Please answer the questions below by writing on the line provided or by checking the box that best describes you. Submit your answers by clicking the button at the bottom to receive your analysis for several sleep-related disorders.

During the past 4 weeks, how often...

1. My sleep is fitful or disturbed.
 
2. I feel refreshed upon awakening in the morning.
 
3. I have difficulty functioning during the day because of my sleep problems
 
4. I am usually fatigued or sleepy during the day.
 
5. I have difficulty falling asleep or staying asleep.
 
6. I snore loudly.
 
7. I have been told that I experience breathing difficulty during sleep.
 
8. I experience discomfort, pain, or unusual sensations in my legs when I am resting or sleeping.
 
9. My legs twitch or "jerk" when I am sleeping.
 
10. My bedtimes and rise times are irregular.
 
11. I am 40 years or older.
 
12. I am overweight.
 
13. I suffer from depression, anxiety, or other psychiatric problems.
 
14. I am a shift worker.
 


 

 

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