Sleep Disorders Questionnaire
This questionnaire is a screening tool for physicians to assist their clinical evaluation of insomnia.
3 minutes to complete
Eligibility
To be eligible to complete the Sleep Disorders Questionnaire, you must be at least 18 years of age, and be able to provide accurate information about your sleep patterns and habits.
Questions for Sleep Disorders Questionnaire
Questions
1.
Do you have trouble falling asleep?
The answer should be a single choice:
- Never
- Rarely
- Occasionally
- Most Nights/Days
- Always
2.
Do you have trouble staying asleep?
The answer should be a single choice:
- Never
- Rarely
- Occasionally
- Most Nights/Days
- Always
3.
Do you take anything to help you sleep?
The answer should be a single choice:
- Never
- Rarely
- Occasionally
- Most Nights/Days
- Always
4.
Do you use alcohol to help you sleep?
The answer should be a single choice:
- Never
- Rarely
- Occasionally
- Most Nights/Days
- Always
5.
Do you have any medical conditions that disrupt your sleep?
The answer should be a single choice:
- Never
- Rarely
- Occasionally
- Most Nights/Days
- Always
6.
Have you lost interest in hobbies or activities?
The answer should be a single choice:
- Never
- Rarely
- Occasionally
- Most Nights/Days
- Always
7.
Do you feel sad, irritable, or hopeless?
The answer should be a single choice:
- Never
- Rarely
- Occasionally
- Most Nights/Days
- Always
8.
Do you feel nervous or worried?
The answer should be a single choice:
- Never
- Rarely
- Occasionally
- Most Nights/Days
- Always
9.
Do you think something is wrong with your body?
The answer should be a single choice:
- Never
- Rarely
- Occasionally
- Most Nights/Days
- Always
10.
Are you a shift worker or is your sleep schedule irregular?
The answer should be a single choice:
- Never
- Rarely
- Occasionally
- Most Nights/Days
- Always
11.
Are your legs restless and/or uncomfortable before bed?
The answer should be a single choice:
- Never
- Rarely
- Occasionally
- Most Nights/Days
- Always
12.
Have you been told that you are restless or that you kick your legs in your sleep?
The answer should be a single choice:
- Never
- Rarely
- Occasionally
- Most Nights/Days
- Always
13.
Do you have any unusual behaviours or movements during sleep?
The answer should be a single choice:
- Never
- Rarely
- Occasionally
- Most Nights/Days
- Always
14.
Do you snore?
The answer should be a single choice:
- Never
- Rarely
- Occasionally
- Most Nights/Days
- Always
15.
Has anyone said that you stop breathing, gasp, snort, or choke in your sleep?
The answer should be a single choice:
- Never
- Rarely
- Occasionally
- Most Nights/Days
- Always
16.
Do you have difficulty staying awake during the day?
The answer should be a single choice:
- Never
- Rarely
- Occasionally
- Most Nights/Days
- Always
Scales Similar to Sleep Disorders Questionnaire
- Insomnia Severity Index
- Pittsburgh Sleep Quality Index
- Epworth Sleepiness Scale
- Movement Disorder
- Society Sleep Scale
- Berlin Questionnaire
- Stanford Sleepiness Scale
Here are some FAQs and additional information
on Sleep Disorders Questionnaire
What are the common symptoms of sleep disorders?
Common symptoms of sleep disorders can include excessive daytime sleepiness, difficulty falling asleep or staying asleep, snoring, restlessness during sleep, and unusual behaviors while sleeping such as sleepwalking or talking.
What are the types of sleep disorders?
The most common types of sleep disorders are insomnia, sleep apnea, narcolepsy, restless leg syndrome, and circadian rhythm disorders.
What can cause sleep disorders?
Sleep disorders can be caused by a number of factors, such as stress, diet, lifestyle, medications, or medical conditions.
How can I tell if I have a sleep disorder?
If you are having trouble sleeping or experiencing any of the common symptoms of sleep disorders, talk to your doctor about it. Your doctor can help diagnose and treat any underlying medical conditions that may be causing the sleep disorder.
What treatments are available for sleep disorders?
Depending on the type and severity of the sleep disorder, treatments can include lifestyle changes, medications, cognitive behavioral therapy, and other therapies.
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