1. How frequently do you experience issues falling asleep at night?
- A) Never
- B) Rarely
- C) Sometimes
- D) Often
- E) Always
2. Do you wake up usually during the night?
- A) Never
- B) Rarely
- C) Sometimes
- D) Often
- E) Always
3. How long does it usually take you to fall back asleep after waking up at night?
- A) Less than 10 minutes
- B) 10-20 minutes
- C) 20-30 minutes
- D) More than 30 minutes
- E) I usually can't fall back asleep
4. Do you snore loudly or has anyone told you that you do?
- A) Never
- B) Rarely
- C) Sometimes
- D) Often
- E) Always
5. Do you feel tired or unrefreshed when you wake up in the morning?
- A) Never
- B) Rarely
- C) Sometimes
- D) Often
- E) Always
6. Do you feel very sleepy or tend to fall asleep during the day?
- A) Never
- B) Rarely
- C) Sometimes
- D) Often
- E) Always
7. Do you have difficulty concentrating, remembering things, or staying focused during the day?
- A) Never
- B) Rarely
- C) Sometimes
- D) Often
- E) Always
8. Have you ever been told that you stop breathing during your sleep?
- A) Never
- B) Rarely
- C) Sometimes
- D) Often
- E) Always
9. Do you experience leg discomfort or the urge to move your legs while trying to sleep?
- A) Never
- B) Rarely
- C) Sometimes
- D) Often
- E) Always
10. How long do you usually sleep each night?
- A) More than 8 hours
- B) 7-8 hours
- C) 6-7 hours
- D) 5-6 hours
- E) Less than 5 hours
Scoring:
- Mostly A's: You likely have a healthy sleep pattern.
- Mostly B's: You might have mild sleep disturbances.
- Mostly C's or D's: You could have a moderate sleep disorder and should consider consulting a healthcare professional.
- Mostly E's: You might have a serious sleep disorder and should seek professional medical advice.
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