Do you have nightmares? C.


. .

You may use either pen or pencil.

Assessment Questionnaire (GSAQ) could: (1), distinguish between sleep disorders (including no sleep disorder); (2), be a reliable and valid sleep disorder screener; and.

The questionnaire includes an assessment of different aspects of your sleep, as well as some features. Do not get enough sleep. .

Sleep Disturbance does not focus on symptoms of specific sleep disorders, nor does it provide subjective estimates of sleep quantities (total amount of sleep, time to fall asleep, amount of wakefulness during sleep).

Johns, M. When you finish the test, add up the values of your responses. Take sleeping pills or other medication to help you sleep.

Patient Name: _____ Date: _____ Weekdays Usual bedtime: am/pm Usual awakening time: am/pm Weekends Usual bedtime: am/pm Usual. during the day or at night.

The sleep specialist will decide which type of study is best to evaluate your sleep problem.

com Patient Name: DOB: Page 1 of 4 Sleep History Questionnaire Briefly describe your primary sleep complaint/problem:.

. Feel unrested during the day, no matter how many hours of sleep you had.

Sleep History Questionnaire (Affix identification label here) URN: Family name: Given name(s): Address: Date of birth: Sex: M F. Epworth Sleepiness Scale 11 How likely are you to nod off or fall asleep in the following situations, in contrast to feeling just tired? This refers to your usual way of life in recent times.

The main objective of the current study was.
Daytime symptoms such as fatigue, mood disturbance, difficulty with attention or memory, and behavioural problems, must be present.


May 25, 2023 · be unable to get back to sleep.

During the past month, how often have you had trouble sleeping because you. Representative Studies Using Scale 151 References 1. .

Narcolepsy is a neurological sleep disorder that causes a potentially disabling level of daytime sleepiness. PHONE: (480) 830-3900 FAX: (480) 830-3901 valleysleepcenter. SLEEP HEART HEALTH STUDY SLEEP HABITS QUESTIONNAIRE. Sleep Study Questionnaire. HOURS OF SLEEP PER NIGHT _____ For each of the remaining questions, check the one best response.


. Answers to the questions are rated on a reliable scale called the Epworth Sleepiness Scale (ESS).

Answers to the questions are rated on a reliable scale called the Epworth Sleepiness Scale (ESS).



ID#: Field Center: ____ ____3 1.

sleep with a pillow,” and the response that best fit how often you sleep with a pillow was “often,” you would mark the item as follows: EXAMPLE Never (0 times per month) Rarely (less than 3 times per month) Sometimes (1-2 times per week) Often (3-4 times per week) Almost every day (5 or more times per week) I sleep with a pillow.