MEDICAL HISTORY
EPWORTH SLEEPINESS SCALE
How likely are you to doze off or fall asleep in the following situations, in contrast to just feeling tired? This refers to your usual way of life in recent times. Even if you have not done some of these things recently try to work out how they would have affected you. Use the following scale to choose the most appropriate number for each situation:
0 = would never doze
1 = slight chance of dozing
2 = moderate chance of dozing
3 = high chance of dozing
SITUATION
SLEEP APNEA: This means pauses in your breathing during sleep
SLEEP SCHEDULE
IT IS VERY IMPORTANT THAT YOU ANSWER EACH OF THE FOLLOWING QUESTION EVEN IF YOU ARE UNAWARE OF ANY SLEEP PROBLEMS. FOR YES OR NO ITEMS CHOOSE ONLY ONE ANSWER.
SHIFT WORK
EXCESSIVE SLEEPINESS
RESTLESS LEGS OR LIMBS:
This means having achy, pins and needles or crawling feelings in your legs or arms.
PARASOMNIAS:
Briefly, this means abnormal movements, behaviors, emotions, perceptions, and dreams during sleep or while falling asleep. For example, sleep walking, sleep talking, sleep terrors, nightmares, confusional arousals, sleep eating, aggressive behavior during sleep, sleep paralysis etc.
AGGRESSIVE BEHAVIOR DURING SLEEP
SLEEP PARALYSIS:
This means "feeling paralyzed" as if you were unable to move any part of your body while falling asleep, on waking up or coming out of a dream.
CATAPLEXY
This means losing muscle strength or become very weak during or immediately while experiencing sudden emotion such as laughter, excitement, surprise or anger. This loss of muscle strength may result in behavior such as dropping things, weakness of the facial muscles, having to sit or falling down.
BED WETTING
SUBSTANCE USE
FAMILY HISTORY OF SLEEP DISORDERS