Questionnaire - Page 6(e) of 9
(1014 maximum possible questions)		 Last updated: May 05, 2008

THE ANALYST TM
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This section covers other sleep-related problems.
665.  Are your legs restless at night? This is a condition known as Restless Legs Syndrome or Periodic Limb Movement.
Don't know
No
Somewhat
Yes, very
666.  Do you have difficulty falling asleep without the use of any sleep aid?
No / don't know
Occasionally
Often
Very often / always
667.  Do you fall asleep only to wake up after a few hours and have trouble falling back to sleep?
No / don't know
Occasionally
Often
Very often / always
668.  Do you have trouble waking up and getting out of bed in the morning?
No / don't know
Occasionally / moderate
Often / severe - I often oversleep, ignore alarm
669.  Do you have sleep apnea (periods of at least 10 seconds where you stop breathing while asleep)?
Don't know
No, definitely not
In the past only
Minor problem
Major problem
670.  Do you snore?
No / don't know
Mildly
Quite a lot
Very much - people complain
671.  Have you been diagnosed with a sleep disorder like hypersomnolence or narcolepsy?
Don't know
No
Similar sleep disorder / doctors uncertain
Hypersomnolence
Narcolepsy

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GLOSSARY

Apnea:  Cessation of breathing.

Narcolepsy:  A cause of daytime sleepiness due to an inherited disorder of the control of dreaming sleep. It should be differentiated from sleep apnea, periodic leg movements and other rarer causes of daytime sleepiness.

Restless Legs Syndrome:  This condition involves "creepy-crawly" sensations, mainly in the legs but occasionally in the arms and trunk. The sensations have the following features: - Occur during periods of inactivity - Become more severe at night - Are tied to an overwhelming urge to move the limb - Are sometimes relieved by movement of the limb - Often cause difficulty staying or falling asleep, leading to fatigue.



 


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