Do you have a Sleep Problem Online Quiz Name First Last Do you feel tired, fatigued or sleepy during the day? Yes No Is your neck size 41cm or more? Yes No Are you aged 50 or more? Yes No Do you wake up gasping for breath, or has someone notice that you stop breathing in your sleep? Yes No Have you been told you snore? Yes No Do you wake up with a dry mouth? Yes No Do you wake up with headaches in the morning? Yes No Do you experience heartburn or acid reflux, or take medication to treat it? Yes No Do you wake up with an aching jaw, or have you been told that you grind your teeth during sleep? Yes No Do you currently have, or had in the past, High Blood Pressure? Yes No Do you suffer from depression or mood disorder or are you currently taking medication for your issue? Yes No Do you have troubled dreams or nightmares? Yes No Do you find it difficult to fall asleep? Yes No Do you find it difficult to stay asleep through the night? Yes No Do you sometimes feel that you have to move your legs to make them feel comfortable? Yes No On average, how many hours of sleep do you get each night? Less than 5 hours 5-7 hours 7-9 hours more than 9 hours How worried are you about your current sleep? A little worried Somewhat worried Very worried Not worried, I sleep well
