21 Elm Street New Milford, CT 06776 Phone 860.355.2611 info@newmilfordhospital.org Emergency Care Medical Services Cancer Care Family Birthing Center One Day Surgery Orthopedic, Spine & Hand Regional Heart Center Sleep Medicine -Are Sleep Disorders  Serious? -Treatment &  Evaluation -Assessment Quiz -Related Studies Specialized Services Surgical Services Assessment Quiz Take this quiz to find out if you have a sleep condition that should be evaluated by a polysomnogram. Please answer honestly. Our sleep center coordinator (left) will help you, if you call or e-mail this quiz. Yes No 1. Are you extremely sleepy during the day? Yes No 2. Do you fall asleep during work, dinner, or while entertaining friends? Yes No 3. Do you snore loudly at night? Yes No 4. Do you stop breathing for short periods at night? Yes No 5. Do you wake up frequently at night? Yes No 6. Are you restless at night (do you hit, kick, or slap your bed partner)? Yes No 7. Do you walk in your sleep? Yes No 8. Do you wet the bed? Yes No 9. Do you have morning headaches? Yes No 10. Are you confused when you wake up and have great difficulty "getting going"? Yes No 11. Have family or friends complained about disturbing changes in your personality? Yes No 12. Do you occasionally forget about tasks you've already finished? Yes No 13. Do you sometimes see things that aren't there (hallucinations)? Yes No 14. Do you have trouble maintaining attention and concentrating? Yes No 15. Do you have "spells" when you unexpectedly drop things? Yes No 16. Do you ever feel unable to move (or paralyzed) just before you fall asleep or wake up? Yes No 17. Do you have insomnia? Yes No 18. Do you have a problem with impotence? Yes No 19. Have you gained more than 10 pounds in the past year? Yes No 20. Do you wake up in the middle of the night with heartburn? First Name* Last Name Telephone* E-mail* (*) Required Fields If you answered "yes" to any of these, talk to your physician or call New Milford Hospital's Center for Sleep Medicine at 860-350-7343. Affiliations Clinical Trials Directions Emergency Medicine Employment Facts & Statistics Find a Doctor Foundation Media Information Medical Offices News Patient Satisfaction Publications/Ads Quality Rankings Visiting Hours How to Volunteer Ways to Give WebNursery Site Map | Disclaimer | Privacy Notice | Give us your feedback | Home Copyright © 2006 New Milford Hospital. All Rights Reserved.