Cochise Sleep Center, LLC

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
__ 1.) I’ve been told that I snore.
__ 2.) I’ve been told that I stop breathing when I sleep,    although I may not remember this when I wake up.
__ 3.) I feel sleepy during the day even though I sleep through the night.
__ 4.) I have high blood pressure.
__ 5.) I have been told that I am a restless sleeper, and I toss and turn a lot at night.
__ 6.) I sweat excessively during the night.
__ 7.) I frequently awaken with headaches.
__ 8.) I suddenly wake up gasping for breath during the night.
__ 9.) I have noticed my heart pounding or beating irregularly during the night.
__ 10.) I have difficulty breathing through my nose.
__ 11.) I am overweight and/or gaining weight.
__ 12.) I seem to be losing my sex drive.
Insomnia
__ 13.) I have difficulty initiating and maintaining sleep.
__ 14.) Thoughts race through my mind and this prevents me from sleeping.
__ 15.) I have early morning awakenings.
__ 16.) I have conditioned myself not to sleep due to anxiety.
Narcolepsy
__ 17.) I had trouble concentrating when I was in school.
__ 18.) I have fallen asleep at inappropriate times
__ 19.) I feel like I go around in a daze.
__ 20.) I experience vivid, frightening nightmares and dream-like scenes upon falling asleep or awakening.
__ 21.) I have trouble at work because of excessive sleepiness.
__ 22.) I experience loss of muscle tone upon expression of strong emotions.
__ 23.) I feel like I have to cram a full day into every hour to get anything done.
__ 24.) I sometimes feel sleep paralysis when waking up or falling asleep.
Nocturnal Myoclonus, or
Restless Legs Syndrome
__ 25.) I experience muscle tension or pain in my legs even when I am otherwise relaxed or awake.
__ 26.) I have noticed, or others have commented that parts of my body jerk.
__ 27.) I have been told that I kick at night.
__ 28.) I experience aching or crawling sensations in my legs.
__ 29.) I experience leg pain during the night. Sometimes I can’t keep my legs still at night, and have to move them.
__ 30.) Even though I sleep through the night, I feel sleepy during the day.
Gastroesophageal Reflux
__ 31.) I wake up with heartburn.
__ 32.) I have chronic cough.
__ 33.) I have to use antacids almost every week for stomach trouble.
__ 34.) I am hoarse in the morning.
__ 35.) I wake up at night coughing and wheezing.
__ 36.) I have frequent sore throats. During the night I suddenly wake up gasping for breath.

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 the Sleep Services of America for more information.