Assess Sleep Hygiene & Status with a Sleep Nutrition Questionnaire

Unlock deeper clinical insights into your patients’ sleep patterns with this comprehensive and professionally formatted assessment tool, expertly crafted by Registered Dietitian and sleep nutrition specialist, Karman Meyer, author of Eat To Sleep: What To Eat & When To Eat It for a Good Night’s Sleep and host of the PBS Special Program Eat To Sleep.

Are you looking for a time-saving resource to thoroughly evaluate the connection between your patients’ dietary habits and their sleep quality? This two-page assessment questionnaire allows you to evaluate sleep hygiene, meal timing related to sleep, potential sleep disruptors, and symptoms that may be causing sleep disturbances, perfect for private practice, telehealth, and clinical settings.

This questionnaire saves you valuable time by systematically evaluating key drivers of sleep disruption:

  • Sleep History & Patterns: Uncovers sleep latency, maintenance issues, duration, and existing diagnoses like insomnia or sleep apnea.
  • Chrononutrition & Meal Timing: Maps out evening meal spacing, pre-bed snack habits, daily eating windows, and morning appetite signals.
  • Potential Sleep Disruptors & Symptoms: Evaluates common sleep disruptors and consumption habits, plus symptoms that may be interfering with quality sleep.
  • Created by a Trusted Expert: Developed by Karman Meyer, RDN, LDN, a recognized authority in the field of sleep nutrition, ensuring clinical relevance and credibility.

This versatile tool is ideal for:

  • Initial Client Intake Sessions: Streamline your intake process by gathering critical sleep and timing data before or during your first consultation.
  • Targeted Sleep MNT Consultations: Guide discussions directly toward actionable nutritional solutions like blood sugar stabilization or caffeine timing adjustments.
  • Telehealth & Private Practices: Easily send as a printable or digital PDF questionnaire to remote clients prior to their appointment.

Benefits for Dietitians:

  • Save Time & Effort: Eliminate the hassle of building a specialized sleep intake tool from scratch—this assessment is ready to use immediately!
  • Identify Root Causes Faster: Rapidly pinpoint whether sleep disruptions stem from circadian timing, nighttime blood sugar crashes, or digestive distress.
  • Elevate Your Practice & Care: Equip yourself with a structured, expert-designed tool that enhances client trust and leads to targeted, effective nutrition interventions.

Product Features:

  • Two-Page Clinical Assessment: Concise, professional layout engineered for optimal patient completion without visual clutter.
  • Clean, Professional Design: Styled with clear headers, rating scales, checkbox matrices, and fill-in lines for a polished look.

Empower your clinical practice and help your patients achieve truly restorative rest with the insight provided in this Sleep Nutrition Questionnaire.

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