Sleep Disturbances & Nervous System Assessment

Section 1: Primary Sleep Pattern

1. Which best describes your main sleep difficulty? (Check all that apply)

☐ Difficulty falling asleep

☐ Waking frequently during the night

☐ Waking very early (3–5am) and unable to return to sleep

☐ Waking with racing heart or panic

☐ Snoring or mouth breathing at night

☐ Restless body / can’t physically settle

☐ Pain interfering with sleep

☐ Fear or anxiety about not sleeping

☐ Sleep disruption linked with low mood

☐ Sleep disruption linked with grief or loss

2. How long has this pattern been present?

☐ Less than 1 month

☐ 1–6 months

☐ 6–12 months

☐ Over 1 year

3. Is there a specific event that preceded this change in sleep?

(Open response)

Section 2: Sleep Onset (Falling Asleep)

If falling asleep is difficult:

4. When trying to fall asleep, what feels most prominent?

☐ Racing thoughts

☐ Body feels alert or tense

☐ Fear of not sleeping

☐ Emotional heaviness

☐ Restless legs/body

☐ Nothing specific — just “not sleepy”

5. Do you notice anticipatory anxiety before bed?

☐ Yes, most nights

☐ Sometimes

☐ Rarely

☐ No

Section 3: Night Awakenings

If you wake during the night:

6. What typically wakes you?

☐ Unknown

☐ Racing heart

☐ Need to urinate

☐ Noise

☐ Pain

☐ Dreams

☐ Shortness of breath

7. When you wake, what state are you in?

☐ Calm but awake

☐ Anxious

☐ Mentally active

☐ Emotionally overwhelmed

☐ Physically uncomfortable

Section 4: Breathing & Airway

8. Do you wake with dry mouth?

☐ Frequently

☐ Sometimes

☐ Rarely

☐ Never

9. Has anyone told you that you snore?

☐ Yes

☐ No

☐ Unsure

10. Do you feel nasal congestion at night?

☐ Often

☐ Sometimes

☐ Rarely

☐ Never

11. During the day, do you tend to breathe through your mouth?

☐ Often

☐ Sometimes

☐ Rarely

☐ Never

Section 5: Body Regulation

12. At bedtime, does your body feel:

☐ Wired but tired

☐ Heavy and fatigued

☐ Restless

☐ Numb or disconnected

☐ Painful or guarded

13. Do you experience:

☐ Jaw clenching

☐ Neck/shoulder tightness

☐ Chest tightness

☐ Pelvic floor tension

☐ General muscle bracing

Section 6: Emotional Patterns at Night

14. Do strong emotions surface more at night?

☐ Grief

☐ Fear

☐ Regret

☐ Loneliness

☐ Anger

☐ No

15. Does nighttime feel emotionally vulnerable or unsafe?

☐ Yes

☐ Sometimes

☐ No

Section 7: Sleep Anxiety & History

16. Do you worry about not sleeping before bed?

☐ Frequently

☐ Occasionally

☐ Rarely

☐ Never

17. Have you experienced a period of severe sleep loss that felt destabilizing or traumatic?

☐ Yes

☐ No

If yes, briefly describe:

(Open response)

Section 8: Energy & Circadian Rhythm

18. How would you describe your daytime energy?

☐ Alert and steady

☐ Fatigued but wired

☐ Flat/low

☐ Variable

19. Do you get morning sunlight within 30 minutes of waking?

☐ Yes

☐ Sometimes

☐ Rarely

☐ Never

20. Is your sleep-wake schedule consistent?

☐ Very consistent

☐ Somewhat

☐ Irregular

Section 9: Pain & Inflammation

21. Do you experience chronic pain?

☐ Yes

☐ No

If yes:

☐ Pain increases at night

☐ Pain is worse in the morning

☐ Stiffness upon waking

Section 10: Sensory & Regulation Style

22. When you try relaxation practices, do you prefer:

☐ Breath-focused

☐ Body-based

☐ Emotional processing

☐ Sensory grounding

☐ Simple repetition/ritual

23. Does stillness feel:

☐ Calming

☐ Uncomfortable

☐ Agitating

☐ Numbing

STEP 1 — Where Is the Breakdown?

A. Difficulty falling asleep?

→ Go to Branch 1

B. Waking during the night?

→ Go to Branch 2

C. Early waking (3–5am)?

→ Go to Branch 3

D. Panic / racing heart on waking?

→ Go to Branch 4

E. Snoring / mouth breathing?

→ Go to Branch 5

F. Restless body / can’t settle physically?

→ Go to Branch 6

G. Pain interfering with sleep?

→ Go to Branch 7

H. Fear of not sleeping?

→ Go to Branch 8

I. Depression-linked disruption?

→ Go to Branch 9

J. Grief-linked disruption?

→ Go to Branch 10

BRANCH 1 — Difficulty Falling Asleep

Ask:

⦁ Is the mind racing?

