instruction: hello doctor what are the causes of sleep disturbances what are some ways to tell if your sleep troubles are sleep anxiety and not a hormonal problem what is the difference between sleep disturbances that are caused by hormones is stress how might someone address each of these different causes of sleep disturbances
output: hello first we should know the patient gender then if female ask if the sleep problems are all the time or more evident prior to periods due date then I would ask both female and male patients to run a thyearoid function test while female patients to also check sexual hormone levels in the blood stress makes it difficult to fall asleep and keep asleep and altering sleep quality hormonal changes will cause an increase in body heat which becomes not stable and adrenalin which alter the quality of sleep and time of sleeping estrogen will cause an increase in body fat in women more around the tummy this will cause snoring and sleep apnea we should ask patients more details about their sleep like is it difficult to fall asleep why do you wake up during the night how many times if yes why in this way we will find more details about the sleeping problems my patients are having sometimes they can sleep but they are so anxious and feel not enough to sleep