Nervous System Questionnaire

Directions: 

• Complete the questionnaire at the beginning of the program.

• Complete the 90-Day Program as designed. 

• Complete the questionnaire at the end of the program.  Use the scoring to determine how much time to dedicate going forward after the program has ended. 

Give yourself one point for each 

• Startle easily 

• Weak gag reflux 

• Overly strong gag reflex

• Trouble sleeping 

• Waking up tired

• Feeling wired and tired 

• Feeling wired after to much conversation 

• Easily stressed with changes 

• Anxiety or depression 

• Loss of intestinal motility (chronic constipation or diarrhea) 

• High or low blood pressure 

• Light/sound sensitivity 

• Supplement or medication reaction 

• EMF sensitivities 

• Mold sensitivities

• Sensitivity to perfume or cologne 

• Chemical sensitivities (paint, gas, new clothing, new furniture, etc.) 

• History of chronic Lyme, Bartonella, Babesia, etc.  (Bartonella is a big one) 

• Constant food reactions 

• Mast cell activation syndrome (MCAS)

• Autoimmunity 

• Nothing you do works

More significant signs 

• POTS 

• IBS 

• Neuropathy (Nerve pain) 

• Tinnitus (ringing in the ears) 

• Complex regional pain syndrome 

• EDS (specifically hypermobility)  

• Fibromyalgia

• Chronic fatigue 

• Pain and weakness in joints and muscles 

Dysregulated Nervous System Questionnaire Scoring 

Use the scoring to determine how much time to dedicate going forward after the program has ended. 

Common Signs of Nervous System Dysfunction 

Physical and Physiological Signs

Breathing Patterns

• Normal Breathing Rate: A healthy resting respiratory rate for adults is typically around 12-16 breaths per minute. This rate reflects a balanced state where the parasympathetic nervous system (rest-and-digest) and sympathetic nervous system (fight-or-flight) are in equilibrium.

• Sympathetic Dominance Breathing: When under stress or in sympathetic overdrive, breathing tends to become shallow and rapid. A rate of over 18 breaths per minute indicates the body is in a state of heightened alertness and stress. Shallow chest breathing, where the diaphragm is barely engaged, often accompanies this state.

Heart Rate Variability (HRV)

• What is HRV? HRV is the variation in time between heartbeats. It reflects how well your nervous system adapts to stress and regulates the balance between the sympathetic (fight-or-flight) and parasympathetic (rest-and-digest) branches.

• Low HRV: A low HRV generally indicates poor vagal tone, chronic stress, or nervous system imbalance. For adults, a low HRV is typically considered below 40 milliseconds (ms). This can reflect difficulty in regulating the nervous system and a state of chronic stress or sympathetic dominance.

• Good HRV: A higher HRV indicates better adaptability and a healthier nervous system. A good HRV is typically above 60 ms, with elite athletes and those with excellent nervous system regulation sometimes having HRVs above 80-100 ms. However, HRV is individual, and the key is noticing your personal trends over time.

• Factors such as age, fitness level, and overall health impact HRV, so it's more useful to track trends in HRV rather than relying solely on the number.

Tight Muscles in Neck, Shoulders, and Jaw from Postural Tension: Chronic tension in these areas often reflects an overactive sympathetic nervous system. Constant muscle tension is a physiological sign that the body is "bracing" itself for stress or perceived threats.

Elevated Resting Heart Rate: A consistently elevated heart rate at rest (above 80 bpm) may indicate sympathetic dominance, especially when it coincides with stress-related symptoms. A normal resting heart rate for adults ranges from 60-80 bpm, but lower rates are common in well-conditioned individuals.

Bloating, Constipation, or Diarrhea: Digestive issues are often linked to poor parasympathetic (vagus nerve) activation. When the body is in a constant fight-or-flight mode, digestion slows down or becomes erratic, leading to gut dysregulation like constipation, diarrhea, or bloating.

Trouble Falling Asleep or Waking Up During the Night: Dysregulation in the nervous system can keep the body in a hyper-alert state, making it hard to wind down, fall asleep, or stay asleep. This also contributes to waking up feeling tired, regardless of the amount of sleep.

Constant Pupil Dilation: Larger pupils, even in normal light, may indicate an overactive sympathetic response. This is because, under stress, the body dilates the pupils to take in more light as part of the fight-or-flight response.

