Sleep Assessment Questionnaires :: Resources

SLEEP-SMART Poster
This poster includes patient interview questions, used by Dr Richard Simon Jr, which facilitate greater awareness about a patient’s sleep, wakefulness, and the impact on daytime function at initial and ongoing patient presentation.
SleepMed Insomnia Index
A test to assess, in general, how you are feeling about your sleep using a "0-4" point scale -- with "0" representing no problem with your sleep and "4" representing a big problem with how you feel about the quality of your sleep.
Berlin Questionnaire
3 groups of questions used to stratify patients according to high or low risk of having sleep apnea
Cleveland Adolescent Sleepiness Questionnaire
Brief, self-reported instrument to measure daytime sleepiness in adolescents
Leeds Sleep Evaluation Questionnaire
10 items that assess qualities of sleep (eg, getting to sleep; quality of sleep; awakeness following sleep; and behavior following awakening) using a visual analog scale
Multidimensional Fatigue Symptom Inventory-Short Form
30-item short form of the Multidimensional Fatigue Symptom Inventory
Observer/Bed Partner Questionnaire
Provide the clinician with information from bed partner that a sleeping person may have difficulty answering
Sleep History Questionnaire
Brief, 21-item questionnaire and Epworth Sleepiness Scale to provide information on a patient's sleep characteristics
Sleep Questionnaire
Patient-administered form to record sleep problems, sleepiness, insomnia, use of caffeine and other over-the-counter stimulants, stress, sleep hygiene, bedroom environment, breathing during sleep, and pain problems
Snoring Questionnaire
Patient-reported questionnaire to assess snoring and other related parameters that may help predict the possibility of obstructive sleep apnea
Insomnia Severity Index
7 questions used to measure severity of insomnia
Epworth Sleepiness Scale
Short, self-reported evaluation of scenarios that provide a measure of daytime sleepiness

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