The New Way To Sleep

Sleep Survey

The following questions are intended to help those seeking information about potential sleep disorders. These address some of the most common sleep disorders but not all clearly all of them (there are at least 70).

If you think you might have a sleep disorder, contact your physician regardless of the results of this questionnaire.

Which statements describe your typical experience? CHECK the questions that you think apply to you frequently or always. If a statement does not apply or is false, simply go on to the next statement. If you have some checked, talk to your doctor about them.

1. I frequently wake up in the middle of the night and can't get back to sleep.
2. Thoughts racing through my mind prevent me from sleeping.
3. I worry about things and have trouble relaxing.
4. I wake up earlier in the morning than I mean to.
5. I lie awake for at least half an hour before I can fall asleep.
6. I am sad and depressed; I'm sometimes afraid to fall asleep.
7. Although I sleep through the night, during the day I feel muscle tension, crawling sensations, or aching in my legs.
8. Except when exercising, I feel sleepy during the day.
9. My legs hurt at night and feel better when I move them.
10. I have been told that I kick at night.
11. Sometimes I can't keep my legs still at night. I feel that I have to move them.
12. When I wake up, my muscles are sore or achy.
13. I use antacids (Rolaids, Tums, Alka-Seltzer, etc.) frequently for stomach upset, and wake up at night with heartburn.
14. I am hoarse in the morning.
15. I have a chronic cough.
16. I wake up at night wheezing or coughing.
17. I often have sore throats.
18. I'm told that I snore loudly.
19. While I don't remember it when I wake up, I'm told that while I'm asleep I stop breathing or gasp for breath.
20. I have high blood pressure.
21. My friends or family say they've noticed changes in my personality, and more daytime sleepiness.
22. I am overweight.
23. I sweat a great deal during the night.
24. My heart seems to pound or beat irregularly during the night.
25. I get headaches in the morning.
26. I am have lost or am losing my sex drive.
27. No matter how hard I try to stay awake during the day, I often fall asleep -- even if I've had a full night's sleep.
28. When I have strong feelings like anger, fear, surprise, or other strong emotions, I get a weak feeling in my knees, jaw, or other muscles.
29. Sleepiness is a problem during work or at school.
30. While falling asleep or soon thereafter, I experience vivid, dreamlike scenes.
31. I sometimes fall asleep during physical effort.
32. I feel as if I need to do a full day's work during every hour in order to get anything done.
33. I feel drowsy while driving, even if I've had a full night's sleep.
34. I often feel paralyzed (not able to move) for brief periods while falling asleep or just after waking up.

About the Questions

The questions may help you recognize symptoms of certain sleep disorders. This is intended as a general source of educational information and doesn't contain medical advice or medical recommendations. It should not be relied upon or used for diagnosis or treatment. If you think you may have a sleep disorder, contact a qualified doctor, regardless of the results of this questionnaire. Getting an evaluation by a qualified doctor is the best way to determine if you have a sleep/wake disorder.

Questions 1 - 6 describe some of the symptoms experienced by people who have insomnia, the persistent inability to fall asleep or stay asleep.

Questions 7 - 12 describe some of the symptoms experienced by people who have nocturnal limb movement disorder, or restless legs syndrome, resulting in uncontrollable leg or arm movements, aching or crawling sensations in the legs, or sometimes arms, during sleep.

Questions 13 - 17 describe some of the symptoms experienced by people with gastroesophageal reflux, a disorder that results from stomach acid backing up into the throat during the night.

Questions 18 - 26 describe some of the symptoms experienced by people who have sleep apnea, a potentially life-threatening disorder. People with sleep apnea quit breathing repeatedly, often hundreds of times during their night's sleep.

Questions 27 - 34 describe some of the symptoms experienced by people with narcolepsy, a complex disorder with uncontrollable sleep attacks during normal waking hours as one of its symptoms.