Emotional and Psychological Signs

High-Stress Emotional Reactivity: Overreacting to minor stressors, feeling easily triggered, or experiencing emotional outbursts are signs of poor nervous system regulation. These symptoms suggest that the sympathetic system is over-activated and the parasympathetic system is not sufficiently balancing it out.

Restlessness or Inability to "Switch Off" (Difficulty relaxing): Feeling constantly "on edge" or unable to fully relax suggests a dominance of the sympathetic nervous system. The body may remain in a state of hyperarousal, even when there's no immediate stress.

Feeling Tired but Wired (Chronic fatigue or burnout): This paradox of being physically and mentally exhausted but unable to relax or rest is a hallmark of nervous system dysregulation. The sympathetic system is driving the body while it’s already depleted.

Anxiety, Depression, or Mood Swings (Mood instability): Dysregulation in the nervous system affects emotional regulation, often resulting in fluctuating moods, periods of anxiety, or feelings of depression. Chronic stress can deplete neurotransmitters, leading to these mental health challenges.

Difficulty Concentrating or Memory Issues (Brain fog and poor focus): A stressed or dysregulated nervous system impacts cognitive function, leading to issues like brain fog, poor memory, and difficulty focusing on tasks.

Behavioral Signs

Avoiding Social Interaction or Overstimulating Environments (Social avoidance and hypervigilance): Nervous system dysregulation can make socializing or being in noisy, crowded places feel overwhelming. This sensitivity is often a sign of an overloaded or overstimulated system.

Overeating, Substance Use, or Other Coping Mechanisms (compulsive behaviors): Engaging in compulsive behaviors may be a way of self-soothing when the nervous system is stuck in sympathetic overdrive. These actions provide temporary relief but don’t resolve the underlying dysregulation.

Chronic Infections or Slow Recovery (frequent illness or low immunity): Poor nervous system regulation, particularly an underactive parasympathetic system, can suppress immune function. This can make you more susceptible to illness and delay recovery times.

Light, Sound, Chemical, or EMF Sensitivities (sensitivity to environmental stimuli): When the nervous system is dysregulated, it can heighten your sensitivity to stimuli like bright lights, loud sounds, or even environmental toxins like chemicals or electromagnetic fields. This is a sign that the system is overloaded and not processing external stimuli efficiently.

Tracking Your Progress 

Tracking your progress while working on balancing your nervous system, vagal tone, and limbic system can help you stay motivated and see how far you've come. Here are several methods you can use:

1. Heart Rate Variability (HRV): Using a device like a fitness tracker or biofeedback tool (e.g., Oura Ring, Whoop, HeartMath) can help you monitor your HRV. A gradual increase in HRV suggests improved nervous system regulation and recovery from stress.

2. Breath Rate: Track your resting breath rate by counting how many breaths you take per minute. An optimal rate is 5-7 breaths per minute for a relaxed, parasympathetic state. A faster rate may indicate a sympathetic response.

3. Sleep Quality: Keep a journal or use a sleep tracker to monitor how restful your sleep is. Improvement in sleep onset, fewer night wakings, and feeling refreshed in the morning are signs of better nervous system balance.

4. Mood and Emotional Balance: Track your mood using journaling or mood-tracking apps. Reduced anxiety, less frequent irritability, and better emotional resilience indicate positive changes.

5. Energy Levels: Monitor how your energy levels fluctuate throughout the day. Feeling more balanced, with less “wired and tired” sensations or afternoon crashes, is a sign of progress.

6. Stress Tolerance: Notice how well you handle stress and changes in routine. Improved stress response, staying calm under pressure, and less overwhelm are key indicators of nervous system resilience.

7. Physical Sensations: Pay attention to bodily cues such as tension, pain, digestion, and food sensitivities. Reduced physical symptoms like headaches, IBS, or sensitivity to light and sound suggest improved regulation.

8. Breathing Patterns: Assess if you’re naturally shifting toward more belly breathing rather than shallow, chest breathing, especially in moments of stress or rest. This indicates better parasympathetic activation.

9. Overall Well-Being: Journaling daily or weekly about your general well-being, calmness, and clarity can give you a broader picture of your progress over time.

10. Response to Co-Regulation: As you incorporate co-breathing or shared calming activities with others, notice how quickly you settle into calm states, especially during moments of connection.

Regular tracking helps you recognize subtle improvements and stay engaged in the process, reminding you that progress happens in small, meaningful ways.