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DeKalb Medical Sleep Disorder Quiz

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.

Notes: If you have other symptoms such as snoring, difficulty falling or staying asleep, or other signs of a potential sleep problem, contact the DeKalb Medical Sleep Disorders Center at 404.501.5927 or via email at sleepinfo@dekalbmedical.org.

If you would like us to contact you, please provide the following information:
Contact Info  
First Name: *Mandatory

Last Name: *Mandatory
Email:
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Primary Care Physician
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Word Verification
Legend:

would never doze = 0
slight chance of dozing = 1
moderate chance of dozing = 2
high chance of dozing = 3

Situation  

Chance of dozing
Sitting and reading

Watching TV

Sitting, inactive, in a public place
(e.g., a theatre or a meeting)

As a passenger in a car for an hour without a break

Lying down to rest in the afternoon when circumstances permit

Sitting and talking with someone

Sitting quietly after a lunch without alcohol

In a car, while stopped for a few minutes in traffic




The DeKalb Medical Sleep Disorders Center will not sell your information or provide it to third party organizations. We respect your privacy and will keep your personal information confidential. Your contact information will solely be used to send you information regarding your sleep quiz.
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DeKalb Medical, 2701 North Decatur Rd., Decatur, GA 30033 | For General Information: 404.501.1000 | For Patient Inquiries: 404.501.5200

 
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