Sleep Assessment Quiz

Sleep Assessment Quiz
On a scale of 1 - 5, (1 being least frequent and 5 being the most frequent) how often do you experience these symptoms?
  • Q1 Do you have trouble falling asleep?
  • Q2 Do you have trouble staying asleep?
  • Q3 Do you take anything to help you sleep?
  • Q4 Do you take alcohol to help you sleep?
  • Q5 Do you experience trouble sleeping due to any medical conditions?
  • Q6 Do you have to work shifts or is your sleep schedule irregular?
  • Q7 Do you experience restlessness and/or discomfort in your legs just before bed?
  • Q8 Have you been told that you are restless or that you kick your legs in your sleep?
  • Q9 Do you have any unusual behaviours or movements during sleep?
  • Q10 Do you snore?
  • Q11 Have you been told that you stop breathing, gasp, snort or choke in your sleep?
  • Q12 Do you have difficulty staying awake during the day?
  • Q13 Have you lost interest in activities you previously found enjoyable?
  • Q14 Do you feel sad, irritable, hopeless or helpless?
  • Q15 Do you feel more anxious or worried?
  • Q16 Do you think something is wrong with your body?