Sleep Disorders Questionnaire

If you answer "yes" to any of the questions, especially when related to unsatisfactory sleep, it may be an indication of a potential sleep disorder. If you have any questions about your responses to this sleep quiz, please contact us and speak to your doctor about making a referral for evaluation.

• Do you snore?
• Have you been told that you stop breathing during your sleep?
• Do you have difficulty falling asleep and/or staying asleep?
• Do you find it difficult to stay alert and awake during waking hours?
• Do you experience a tingling or crawling feeling or nervousness in your legs when trying to sleep?
• Do you have nighttime heartburn, pain, or discomfort?
• Is your sleep affected by your sleep environment or the sleep difficulties of a bed partner?
• How would you rate your sleep: Poor, Fair or Good?