Complete the following survey to determine whether you have symptoms of a sleep disorder.

Yes No
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 get morning headaches.
7. I often wake up gasping for breath.
8. I am overweight.
9. I often feel sleepy and struggle to remain alert during the day.
10. I frequently wake up with a dry mouth.
11. I have difficulty falling asleep.
12. Thoughts race through my mind and prevent me from getting to sleep.
13. I anticipate a problem with sleep several times a week.
14. I often wake up and have trouble going back to sleep.
15. I worry about things and have trouble relaxing.
16. I wake up earlier in the morning than I would like to.
17. I lie awake for half an hour or more before I fall asleep.
18. I often feel sad or depressed because I can't sleep.
19. I have trouble concentrating at work or school.
20. When I am angry or surprised, I feel like my muscles are going limp.
21. I have fallen asleep while driving.
22. I often feel like I am in a daze.
23. I have experienced vivid dreamlike scenes upon falling asleep or awakening.
24. I have fallen asleep in social settings such as movies or at a party.
25. I have vivid dreams soon after falling asleep or during naps.
26. I have "sleep attacks" during the day no matter how hard I try to stay awake.
27. I have episodes of feeling paralyzed during my sleep.
28. I wake up at night with an acid/sour taste in my mouth.
29. I wake up at night coughing or wheezing.
30. I have frequent sore throats.
31. I have heartburn at night.
32. During the night I suddenly wake up feeling like I am choking.
33. I have noticed (or others have commented) that parts of my body jerk during sleep.
34. I have been told that I kick and jerk during sleep.
35. When trying to go to sleep, I experience an aching or crawling sensation in my legs.
36. I experience leg pain or cramps at night.
37. Sometimes I can't keep my legs still at night; I just have to move them to feel comfortable.
38. Even though I slept during the night, I feel sleepy during the day.