 |  | Preston Sleep Soultions
300 S. Price Street
Kingwood, WV 26537
Why Preston Sleep Solutions?
State of the art Sleep lab equipment
Our sleep lab uses MedcareŽ computerized polysomnography system with advanced technology and simultaneous video and audio monitoring.
1. Do you snore at night? Yes no occasionally
2. Witnessed pauses in breathing while sleep? Yes no occasionally
3. Do you have difficulty falling asleep? Yes no occasionally
4. Do you have difficulty maintaining sleep? Yes no occasionally
5. Experience a restless sensation in legs while lying awake in bed? Yes no occasionally
6. Kicking and twitching movements while asleep? Yes no occasionally
7. Experience excessive daytime tiredness? Yes no occasionally
8. Have you ever awakened feeling paralyzed? Yes no occasionally
9. Experience a sudden loss of strength in your arms or legs? Yes no occasionally
10. If previous answer is yes, were these events brought on by a
sudden frightening event of laughter? Yes no occasionally
Do you frequently awaken with: (please circle all that apply)
| Dry Mouth | Nasal Congestion | Headache |
| Heartburn | Chest Pain | Excessive Sweating |
| Chocking and Gasping | Feeling Groggy or Unrefreshed | |
According to the following scale (rated from 0 to 3) how likely are you to dose off or fall asleep in the following situations. Try to be as honest as possible and if possible have your significant other help you fill this out.
0 - NEVER 1 - SLIGHT CHANCE 2 - MODERATE 3 - ALWAYS
(Circle Answer)
Sitting and reading 0 1 2 3
Watching T.V. 0 1 2 3
Sitting, inactive in a public place (movie, meeting, etc.) 0 1 2 3
Sitting and talking to someone 0 1 2 3
Sitting quietly after lunch without alcohol 0 1 2 3
As a passenger in a car for an hour without a break 0 1 2 3
Driving a vehicle for two or more hours 0 1 2 3
Lying down to rest in the afternoon when circumstances permit 0 1 2 3
_______________
TOTAL
A total score of 10 or more suggests that you may need further evaluation by a physician to determine the cause of your excessive daytime sleepiness and whether you have an underlying sleep disorder. This scale should not be used to make your own diagnosis. It is intended as a tool to help you identify your own level of daytime sleepiness, which is a symptom of many sleep disorders. | |
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