SLEEP QUIZ

1. Are you generally dissatisfied with the quality of your sleep?

Yes
No

2. Do you usually find sleep un-refreshing?

Yes
No

3. Do you snore on a regular basis?

Yes
No

4. Do you hold your breath during sleep?

Yes
No

5. Do you have persistent trouble getting to or staying asleep?

Yes
No

6. Do you frequently have trouble staying alert and awake all day?

Yes
No

7. Do you have trouble getting to sleep because your legs or arms feel "funny", restless or uncomfortable?

Yes
No

8. Do you have unusual behaviors or movements during sleep?

Yes
No

9. Do you do or say things during sleep that you can't remember the next day?

Yes
No

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Last Name *

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