3 minutes to complete
The Functional Outcomes of Sleep Questionnaire is typically completed by individuals over the age of 18 who have experienced sleep disturbances or disorders.
Do you have difficulty concentrating on the things you do because you are sleepy or tired?
Do you generally have difficulty remembering things because you are sleepy or tired?
Do you have difficulty finishing a meal because you become sleepy or tired?
Do you have difficulty working on a hobby (e.g., sewing, collecting, gardening) because you are sleepy or tired?
Do you have difficulty doing work around the house (e.g., cleaning, laundry, taking out trash, repair) because you are sleepy or tired?
Do you have difficulty operating a motor vehicle for short distances (less than 100 miles) because you are sleepy or tired?
Do you have difficulty operating a motor vehicle for long distances (greater than 100 miles) because you are sleepy or tired?
Do you have difficulty getting things done because you are too sleepy or tired to drive or take public transportation?
Do you have difficulty taking care of financial affairs and paperwork (e.g., writing checks, paying bills, keeping records, filling tax forms) because you are sleepy or tired?
Do you have difficulty performing employed or volunteer work because you are sleepy or tired?
| Scale | Score |
|---|---|
| No difficulty | 1 |
| Yes, a little difficulty | 2 |
| Yes, moderate difficulty | 3 |
| Yes, extreme difficulty | 4 |
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