Test | St Petersburg, FL | St. Petersburg Sleep Disorders Center | 727-360-0853

Take this simple test to determine the quality of your sleep

St. Petersburg Sleep Disorders Center will help you understand what is holding you back from the quality sleep you deserve.
 

Take this simple test, print the results and show them to your doctor
It can help determine the quality of your sleep. If you experience the symptom on a regular basis, check "yes"

Click here for a printer friendly test

1. Do you snore loudly?
Yes __    No__ 

2. Do you stop breathing or gasp for breath while you sleep? You've been told this but don't remember when you wake up.
Yes __    No__ 

3. Do you have high blood pressure?
Yes __    No__ 

4. Do you hear from your friends and family that they have noticed changes in your personality?
Yes __    No__ 

5. Are you gaining weight?
Yes __    No__ 

6. Do you sweat excessively during the night?
Yes __    No__ 

7. Do you experience your heart pounding or beating irregularly during the night?
Yes __    No__ 

8. Do you get headaches in the morning?
Yes __    No__ 

9. Do you seem to be losing your sex drive?
Yes __    No__ 

10. Do you fall asleep during the day, even when you've had a good night's sleep?
Yes __    No__ 

11. Do you go limp when you experience strong emotions such as anger, fear,or surprise?
Yes __    No__ 

12. Do you fall asleep while driving, even after a good night's sleep?
Yes __    No__ 

13. Do you experience vivid dream-like scenes upon or soon after falling sleep?
Yes __    No__ 

14. Do you fall asleep during physical effort?
Yes __    No__ 

15. Do you feel that you must cram in a full day into every hour to get anything done?
Yes __    No__ 

16. Do you have trouble at work or school because of sleepiness?
Yes __    No__ 

17. Do you sometimes feel totally paralyzed (unable to move) for brief periods when falling asleep or just after awakening?
Yes __    No__ 

18. Do you still feel sleepy during the day, even though you slept through the night?
Yes __    No__ 

19. Do you experience tension, aching, or crawling sensations in your legs other than when exercising?
Yes __    No__ 

20. Are you ever told you kick at night?
Yes __    No__ 

21. Do you experience leg pain during the day while trying to relax?
Yes __    No__ 

22. Do you ever feel that you can't keep your legs still at night, or that you have to move them?
Yes __    No__ 

23. Do you awaken with sore or aching muscles?
Yes __    No__ 

24. Do thoughts race your through your mind and prevent you from sleeping?
Yes __    No__ 

25. Do you wake up during the night and then can't go back to sleep?
Yes __    No__ 

26. Do you worry about things and have trouble relaxing?
Yes __    No__ 

27. Do you wake up earlier in the morning than you want to?
Yes __    No__ 

28. Do you lie awake for half an hour or more before you fall asleep?
Yes __    No__ 

29. Do you feel sad, depressed and afraid to go to sleep?
Yes __    No__ 

This simple test may be able to help you determine if you are having any problems. Review the guidelines which will help you identify your problem.

GUIDELINES: Questions 1-10 may be symptoms of Sleep Apnea (a pause in breathing which may occur many times a night and can be life threatening). Questions 10-18 may be symptoms of Narcolepsy (characterized by day-time sleep attacks). Questions 18-22 may be symptoms of Nocturnal Myoclonus and Restless Leg Syndrome (one leg jerking during the night). Questions 23-29 may be frequent symptoms found in patients with various types of Insomnia (the inability to fall asleep or stay asleep).

The Epworth Sleepiness Scale

Age (in years): ___
Height:              ___
Weight:              ___
Your sex:  Male ___    Female ___

How likely are you to doze 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. Even if you have not done some of these things recently, try to work out how they would have affected you. Use the following scale to choose the most appropriate number for each situation:

0 = would never doze
1 = slight chance of dozing
2 = moderate chance of dozing
3 = high chance of dozing

Sitting and reading:
0 __ 1 __ 2 __ 3 __

Sitting, inactive in a public place (e.g., a theater or a meeting):
0 __ 1 __ 2 __ 3 __

Watching TV:
0 __ 1 __ 2 __ 3 __

As a passenger in a car for an hour without a break:
0 __ 1 __ 2 __ 3 __

Lying down to rest in the afternoon when circumstances permit:
0 __ 1 __ 2 __ 3 __

Sitting and talking to someone:
0 __ 1 __ 2 __ 3 __

Sitting quietly after lunch without alcohol:
0 __ 1 __ 2 __ 3 __

In a car, while stopped for a few minutes in traffic:
0 __ 1 __ 2 __ 3 __

GUIDELINES: The Epworth Sleepiness Scale Age (in years): Your sex (male=M, female= F) How likely are you to doze 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. Even if you have not done some of these things recently, try to work out how they would have affected you. Use the following scale to choose the most appropriate number for each situation: This test has been designed as a guideline to help you identify your problems.

Normal score is 8 on this test. If you score higher than 10 you have excessive daytime sleepiness.

© 2017 hibu,Inc.  All Rights Reserved | Privacy Policy