Sleep Disorders Center
There are more than 80 types of sleep disorders, including sleep apnea, insomnia and restless legs syndrome. We understand that these conditions can significantly affect healthy sleep–and this, in turn, impacts your overall health, safety and quality of life.
At Dukes Memorial Hospital's Sleep Disorders Center, a team of medical professionals will evaluate your symptoms and find ways to help you get a better, safer night's rest.
Sleep Disorders Questionnaire
This questionnaire may help you identify symptoms that could indicate a sleep disorder. Print this page out and place a check next to each symptom you have experienced in the last year, then consult your physician.
- I have difficulty falling asleep.
- I worry about things and have trouble relaxing.
- I lie awake for half an hour or more before I fall asleep.
- I feel sad and depressed.
- I've been told that I stop breathing while I sleep, although I don't remember this when I wake up.
- I have noticed my heart pounding or beating irregularly during the night.
- I get morning headaches.
- I am overweight.
- I feel sleepy during the day even though I sleep through the night.
- During the night, I suddenly wake up gasping for breath.
- I wake up with heartburn.
- I have to use antacids almost every week for stomach trouble.
- When I am angry or surprised, I feel as if I'm going limp.
- I have fallen asleep while driving.
- I have experienced vivid nightmares or dream-like scenes upon falling asleep or waking.
- I feel as if I'm hallucinating when I fall asleep.
- I have trouble at work because of sleepiness.
- I feel unable to move when I am waking up or falling asleep.
- I experience aching or "crawling" sensations in my legs.
- Sometimes I can't keep my legs still at night. I just have to move them.
QUESTIONS 1 through 4
If you marked two or more spaces, you may show symptoms of insomnia, a persistent inability to fall asleep or stay asleep.
QUESTIONS 5 through 9
If you marked three or more spaces, you may show symptoms of sleep apnea, a life-threatening disorder that causes you to stop breathing repeatedly - often several hundred times per night - during your sleep.
QUESTIONS 10 through 12
If you marked two or more spaces, you may show symptoms of gastro esophageal reflux, a disorder caused when acid from the stomach "backs up" into the esophagus during the night.
QUESTIONS 13 through 18
If you marked three or more spaces, you may show symptoms of narcolepsy, a life-long disorder characterized by uncontrollable sleep attacks during the day.
QUESTIONS 19 through 20
If you marked one or both of these boxes, you may show symptoms of nocturnal myoclonus or restless legs syndrome, a disorder characterized by pain or crawling sensations in the legs.
This test in intended for a general source of education information and does not contain medical advice. It should not be used for diagnosis or treatment. Only an interpreted sleep study can determine if you have specific sleep disorders.
If you have questions, speak to your doctor first, and then contact:
(765) 475-2375 (765) 475-2375