Sleep Questionaire


1) Do you snore or have you been told that you snore?

2) Do you feel sleep, tired / do you take naps / while watching TV/ reading / as a passenger or while driving / after a meal?

3) Do you wake up at night?

4) Do you wake up chocking / gasping for air / headaches / sweating / acid reflux / heart palpitations?

5) Do you kick at night, or is the blanket off when you wake up?

6) Are you overweight?

7) Have you been told that you stop / or that your breathing changes in you sleep?

8) Do you have a problem falling asleep?

9) Do you have unusual behavior during sleep / sleepwalking / sleep talking / acting out of dreams / bed wetting / hallucinations?

10) Are you a shift worker?

11) Do you have a tingling sensation in your legs while trying to fall asleep, is it relieved with movement?

12) Do you have difficulty breathing through your nose?

13) Do you feel weak when experiencing strong emotion (laughter, anger, etc.), muscle paralysis (inability to move)?

14) Do you have a history of hypertension, stroke, depression, anxiety, angina, or diabetes?

Thank you for submitting the quiz