Child Sleep Disturbance Screening


The following sleep test is for educational purposes only.  Your answers to the following questions will be compared to those given by subjects with and without sleep disturbance concerns.   

Directions: If you are not sure how to mark some questions, observe your child sleep on two different nights for two hours, beginning approximately 1-2 hours after he falls asleep and then again for 60 minutes
before he wakes. If possible, rate your child’s behaviors when s/he is not taking medication.

The following questions relate to your child’s usual sleep habits during the past month only. Your answers should indicate the most accurate reply for the majority of days and nights in the past month.

Child Sleep Disturbance Survey

Progress:

Over the past month, my child breathes through the mouth while asleep.

Over the past month, my child rolls or moves around the bed when sleeping

Over the past month, my child has raspy breathing or snores lightly at night.

Over the past month, my child sweats a lot while asleep

Over the past month, my child appears sleepy more often in daytime than other children of the same age

Over the past month, my child wakes up during the night

Over the past month, my child takes more than 30 minutes to fall asleep once child is in bed and attempts to sleep

Over the past month, my child sleeps in strange positions such as cocking the head backwards or sleeping while sitting upright on pillows or kneeling.

Over the past month, my child shows confusion or disorientation when awakened

Over the past month, my child makes repeated leg or arm jerking movements during sleep

Please complete and receive your results by email:

The above sleep test is a screening to be used  for educational purposes only.  It is not intended to replace advice given by a qualified medical professional.  Sleep disturbances can be caused by serious underlying medical conditions, which should be evaluated by your physician.

The Child Sleep Disturbance Screening is adapted from the PSQI. All rights reserved.