The Sleep Apnea Center is: Coordinated by a Registered Polysomnographic Technologist Staffed with Registered and Registry Eligible Technicians Furnished for your comfort Our computerized Sleep Apnea Center and staff are committed to optimizing the quantity and quality of our community's sleep. For Further Inquiries Call: Monday through Friday 7:30am to 4:30pm Telephone: 530-876-7242 Fax: 530-876-7989 5974 Pentz Road Paradise, CA 95969 This questionnaire is meant to inform you of symptoms that are similar to those individuals with sleep disorders. This is a general source of educational information and does not contain medical advice for diagnosis or treatment. Only a complete history and Polysomnography sleep study can determine if you have a specific sleep disorder.

How well do you sleep?

Quality Sleep

One out of every four Americans suffers with some form of sleep disorder.

Sadly, only about 5% are diagnosed and treated for one or more of the 84 different International Sleep Disorder Classifications.

Left untreated, sleep disorders can have potentially serious, even life-threatening risks.

More than 20 million Americans suffer from one of the more serious sleep disorders.
Obstructive Sleep Apnea is as prevalent as Asthma, and yet has only become well known in the last two decades. Obstructive Sleep Apnea gone untreated can cause or increase the likelihood of high blood pressure, heart attack, and stroke, as well as many other significant health problems.

More than 70 million Americans have chronic Insomnia or the difficulty of initiating and maintaining sleep. 40% of chronic Insomnia is caused by physical problems. Sleep may be delayed, disrupted, restless or otherwise limited, resulting in poor quality sleep.

Quality sleep is important to maintain our physical and emotional health and well-being.


Once detected, most sleep disorders can be corrected. Our computerized Sleep Apnea Center and staff are committed to optimizing the quantity and quality of our community's sleep.

This simple test is designed to alert you to many problems associated with poor quality sleep. If you have experienced any of these symptoms in the last year, you should consult your physician.

If you think you have a problem, please consult your physician or contact he Sleep Apnea Center. Only a complete history and Polysomnography sleep study can determine if you have a specific sleep disorder.

Nocturnal Myoclonus or Restless Leg Syndrome
A disorder characterized by pain or "crawling" sensations in the legs.

Other than when exercising, I experience muscle tension in my legs.

• I have noticed (or others have stated) that parts of my body jerk.
  
• I have been told that I kick at night.
  
• I experience aching or "crawling" sensations in my legs.
  
• I experience leg pain at night.
  
• Sometimes I cannot keep my legs still at night. I have to move them.
  
• I awaken with sore, achy muscles.
  
• Even though I slept through the night, I feel sleepy during the day.
  

• I have had trouble concentrating.
  
• When I am angry or surprised, I feel like going limp.
  
• I have fallen asleep while driving.
  
• I feel as if I go around in a daze.
  
• I experience vivid dreamlike scenes upon falling asleep or awakening.
  
• I have fallen asleep during physical effort.
  
• I feel like I am hallucinating when I fall asleep.
  
• I feel like I have to cram a full day into each hour to get things done.
  
• I have fallen asleep when laughing or crying.
  
• I have trouble at work because of sleepiness.
  
• I have vivid nightmares soon after falling asleep.
  
• I fall asleep during the day.
  
• No matter how hard I try to stay awake, I fall asleep anyway.
  
• I feel unable to move when I am waking up or falling asleep.
  

• I wake up with heartburn.
  
• I have a chronic cough.
  
• I have to use antacids almost every week for stomach trouble.
  
• I have morning headaches.
  
• I wake up at night coughing or wheezing.
  
• I have frequent sore throats.
  
• During the night, I suddenly wake up gasping for breath.
  

• I have been told that I snore.
  
• I've been told that I stop breathing while I sleep, although I don't remember this when I awaken.
  
• I have high blood pressure.
  
• My friends/family say they have noticed changes in my personality.
  
• I am gaining weight.
  
• I sweat excessively during the night.
  
• I have noticed my heart pounding/beating irregularly during the night.
  
• I get morning headaches.
  
• I have trouble sleeping when I have a cold.
  
• I suddenly wake up gasping for breath during the night.
  
• I am overweight.
  
• I seem to be losing my sex drive.
  
• I feel sleepy during the day even though I slept through the night.
  

• I have difficulty falling asleep.
  
• Thoughts race through my mind and this prevents me from sleeping.
  
• I feel afraid to go to sleep.
  
• I wake up during the night and cannot go back to sleep.
  
• I worry about things and have trouble relaxing.
  
• I wake up earlier in the morning than I would like.
  
• I lie awake for half an hour or more before I fall asleep.
  
• I feel sad and depressed.
  

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