Patients

Download a Sleep Quiz PDF
One in three Americans suffer from a sleep disorder,
causing great discomfort for millions of people
both day and night. Sleep disorders also increase
the risk of developing other health-related problems
such as hypertension, depression, job impairment,
industrial accidents and driving fatalities.
The following questionnaire will tell you if you
have symptoms which may be indicative of a sleep
disorder. This information is meant to be used
as an educational resource only, not as medical
advice.
Sleep Apnea
Insomnia
Narcolepsy
Nocturnal Myoclonus, or Restless Legs
Syndrome
Gastroesophageal Reflux
Check Your Score:
Questions 1 – 12
If you checked three or more boxes, you show symptoms
of Sleep Apnea, a life threatening disorder which
causes you to stop breathing repeatedly while
you sleep.
Questions 13 – 16
If you checked three or more boxes, you show symptoms
of Insomnia, a persistent inability to fall or
stay asleep.
Questions 17 – 24
If you checked three or more boxes, you show symptoms
of Narcolepsy, a lifelong disorder characterized
by uncontrollable sleep attacks during the day.
Questions 25 – 30
If you marked three or more boxes, you show symptoms
of Nocturnal Myoclonus, or Restless Legs Syndrome,
a disorder characterized by pain or “crawling”
sensations in the legs
.
Questions 31 – 36
If you marked three or more boxes, you show symptoms
of Gastroesophageal Reflux, a disorder caused
when acid from the stomach “backs up”
into the esophagus during the night. This condition
can lead to damage of the esophagus, and to pneumonia.
If you think that you suffer from a sleep disorder,
or would like more information on sleep disorders,
speak with your physician or call Sleep Services
of America for more information.
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