Sleep Disorders Checklist

This quick test can help you determine your quality of sleep and alert you to possible sleep problems. Print out this checklist and circle the number beside any symptoms you experience on a regular basis.

1. I’ve been told that I snore loudly.
2. I’ve been told that I stop breathing or gasp for breath while I sleep, although I don’t remember this when I wake up.
3. I have high blood pressure.
4. My friends and family say they have noticed changes in my personality.
5. I am gaining weight.
6. I sweat excessively at night.
7. I have noticed my heart pounding or beating irregularly during the night.
8. I get morning headaches.
9. I seem to be losing my sex drive.
10. No matter how hard I try to stay awake, I still fall asleep even after a full night’s sleep.

Questions 1-10 describe the common symptoms of Sleep Apnea, a potentially life-threatening disorder that causes you to stop breathing repeatedly-often several hundred time per night.

11. When I exercise strong emotions such as anger, fear, or surprise, I go limp.
12. I have fallen asleep while driving- even after a full night’s sleep.
13. I experience vivid dream-like scenes soon after falling asleep.
14. I have fallen asleep during physical effort.
15. I feel as though I have to cram a full day into every hour to get anything done.
16. I have trouble at work or school because of sleepiness.
17. I often feel totally paralyzed (unable to move) for brief periods when falling asleep or just after awakening.

Questions 11-17 describe the common symptoms of Narcolepsy, a lifelong disorder that involves uncontrollable sleep attacks during the day.

18. I have to use antacids (Rolaids, Tums, Alka-Seltzer, etc.) almost every week for stomach trouble and I wake up with heart burn.
19. I have a chronic cough.
20. I have morning hoarseness.
21. I wake up at night coughing or wheezing.
22. I have frequent sore throats.
23. Even though I slept through the night, I still feel sleepy during the day.

Questions 18-23 describe the common symptoms of Gastroesophogeal Reflux, a disorder caused by stomach acid “backing-up” into the throat at night.

24. Other than when exercising, I experience muscle tension, aching, or crawling sensation in my legs.
25. I have been told that I kick at night.
26. I experience leg pain during the night.
27. Sometimes I can’t keep my legs still at night. I have to just move them.
28. I awaken with sore or aching muscles.

Questions 24-28 describe the common symptoms of Restless Leg Syndrome, a disorder that involves pain or “crawling” sensations in the legs.

29. Thoughts race through my mind and this prevents me from sleeping.
30. I wake up during the night and can’t go back to sleep.
31. I worry about things and have trouble relaxing.
32. I wake up earlier in the mornings than I would like to.
33. I lie awake half an hour or more before I fall asleep.
34. I feel sad and depressed; I feel afraid to go to sleep.

Questions 29-34 describe the common symptoms of Insomnia, a persistent inability to fall or stay asleep.

If you experience any of the symptoms in the quiz, you may need further testing to make a diagnosis. Your physician or one of our neurologists can refer you to Columbus Regional Hospital for a sleep study.