Sleep Disorders Screening Survey

Please read the statements below in this survey. Answer true or false for each one. When you are finished, click the "submit" button.

I feel sleepy during the day, even when I get a good night's sleep.

I get very irritable when I can't sleep.

I often wake up at night and have trouble falling back to sleep.

It usually takes me a long time to fall asleep.

I often wake up very early and can’t fall back to sleep.

I experience an uncomfortable/restless sensation in my legs at night.

My legs often move or jerk during the night.

I sometimes wake up gasping for breath.

My bed partner says my snoring keeps her/him from sleeping.

I have fallen asleep while driving.



False to all

You answered all questions "false" and therefore did not indicate that you have any of these symptoms. However, if you are concerned about your sleep health, please review the information on this Web site and speak with your medical provider. To find a sleep center in your area, please visit http://www.sleepcenters.org.

1 true

You answered "true" for one question and therefore may have a symptom consistent with a sleep disorder. Please review the information in An Overview of Sleep Disorders on this site. If you remain concerned about your sleep, you should discuss your symptom with your medical provider. To find a sleep center in your area, please visit http://www.sleepcenters.org

2 true

You answered "true" for two questions and therefore may have symptoms consistent with a sleep disorder. Please review the information in An Overview of Sleep Disorders on this site. If you remain concerned about your sleep, you are strongly encouraged to discuss these issues with your medical provider. To find a sleep center in your area, please visit http://www.sleepcenters.org.

2 or more true

You answered "true" to more than two questions and therefore may have symptoms consistent with a sleep disorder. Please review the information in An Overview of Sleep Disorders on this site. In addition, you are strongly encouraged to discuss these sleep issues with your medical provider. To find a sleep center in your area, please visit http://www.sleepcenters.org.

This content was last reviewed on December 18, 2007