Scribd
Upload
217 views

GSAQ

This document is a global sleep assessment questionnaire containing 11 questions about sleep habits and quality over the past 4 weeks. Respondents are asked to select one of four frequency options ("Never", "Sometimes", "Usually", "Always") for each question about difficulties falling or staying asleep, unintentional daytime sleepiness, sleep interfering with daily activities, work preventing enough sleep, snoring, breathing pauses at night, restless legs sensations, leg jerks or twitches, nightmares or violent sleep behaviors, and feelings of sadness or anxiety. The questions cover topics like sleep onset and maintenance, daytime sleepiness, effects on daily functioning, breathing issues, leg sensations, dreams and behaviors, and mood.

Uploaded by

Giga Hasabi
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
217 views

GSAQ

This document is a global sleep assessment questionnaire containing 11 questions about sleep habits and quality over the past 4 weeks. Respondents are asked to select one of four frequency options ("Never", "Sometimes", "Usually", "Always") for each question about difficulties falling or staying asleep, unintentional daytime sleepiness, sleep interfering with daily activities, work preventing enough sleep, snoring, breathing pauses at night, restless legs sensations, leg jerks or twitches, nightmares or violent sleep behaviors, and feelings of sadness or anxiety. The questions cover topics like sleep onset and maintenance, daytime sleepiness, effects on daily functioning, breathing issues, leg sensations, dreams and behaviors, and mood.

Uploaded by

Giga Hasabi
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
You are on page 1/ 1

GLOBAL SLEEP ASSESSMENT QUESTIONNAIRE

INSTRUCTIONS: Please answer the questions below by writing on the line provided or by checking
the box that best describes you. Please select only one answer for each question.

During the PAST 4 WEEKS, howoften

(Check one box on each line.)


1 Did you have difficulty falling asleep. staying
asleep, or feeling poorly rested in the morning? D Never D SometimesD UsuallyD Always
2. Did you fall asleep unintentionally or have to
fight to stay awake during the day? D Never D Sometimes
D UsuallyD Always
3. Did sleep difficulties or daytime sleepiness
interfere with your daily activities? D Never D SometimesD UsuallyD Always
4. Did work or other activities prevent you from D Never D SometimesD UsuallyD Always
getting enough sleep?

5. Did you snore loudly? D Never D SometimesD Usually D Always


6. Did you hold your breath, have breathing
pauses, or stop breathing in your sleep? D Never D SometimesD Usually D Always
7. Did you have restless or "crawling" feelings in
your legs at night that went away if you moved D Never D Sometimes
D Usually D Always
your legs?

8. Did you have repeated rhythmic leg jerks or leg


twitches during your sleep? D Never D SometimesD Usually D Always
9. Did you have nightmares, or did you scream,
walk, punch, or kick in your sleep? D Never D SometimesD Usually D Always
10. Did the following things disturb your sleep'

a.
b.
c.
d.
e. Worries
Pain
Other
Medications
Other: physical problems D Never D SometimesD Usually D Always
D Never D SometimesD UsuallyD Always
D Never D SometimesD UsuallyD Always
D Never D SometimesD UsuallyD Always
D Never D SometimesD Usually D Always
(Please specify)
11 Did you feel sad or anxious? D Never D SometimesD UsuallyD Always

OPhannacia Corporation 200 1 All Rights Reserved


This questionnaire was developed through a grant from Phannacia Corporation

You might also like