Sleepiness Survey

The sleep specialists at Kansas City’s Rowe Neurology Institute have put together an online survey to help visitors assess the quality of their sleep based on their waking experiences.  There are no wrong answers, but the quiz will give you a score and show you which of your answers indicate you’re doing fine, and which answers might be cause for further investigation.

The first set of questions relates to your sleep at night.

How long after getting in bed do you usually fall asleep?

 
 
 
 

How often do you have difficulty falling asleep (1 hour or longer)?

 
 
 
 

Do you ever wake in the night and have trouble getting back to sleep?

 
 
 
 

How often do you wake up in the morning still feeling tired?

 
 
 
 

Do your legs jerk at night?

 
 
 
 

Do you snore? And if so, has anyone ever seen you stop breathing in your sleep?

 
 
 

How much do you sleep in a position other than on your back? (i.e., side or front)

 
 
 
 

Do you have a family history of sleep disorders, such as narcolepsy or sleep apnea?

 
 

The last group of questions relates to your waking hours.  In these situations, how likely are you to doze off or fall asleep?

a. How likely are you to doze off... Sitting and Reading?

 
 
 
 

b. How likely are you to doze off... Watching TV?

 
 
 
 

c. How likely are you to doze off... Sitting, inactive in a public place (Theatre, meeting, etc.)?

 
 
 
 

d. How likely are you to doze off... As a passenger in a car, for an hour without a break?

 
 
 
 

e. How likely are you to doze off... Lying down to rest in the afternoon?

 
 
 
 

f. How likely are you to doze off... Sitting and talking to someone?

 
 
 
 

g. How likely are you to doze off... Sitting quietly after lunch, without alcohol?

 
 
 
 

h. How likely are you to doze off... In a car while stopped for a few minutes in traffic?

 
 
 
 

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