Articles

OVERCOMING INSOMNIA: CURRENT HEALTH AND LIFESTYLE

Rate your overall health on a scale of 1 (poor) to 10 (excellent).

List any chronic diseases or conditions (asthma, allergies, arthritis, ulcer, back pain, high blood pressure, diabetes, etc.).

List past major illnesses, injuries, and hospitalizations, including approximate dates the problem began, treatment, date/of recovery, any lingering symptoms.

List any medical problems within the last year or so, including any seasonal problems such as allergies, mood swings, etc.

Are you seeing a psychiatrist or any other type of counselor? If yes, for how long? Describe any therapeutic program you are following (drugs, counseling, etc.).

If you think you are overweight, indicate by how many pounds.

Indicate any findings from a recent physical examination, such as blood pressure, heart rate, and overall health.

Rate your overall energy level on a scale of 1 (constantly fatigued) to 10 (constantly energetic).

If you currently work, how many hours a day? Do you consider yourself a workaholic?

Do you smoke? If so, how many packs a day?

Do you drink? If so, how many drinks per week?

Do you regularly drink a nightcap to help you sleep? If so, how many drinks?

How much of the following do you consume on the average each day:

coffee (caffeinated) (6-ounce cups)

coffee (decaffeinated) (6-ounce cups)

tea (caffeinated) (6-ounce cups)

tea (herbal or decaffeinated) (6-ounce cups)

caffeinated soft drinks (6-ounce cups)

chocolate (2-ounce bars)

Rate your general eating habits on a scale of 1 (irregular eating schedule; poor nutritional balance) to 10 (regular schedule, balanced diet).

Within the last thirty days, have you taken:

Any prescription drugs for sleep? List the drug, dosage, and regimen.

Any non-prescription sleeping aids? List name, dosage, active ingredient if known.

Any other medication for any medical problem? List all drugs, injections, dosages, and regimens, and whether drug is prescription or over-the-counter.

Any illegal drugs (marijuana, cocaine, hallucinogenics, amphetamines)?

Do you exercise regularly? If so, indicate the types of exercise, frequency, your typical regimen, time of day of exercise.

Do you practice any form of structured relaxation exercises (including transcendental meditation, yoga, Zen, etc.)? If so, describe your regimen.

How many people share your living quarters? What ages?

Do you have a bedmate (spouse, lover)?

How many times per month do you have sexual intercourse?

Rate your sexual activity on a scale of 1 (very unsatisfactory) to 10 (very satisfactory).

Describe any sexual problems such as impotence, frigidity, etc. Do you experience headaches on waking? How often?

Do you feel you are not able to think as quickly or as effectively as you used to?

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