Sleep Disorder Screening Questionnaire
This is a screening questionnaire to explore how common sleeping disorders are in MSers.
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Q1: I have been told that I snore.
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Q2: I have been told that I stop breathing when I sleep.
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Q3: I have high blood pressure.
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Q4: My friends and family say that I’m grumpy and irritable.
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Q5: I have fallen asleep while driving.
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Q6: I have noticed my heart pounding or beating irregularly during the night.
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Q7: I get morning headaches.
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Q8: I suddenly wake gasping for breath.
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Q9: I am overweight.
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Q10: I seem to be losing my sex drive
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Q11: I often feel sleepy and struggle to remain alert.
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Q12: I frequently wake with a dry mouth.
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Q13: I have difficulty falling asleep.
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Q14: Thoughts race through my mind and prevent me from sleeping.
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Q15: I anticipate a problem with sleep several times a week.
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Q16: I wake up and cannot go back to sleep.
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Q17: I worry about things and have trouble relaxing.
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Q18: I wake up earlier in the morning than I would like to.
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Q19: I lie awake for half an hour or more before I fall asleep.
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Q20: When I am angry or surprised, I feel like my muscles go limp.
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Q21: I often feel like I am in a daze.
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Q22: I have experienced vivid dreamlike scenes.
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Q23: I have fallen asleep in social settings such as the movies or at a party.
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Q24: I have trouble at work because of sleepiness.
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Q25: I have dreams soon after falling asleep or during naps.
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Q26: I have “sleep attacks” during the day no matter how hard I try to stay awake.
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Q27: I have had episodes of feeling paralyzed during my sleep or on awakening.
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Q28: Other than when exercising, I still experience muscle tension in my legs.
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Q29: I have noticed (or others have commented) that parts of my body jerk during sleep.
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Q30: I have been told I kick at night.
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Q31: When trying to go to sleep, I experience an aching or crawling sensation in my legs.
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Q32: I experience leg pain and cramps at night.
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Q33: Sometimes I can’t keep my legs still at night. I just have to move them to feel comfortable.
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Q34: Even though I slept during the night, I feel sleepy during the day.
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Scoring system
Questions 1-12: If you marked three or more boxes, you show symptoms of Sleep Apnea – a potentially serious disorder which causes you to stop breathing repeatedly, often hundreds of times in the night during your sleep.

Questions 13-19: If you marked three or more boxes, you show symptoms of Insomnia – a persistent inability to fall asleep or stay asleep.

Questions 20-27: If you marked three or more boxes, you show symptoms of Narcolepsy – a life long disorder characterized by uncontrollable sleep attacks during the day.

Questions 28-34: If you marked three or more boxes, you show symptoms of Periodic Limb Movement Disorder uncontrollable leg or arm jerks during sleep or Restless Leg Syndrome – uncomfortable feelings in the legs at night.

This is an anonymous survey; you will therefore need to PRINT the survey after completing it, prior to submitting it, if you want to use it to assess yourself for a sleep disorder.
Demographics
The demographics will help when analyzing the data above.
Sex
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Age (yrs)
Type of MS
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How long have you had MS (yrs)?
Disclaimer
No personal identifiers, including your computer's IP address, will be collected as part of this survey. Please note that by completing this survey you are consenting to the data you provide being analysed by Prof. Giovannoni and his collaborators. Results of this survey will be presented on this blog and may be submitted for publication.
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