Sleep Assessment Questions

Sleep is an important component to our overall health.  We know that our sleep schedules can be altered through our family and work commitments.  There are several questionnaires available to help screen for possible sleep issues.  We have included several for your review,  Berlin Questionnaire , Epworth Sleepiness Scale, and Sleep Quality Survey.

 

Types of questions your healthcare provider may ask.

 

Do you have difficulty falling asleep?

Do you try to have a set time that you go to bed?

Do you have a set time to wake up in the morning?

Sleep Schedule

Time you go to bed__________

Time you wake up __________  Do you use an alarm?

How many hours do you lay in bed___________?

How long does it take for you to fall asleep?

Do you use supplements to fall asleee?

Do you wake up at night?  If so why and how often?_______

Where to you sleep?  Bedroom _______  Couch ______  Recliner______

Do you share a bed with someone?

Do you watch TV, play games on computer, or study in bed?

Do you drink alcohol prior to going to bed?

Do you have  caffeine  in the evening?

 

Do you take naps during the day

Do you exercise daily?

What time do you exercise?

 

Do you snore?  Or have others told you that you snore?

Has anyone ever told you your oxygen saturation drops when you sleep?

 

NOTE that your healthcare provider will look at all aspects of your life to help determine what is interfering with your sleep.