  • Do you wake up feeling fatigued?
  • Do you rely on an alarm to wake up?
  • Do you rely on medications (OTC or RX) in order to get a better night’s sleep?
  • Do you consume more than 3 caffeinated beverages per day?
  • Do you consume caffeine after 1pm? (includes chocolate, iced tea, hot chocolate, etc.)
  • Do you drink more than 2 alcoholic beverages in the evening?
  • Do you find it easier to fall asleep after drinking alcoholic beverages?
  • Do you find that you do not stay asleep after drinking alcoholic beverages?

Test score meaning
If you answer “yes” to 3 or more of the above questions, your sleep issues may be a significant factor in your inability to lose weight and you may benefit from the following suggestions:

  • Darken the room (wear an eye mask if necessary)
  • Don’t over-stimulate yourself before bed, i.e., computer, working late, watching television, phone calls, etc.
  • Use your bedroom only for sleep/sex.

Snooze Foods
Consumed at bedtime, these food help induce sleep: Warm milk, Turkey, Nuts (i.e., almonds, hazelnuts, walnuts), Seeds (i.e., pumpkin, sunflower), Chamomile tea, and Eggs (boiled is easiest!)

Thyroid Function Questionnaire

  1. Do you have family history of hypothyroidism or other thyroid problems?
  2. Is your skin dry without the use of lotion?
  3. Do you suffer from constipation?
  4. Are your menstrual cycles irregular?
  5. Do you have high cholesterol?
  6. Do you have low blood pressure?
  7. Is your hair dry?
  8. Are your nails brittle?
  9. Is your hair thinning?
  10. Is the outer third of your eyebrows missing or thinning?
  11. Does your skin have a yellow tint?
  12. Do you sometimes suffer from depression?
  13. Do you suffer from mood swings?
  14. Do you need caffeine and/or other stimulants to get you going?
  15. Do you have low energy levels?
  16. Do you have a low sex drive?
  17. Do you note any forgetfulness?
  18. Do you have difficulty losing weight?
  19. Is it easy for you to gain weight?
Test score meaning
If you have answered “yes” to 5 or more of these questions, you may have hypothyroidism (low thyroid hormone function) and require thyroid testing. The thyroid gland regulates metabolism and hormone function, and is important for numerous physiological functions in the body.