This quiz should only take about 5 minutes to finish, and is completely free and confidential.
Please answer the following questions about your sleep symptoms over the last 3 months.

Question1:


Answer for what has been typical for you for the last 3 months

My work or other activities prevent me from getting at least 6 hours of sleep

Question 2:


Answer for what has been typical for you for the last 3 months

My bedtime or waketime varies by more than 3 hours

Question3:


Answer for what has been typical for you for the last 3 months

It takes me 30 minutes or more to fall asleep.

Question 4:


Answer for what has been typical for you for the last 3 months

I am awake 30 minutes or more during the night.

Question 5:


Answer for what has been typical for you for the last 3 months

I am awake 30 or more minutes before I have to and can't fall back sleep

Question 6:


Answer for what has been typical for you for the last 3 months

I am tired, fatigued or sleepy during the day.

Question 7:


Answer for what has been typical for you for the last 3 months

I sleep better if I go to bed before 9pm and wake up before 4:30am

Question 8:


Answer for what has been typical for you for the last 3 months

I sleep better if I go to bed late (after 1:00am) and wake up late (after 9:00 am).

Question 9:


Answer for what has been typical for you for the last 3 months

I am prone to fall asleep at inappropriate times or places

Question 10:


Answer for what has been typical for you for the last 3 months

I snore

Question 11:


Answer for what has been typical for you for the last 3 months

I wake up with dry mouth in the morning (cotton mouth)

Question 12:


Answer for what has been typical for you for the last 3 months

My snoring is so loud, that my bed partner complains.

Question 13:


Answer for what has been typical for you for the last 3 months

I have been told that I stop breathing in my sleep

Question 14:


Answer for what has been typical for you for the last 3 months

I wake up choking or gasping for air

Question 15:


Answer for what has been typical for you for the last 3 months

I feel uncomfortable sensations in my legs, especially when sitting or lying down, that are relieved by moving them

Question 16:


Answer for what has been typical for you for the last 3 months

I have an urge to move my legs that is worse in the evenings and nights

Question 17:


Answer for what has been typical for you for the last 3 months

I wake up frequently during the night for no reason

Question 18:


Answer for what has been typical for you for the last 3 months

When angered, humored, frightened, I experience sudden muscle weakness

Question 19:


Answer for what has been typical for you for the last 3 months

When falling asleep or waking up, I experience scary dream like images

Question 20:


Answer for what has been typical for you for the last 3 months

When I am first awakening, I feel like I can't move

Question 21:


Answer for what has been typical for you for the last 3 months

I have nightmares

Question 22:


Answer for what has been typical for you for the last 3 months

For no reason, I awaken suddenly, feeling startled and afraid

Question 23:


Answer for what has been typical for you for the last 3 months

I have been told that I walk, eat, act strangely or violently when asleep

Question 24:


Answer for what has been typical for you for the last 3 months

I grind my teeth or clench my jaw while I sleep

Question 25:


Answer for what has been typical for you for the last 3 months

My sleep difficulties interfere with my daily activities