INTEGRIS Sleep Disorders Center of Oklahoma: Do You Have a Sleep Disorder?

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Do You Have a Sleep Disorder?

1. I'm told I snore.	qYes qNo
2. I'm told I have irregular breathing when I sleep.	qYes qNo
3. I'm tired or sleepy during the day although I slept the previous night.	qYes qNo
4. I have come close to falling asleep while driving.	qYes qNo
5. I'm told I am a restless sleeper.	qYes qNo
6. I have to use the restroom at night.	qYes qNo
7. I have high blood pressure.	qYes qNo
8. I often awaken with headaches and/or dry mouth.	qYes qNo
9. I am losing my sex drive.	qYes qNo
10. When I'm hungry, surprised, or when I laugh I feel a sudden loss of muscle control.	qYes qNo
11. I have experienced vivid dreamlike scenes on falling asleep or awakening.	qYes qNo
12. sometimes I feel unable to move when I'm waking up or falling asleep.	qYes qNo
13. It takes 30 minutes or more to fall asleep.	qYes qNo
14. Thoughts race through my mind when I'm trying to go to sleep.	qYes qNo
15. I wake up during the night and can't go back to sleep.	qYes qNo
16. I feel sad or depressed most of the time.	qYes qNo
17. The muscles in my legs are tense even when I'm relaxed.	qYes qNo
18. I'm told that I kick at night.	qYes qNo
19. I have aching/crawling sensations in my legs.	qYes qNo
20. I have leg pain at night.	qYes qNo

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INTEGRIS Sleep Disorders Center of Oklahoma

OKC Area
(405) 636-7700

Toll-Free
(888) 53-SLEEP