Noran Neurology Sleep Center Questionnaire

Sleep disorders affect millions of Americans. Understanding one's sleep disorder and getting proper treatment can be a truly life changing event.

Please take a moment to answer the following sleep-related questions to find out if a sleep study may be appropriate for you.

I have been told I snore.

Yes

No

I have sudden shortness of breath/gasp for air in my sleep.

Yes

No

I wake feeling unrefreshed in the morning.

Yes

No

I feel tired or fall asleep during the day, even if I slept all night.

Yes

No

I wake frequently during the night and have racing thoughts.

Yes

No

I wake with morning headaches.

Yes

No

I have difficulty falling asleep.

Yes

No

I feel aching, crawling, cramping sensations in my legs.

Yes

No

I wake up with sore or stiff muscles

Yes

No

My neck size is 17 inches or larger.

Yes

No

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