Do I have a sleep disorder?
Yes No  
1. I have been told that I snore
2. I have been told that I hold my breath while I sleep
3. I have high blood pressure
4. I have been told that I’m grumpy and irritable
5.  I wish I had more energy
6. I wake up with headaches
7. I wake up gasping for air
8. I wake up with chest pain
9. I wake up with a dry mouth and sore throat
10. I have difficulty with breathing through my nose at night
11. I nod off easily during the day
12. I become sleepy while driving
For questions 1 – 12 I answered yes times
Questions 1-12:
If you answered yes to three or more questions, you have symptoms of SLEEP APNEA, a potentially serious disorder that causes you to stop breathing many times throughout the night.

Yes No  
13. I have difficulty falling asleep
14. My mind races while I sleep
15. I worry about things and have trouble relaxing
16. It takes me more than 30 minutes to fall asleep
17. I often feel sad or depressed because I can’t sleep
18. Even before bedtime I worry I won’t sleep
For questions 13 – 18 I answered yes times
Questions 13-18:
If you answered yes to three or more questions, you have symptoms of INSOMNIA, a persistent inability to fall or stay asleep.

Yes No  
19. I have trouble concentrating at work or school
20. When I laugh my muscles go limp
21. When I get angry or surprised my muscles go limp
22. I’ve felt paralyzed upon waking up in the morning
23. I remember dreams during my daytime naps
24. I have dreamlike episodes while I’m awake
25. I have fallen asleep at work, movies, parties, etc.
For questions 19 – 25 I answered yes times
Questions 19-25:
If you answered yes to three or more questions, you have symptoms of
NARCOLEPSY, a disorder that causes an extreme desire to sleep during the day, regardless of the rest you may have acquired during the night.

Yes No  
26. Late in the day my calves or thighs ache
27. While relaxing my calves or thighs ache
28. For leg relief, I walk, shower or bathe
29. My leg jerks before I fall asleep
30. I’ve been told my legs jerk while I’m asleep
For questions 26 – 30 I answered yes times
Questions 26-30:
If you answered yes to three or more questions, you have symptoms of
RESTLESS LEGS SYNDROME or PERIODIC LIMB MOVEMENT DISORDER.