The Sleep Laboratory is
sponsored by
Johnson Memorial Hospital's
Pulmonary Department.

One out of five Americans has a sleep disorder that robs them of sleep, energy and attention and could, potentially, put them and others at risk for injury. Many of these people suffer needlessly, simply because they are unaware that a problem exists.

Once detected, most sleep disorders can be corrected. The simple test below is designed to alert you to any problems resulting from poor-quality sleep. If you have experienced any of the following symptoms in the last year, click on the box beside the number. When you are through, click on the "submit" button at the bottom of a page. Your completed test will be returned to Johnson Memorial Hospital's Pulmonary Department via a secure server and, should your answers indicate a possible sleep problem, a staff member will call you to discuss.

Please note that this test informs you of symptoms that are similar to those experienced by individuals with sleep disorders. It is intended as a general source of educational information and does not contain medical advice. It should not be used for diagnosis or treatment.

*Required Field
*Phone Number
*E-mail Address

1.  I have difficulty falling asleep.
2.  Thoughts race through my mind and this prevents me from sleeping.
3.  I feel afraid to go to sleep.
4.  I wake during the night and can't go back to sleep.
5.  I worry about things and have trouble relaxing.
6.  I wake up earlier in the morning than I would like to.
7.  I lie awake for half an hour or more before I fall asleep.
8.  I feel tired or sleepy during the day and/or evening.
9.  I feel sad and depressed.
10.  I've been told that I snore.
11.  I've been told that I stop breathing while I sleep.
12.  I have high blood pressure.
13.  My friends and family say they have noticed changes in my personality.
14.  I am gaining weight.
15.  I sweat during the night
16.  I have noticed my heart pounding during the night.
17.  I get morning headaches.
18.  I sometimes wake up with a dry mouth.
19.  I suddenly wake up gasping for breath during the night.
20.  I am overweight.
21.  I seem to be losing my sex drive.
22.  I sometimes have to fight sleep while driving or watching a movie.
23.  I feel sleepy during the day even though I slept through the night.
24.  I have trouble concentrating in school or in meetings at work.
25.  When angry or surprised, I feel like I'm going limp.
26.  I have fallen asleep while driving.
27.  I feel like I go around in a daze.
28.  I have experienced vivid dream-like scenes upon falling asleep or awakening.
29.  I have fallen asleep during physical effort.
30.  I feel like I am hallucinating when I fall asleep.
31.  I feel like I have to cram a full day into every hour to get anything done.
32.  I have fallen asleep when laughing or crying.
33.  I have trouble at work because of sleepiness.
34.  I have vivid nightmares soon after falling asleep.
35.  I fall asleep while watching TV or a movie.
36.  No matter how hard I try to stay awake, I fall asleep anyway.
37.  I feel unable to move when I am waking up or falling asleep.
38.  I have been told that I kick at night.
39.  I have noticed (or others have told me) that parts of my body jerk during sleep.
40.  Other than when exercising, I experience muscle tension in my legs.
41.  I experience leg pain during the night.
42.  I experience an aching, "crawling" sensation in my legs while in bed.
43.  Sometimes I can't keep my legs still at night; I just have to move them.
44.  I awaken with sore or achy leg muscles.
45.  Even though I slept through the night, I still feel sleepy during the day.


Back to the top