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Sleep Test

Please print this page using your browser's print function and circle the number next to each statement that is true for you. If a statement does not apply or is false, leave it blank.

  1. I have been told that I snore.
  2. I have been told that I stop breathing while I sleep.
  3. I have high blood pressure.
  4. My friends and family say that I am often grumpy and irritable.
  5. I wish I had more energy.
  6. I sweat excessively during the night.
  7. I have noticed my heart pounding or beating irregularly during the night.
  8. I get morning headaches.
  9. I have trouble sleeping when I have a cold.
  10. I suddenly wake up gasping for breath during the night.
  11. I am overweight.
  12. I seem to be losing my sex drive.
  13. I often feel sleepy and struggle to stay alert.
  14. I frequently wake with a dry mouth.
  15. I often have difficulty falling asleep.
  16. Thoughts race through my mind and prevent me from sleeping.
  17. I anticipate a problem with sleep almost every night.
  18. I wake up during the night and cannot go back to sleep.
  19. I worry about things and have trouble relaxing.
  20. I wake up earlier in the morning than I would like to.
  21. I lie awake for half an hour or more before I fall asleep.
  22. I often feel sad and depressed.
  23. I have had trouble concentrating at work and school.
  24. When I am angry or surprised, I feel like my muscles are going limp.
  25. I have fallen asleep while driving.
  26. I often feel like I am going around in a daze.
  27. I have experienced vivid dream like scenes upon falling asleep or awakening.
  28. I feel like I am hallucinating when I fall asleep.
  29. Naps are refreshing to me.
  30. I have fallen asleep in social settings such as the movies or at a party.
  31. I have trouble at work because of sleepiness.
  32. I have dreams soon after falling asleep or during naps.
  33. I have “sleep attacks” during the day no matter how hard I try to stay awake.
  34. I have had episodes of feeling paralyzed during my sleep.
  35. I wake up at night with an acid/sour taste in my mouth.
  36. I wake up at night coughing or wheezing.
  37. I have frequent sore throats.
  38. During the night, I suddenly wake up feeling like I am choking.
  39. Other than when exercising, I still experience muscle tension in my legs.
  40. I have noticed (or others have commented) that parts of my body jerk
    during my sleep.
  41. I have been told that I kick at night.
  42. When trying to go to sleep, I experience an aching or crawling sensation in my legs.
  43. I experience leg cramps or pain during the night.
  44. Sometimes I can’t keep my legs still at night. I just have to move them to feel comfortable.
  45. I awaken with sore or achy muscles.
  46. Even though I slept during the night, I feel sleepy during the day.

SCORING THE TEST:

Questions 1-14: If you marked 3 or more of these questions, this may indicate symptoms of sleep apnea. Take this test to your doctor to see if a sleep study is indicated.

Questions 15-22: If you marked 3 or more of these questions, this may indicate symptoms of insomnia. Take this test to your doctor to see if a sleep study is indicated.

Questions 23-34: If you marked 3 or more of these questions, this may indicate symptoms of narcolepsy. Take this test to your doctor to see if a sleep study is indicated.

Questions 35-38: If you marked 2 or more of these questions, this may indicate symptoms of gastroesophageal reflux. Take this test to your doctor to see if a sleep study is indicated.

Questions 39-46: If you marked 3 or more of these, this may indicate symptoms of nocturnal myoconus or restless leg syndrome. Take this test to your doctor to see if a sleep study is indicated.