Self-Assessment Forms

SLEEP DISORDERS

The following forms are provided to help you and your doctor evaluate your sleep problems.  Print these forms, fill them out and bring to your appointment. If you are not sure what forms you need to fill out please contact us via e-mail or telephone.

Epworth Sleepiness Scale is helpful to assess daytime sleepiness (if you are tired, have reduced concentration, reduced job performance). It is used in diagnosis and follow up care of patients with insomnia, narcolepsy and sleep apnea.

Sleep Disorder Assessment is a useful screening tool for various sleep disorders. Patients with sleep complaints should start with this form.

Sleep Diary is a two week diary that documents your sleep and wake behavior patterns (time in bed, exercise,caffeinated drinks).

Insomnia questionnaire is used to assess the severity of difficulty falling and staying asleep.