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 MALE QUESTIONNAIRE - PAGE 6(b) 

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SYMPTOMS: SLEEP: OTHER PROBLEMS

If you sleep with a partner, they may be able to help you answer some of these questions.
646.  Do you ever wake up with a dry mouth?
No / don't know
Occasionally - less than once per month
Often - at least once per month
647.  Do you ever wake up during the night gasping for air, or with a choking sensation?
No / don't know
Occasionally - less than once per month
Often - at least once per month
648.  Do you experience restless sleep, tossing and turning during the night?
No / don't know
A little
Very much so
649.  Are your legs restless at night? This is a condition known as Restless Legs Syndrome.
Don't know
No
Somewhat
Yes, very
650.  Do you have difficulty falling asleep?
No / don't know
Occasionally
Often
Very often / always
651.  Do you fall asleep only to wake up after a few hours and have trouble falling back to sleep?
No / don't know
Occasionally
Often
Very often / always
652.  Do you have trouble waking up and getting out of bed?
No / don't know
Occasionally / moderate
Often / severe - I often oversleep, ignore alarm
653.  Do you have sleep apnea (periods of at least 10 seconds where you stop breathing while asleep)? If you sleep with a partner, you may want to ask them.
Don't know
No, definitely not
In the past only
Minor problem
Major problem
654.  Do you snore? If unsure, try to ask someone who has been with you while you sleep.
No / don't know
Mildly
Quite a lot
Very much - people complain
655.  Have you been diagnosed with a sleep disorder such as hypersomnolence or narcolepsy?
Don't know
No
Similar sleep disorder / doctors uncertain
Hypersomnolence
Narcolepsy

Add any additional information here for the questions above:

Please mention the question number(s) if possible.

 


 


GLOSSARY

Apnea
Cessation of breathing.

Narcolepsy
A cause of daytime sleepiness due to an inherited disorder of the control of dreaming sleep. It should be differentiated from sleep apnoea, periodic leg movements and other rarer causes of daytime sleepiness.

Restless Legs Syndrome
This condition involves "creepy-crawly" sensations, mainly in the legs but occasionally in the arms and trunk. The sensations have the following features:
- Occur during periods of inactivity
- Become more severe at night
- Are tied to an overwhelming urge to move the limb
- Are sometimes relieved by movement of the limb
- Often cause difficulty staying or falling asleep, leading to fatigue.





























 
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