Section 1 of 7
Your Sleep Pattern
1I wake up easily during the night and have a hard time falling back asleep.
2I have disturbing or stressful dreams that I still remember when I wake up.
3I feel my heart racing or pounding even when I'm just sitting still or lying in bed.
4My head feels swimmy or foggy, or I get dizzy spells throughout the day.
5My arms and legs feel heavy and drained — like they've got nothing left in them.
6I have a poor appetite, or food just has no taste or appeal to me lately.
7My complexion looks pale, dull, or has lost its healthy color — people sometimes comment on it.
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Section 2 of 7
Digestion & Body Sensations
8My head feels heavy — like it's wrapped in a wet towel — and I feel groggy even after sleeping.
9I feel a lot of phlegm or mucus in my throat, or my chest feels tight and congested.
10I get nauseous or have an unsettled stomach after meals, or I burp and feel bloated a lot.
11I have a bitter taste in my mouth, especially first thing in the morning.
12I get acid reflux or a sour taste coming up my throat, especially after eating.
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Section 3 of 7
Emotions & Stress
13I feel emotionally down, depressed, or kind of numb inside.
14I find myself sighing deeply a lot — and it actually makes me feel a little better when I do.
15I have a dull, shifting ache or pressure along my ribs or the sides of my chest — not from a muscle injury.
16My sleep gets noticeably worse when I'm stressed, upset, or going through something emotionally hard.
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Section 4 of 7
Heat, Night Sweats & Kidney Signs
17It takes me more than 30–60 minutes to fall asleep almost every night.
18I wake up sweating at night — or I feel a restless, burning heat in my palms, soles of my feet, or chest, especially in the evening.
19My mouth and throat feel dry — but strangely, I don't feel that thirsty or want to drink much water.
20My lower back feels weak or achy, and my knees feel unsupported — not from an injury or heavy exercise.
21My feet or lower legs feel cold — even when my upper body or face feels warm or flushed.
22I have ringing or buzzing in my ears, or I'm forgetting things more than I used to.
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Section 5 of 7
Anger, Heat & Irritability
23I lose my temper easily, or I feel sudden bursts of anger that are hard to control.
24My eyes feel red, dry, or bloodshot — sometimes along with a pounding headache.
25I'm extremely thirsty, drink a lot of water, and notice my urine is dark yellow.
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Section 6 of 7
Anxiety, Fear & Energy
26I startle easily — I jump at small noises or unexpected things, and feel a wave of fear or dread.
27I feel short of breath or physically wiped out even without doing anything physically demanding.
28I feel a lingering sense of unease or low-level worry that I can't quite shake, even when nothing bad is happening.
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Section 7 of 7
Sleep History & Chronic Signs
29My sleep problems have been going on for months or years — and they feel stuck, no matter what I try.
30I have a sharp, stabbing pain that always hurts in the same exact spot — in my head or chest — like a pinpoint.
31My complexion looks dull or dark, or I have dark circles under my eyes that won't go away no matter how much I sleep.
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