Sleep Apnea Questionnaire

1. I have been told that I snore.

2. I have been told that I hold my breath while I sleep.

3. I have high blood pressure.

4. My friends and family say that I'm often grumpy and irritable.

5. I wish I had more energy.

6. I sweat excessively during the night.

7. I have noticed my heart pounding or beating irregularly during the night.

8. I get morning headaches.

9. I suddenly wake-up gasping for breath.

10. I am overweight.

11. I seem to be losing my sex drive.

12. I often feel sleepy and struggle to remain alert.

13. I frequently awake with a dry mouth.

14. I have difficulty falling asleep.

15. Thoughts race through my mind and prevent me from sleeping.

16. I anticipate a problem with sleep several times a week.

17. I wake up and cannot go back to sleep.

18. I worry about things and have trouble relaxing.

19. I wake up earlier in the morning than I would like to.

20. I lie awake for half an hour or more before I fall asleep.

21. I often feel sad and depressed.

22. I have trouble concentrating at work or school.

23. When I am angry or surprised, I feel like my muscles are going limp.

24. I have fallen asleep while driving.

25. I often feel like I am in a daze.

26. I have experienced dreamlike scenes upon falling asleep or awakening.

27. I have fallen asleep in social settings such as movies or at a party.

28. I have trouble at work because of sleepiness.

29. I have dreams soon after falling asleep or during naps.

30. I have "sleep attacks" during the day no matter how hard I try to stay awake.

31. I have had episodes of feeling paralyzed during my sleep.

32. I wake up at night with an acid/sour taste in my mouth.

33. I wake up at night coughing or wheezing.

34. I have frequent sore throats.

35. During the night I suddenly wake up feeling like I'm choking.

36. Other than when exercising, I experience muscle tension in my legs.

37. I have noticed (others have commented) that parts of my body jerk during sleep.

38. I have been told that I kick at night.

39. When trying to go to sleep I experience an aching or crawling sensation in my legs.

40. I experience leg pain or cramps at night.

41. Sometimes I can't keep my legs still at night, I just have to move them to feel comfortable.

42. Even though I sleep during the night, I feel sleepy during the day.