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One Minute Sleep Quiz



Please answer the questions below by writing on the line provided or by checking the box that best describes you. Submit your answers by clicking the button at the bottom to receive your analysis for several sleep-related disorders.

During the past 4 weeks, how often...

1. Did you have difficulty falling asleep, staying asleep, or feeling poorly rested in the morning?
   
2. Did you fall asleep unintentionally or have to fight to stay awake during the day?
   
3. Did sleep difficulties or daytime sleepiness interfere with your daily activities?
   
4. Did work or other activities prevent you from getting enough sleep?
   
5. Did you snore loudly?
   
6. Did you hold your breath, have breathing pauses, or stop breathing in your sleep?
   
7. Did you have restless or "crawling" feeings in your legs at night that went away if you moved your legs?
   
8. Did you have repeated rhythmic leg jerks or leg twitches during your sleep?
   
9. Did you have nightmares, or did you scream, walk, punch, or kick in your sleep?
   
10. Did the following things disturb your sleep:
 
a) Pain  
b) Other physical problems  
c) Worries  
d) Medications  
e) Other  
11. Did you feel sad or anxious?
   
12. Do you work the night shift?
   

























Patient Resources


One Minute Sleep Quiz

Sleep Inventory

Sleep Log

 
 

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