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SLEEP QUESTIONNAIRE (SQ)

SLEEP LOSS

Insomnia: Difficulty falling asleep?

Middle Insomnia: Waking up in the middle of the night,

Takes more than 20 minutes to fall back to sleep?

Early Awakening: Awaken very early in the morning, unable to fall back asleep?

Excess Sleep
Sleeping more than 10 hours during a 24-hour period,

Breathing Difficulties
Wake up in the night unable to breathe or gasping for breath?

Told that you have pauses in your breathing while you sleep?

Daytime sleepiness
Fall completely asleep at unpredicted times during the day

"Sleep attacks" you can't resist

Does sleepiness interfere with driving, using machines, or talking?

Had any accidents or near accidents because of sleepiness?

NIGHT TIME DISTURBANCE
Awaken from sleep paralyzed, mind awake but unable to move?

Awaken from sleep in a state of panic or terror

Awaken from sleep screaming, violent, or confused?

Have you been told that you thrash violently in your sleep?

Legs feel restless, uncomfortable (have to keep moving) before or during sleep?

Nightmares three or more times a week

Restless sleep, tossing and turning

Grind your teeth at night