Sleep Study Questionnaire

The purpose of this brief questionnaire is to accrue information now that may prevent us getting Alzheimer’s/Dementia in the future.

Alzheimer’s is now being referred as Type 3 Diabetes!!

Through the use of MRI’s andf other state of the art diagnostics, the above problems actually begin to show up in our 30s.

All of the questions below are approximates—please answer as such

1. What time do you go to sleep at night  ____________
2. Do you wake up during the night  ___________
3. If so how many times do you wake up during the night  ______________
4. Do you take Ambien, Xanax, Diazepam’s, Melatonin etc. to help provoke sleep  ______________
5. If yes to the above, do you use every night or just some nights _____________
6. Have you ever been officially diagnosed having sleep apnea  _______________
7. Would you say that overall and in general, you get a good night’s sleep  ______________
8. On a level of 1-10 how would you honestly rate your stress levels  ___________