⦁ Is there anticipatory anxiety?

⦁ Does the body feel activated?

If mental speed → Hyperarousal

Start:

⦁ Bhramari (low tone)

⦁ Extended exhale nasal breathing

⦁ Body scan

If anticipatory fear → Conditioned arousal

Start:

⦁ Counting exhales

⦁ Very short predictable sequence

⦁ Same poses nightly

BRANCH 2 — Frequent Night Awakenings

Ask:

⦁ Calm but awake?

⦁ Anxious?

⦁ Physically restless?

Calm but awake → Autonomic instability

Start:

⦁ Slow nasal breathing

⦁ Counting exhales

⦁ Supine twist (very passive)

Anxious → CO₂ / over-breathing

Start:

⦁ Nose-only breathing with long exhale

⦁ Micro Bhramari

Restless → Incomplete discharge

Start:

⦁ Longer exhale breathing

⦁ Supported forward fold

BRANCH 3 — Early Morning Awakening (3–5am)

Ask:

⦁ Emotional tone present?

⦁ Feels biological?

Emotional tone → Grief / processing

Start:

⦁ Gentle nasal breathing

⦁ Loving-kindness

⦁ Side-lying fetal

Flat but alert → Cortisol rhythm disruption

Start:

⦁ Soft nasal breathing only

⦁ Sensory anchoring

Stay horizontal (no stimulation)

BRANCH 4 — Racing Heart / Panic on Waking

Ask:

⦁ Dry mouth?

⦁ Mouth open?

⦁ Chest tight?

Yes → Airway / CO₂ issue

Start:

⦁ Nose-only breathing

⦁ Humming (closed mouth)

⦁ Hands on belly/chest

If persistent → evaluate nasal obstruction

BRANCH 5 — Snoring / Mouth Breathing

Ask:

⦁ Nasal congestion?

⦁ Jaw slack?

⦁ Tongue low?

Likely nasal obstruction

Start:

⦁ Daytime nasal breathing practice

⦁ Breath awareness at nostrils

⦁ Neck / upper thoracic mobility

Likely low tongue tone

Start:

⦁ Bhramari before bed

⦁ Jaw and tongue release

BRANCH 6 — Restless Body / Can’t Settle

Ask:

⦁ Wired?

⦁ Suppressed emotion?

⦁ Didn’t move much today?

Excess nervous energy

Start:

⦁ Gentle ujjayi

⦁ Yin-style hip openers

Incomplete discharge

Start:

⦁ Progressive muscle relaxation

⦁ Long-held forward folds (supported)

BRANCH 7 — Chronic Pain Interfering With Sleep

Ask:

⦁ Is pain sharp/inflammatory?

⦁ Is it muscular guarding?

Guarding pattern

Start:

⦁ Breath to sensation

⦁ Joint-specific supported poses

Inflammatory

Start:

⦁ Soft nasal breathing

⦁ Gentle traction & decompression

BRANCH 8 — Sleep Anxiety / Fear of Not Sleeping

Ask:

⦁ Is fear present before bed?

⦁ Past severe sleep loss?

Conditioned arousal

Start:

⦁ Counting exhales

⦁ Very short predictable sequence

Past traumatic sleep loss

Start:

⦁ Bhramari (audible reassurance)

⦁ Letting-go phrases

⦁ Ritual consistency

BRANCH 9 — Depression-Linked Sleep Disruption

Ask:

⦁ Daytime flat energy?

⦁ Hard to feel sensation?

Low circadian amplitude

Start:

⦁ Gentle rhythmic breathing

⦁ Mild supported backbends

Withdrawal from sensation

Start:

⦁ Sensory anchoring

⦁ Chest opening with safety

BRANCH 10 — Grief-Related Sleep Disturbance

Ask:

⦁ Emotional waves?

⦁ Identity instability?

Emotional waves

Start:

⦁ Breath with sound release

⦁ Grief witnessing

⦁ Heart-holding posture

Identity / safety disruption

Start:

⦁ Compassion practice

⦁ Long stillness with support

FINAL FILTER

After identifying category:

⦁ Choose ONE breath practice.

⦁ Add ONE nervous system intervention.

⦁ Add ONE shape (if needed).

Keep session under-stimulating.

Core Clinical Reminder

Fragile sleep systems improve with:

⦁ Predictability

⦁ Repetition

⦁ Low stimulation

⦁ Breath-first sequencing

Escalation rarely solves fragility.