Male Questionnaire
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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.

Q541

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

Q542

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

Q543

Do you ever wake up choking on a mouthful of stomach acid that is burning your mouth and throat?
  • No / don't know
  • Very rarely
  • Yes, at least once a year
  • Yes, at least once a month
  • Yes, at least once a week

Q544

Do you experience restless sleep, tossing and turning during the night?
  • No / don't know
  • A little
  • Very much so

Q545

Do you have difficulty falling asleep?
  • No / don't know
  • Occasionally
  • Often
  • Very often / always

Q546

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

Q547

Do you have trouble waking up and getting out of bed?
  • No / don't know
  • Occasionally / moderate
  • Often / severe - I often oversleep, ignore alarm

Q548

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

Q549

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

Q550

Have you been diagnosed with a sleep disorder such as Hypersomnolence or Narcolepsy?
  • Don't know
  • No
  • Similar sleep disorder / doctors uncertain
  • Hypersomnolence
  • Narcolepsy