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, describe: Do you have difficulty distinguishing your dreams from reality? Yes/No If yes, describe: ? General How often do you wake with morning headaches? Never/Monthly/Weekly/Daily Have you ever been told that you stop breathing during your sleep? Yes/No If yes, how often do you stop breathing during sleep? Some nights/Every night Have you ever awoken with a snort, choking sensation, or short of breath? Yes/No If yes, Have you ever been unable to move your body just as you were falling asleep or waking up? Yes/No If yes
, describe: Please recall your weight history Please list your current medical problems, such as high blood pressure, heart disease, stroke, lung disease, etc. ? Family History Do other members of your immediate family (e.g. father, mother, siblings, children) snorecounselor? Yes/No Currently? ? Social History Have you ever smoked cigarettes? Yes/No Do you currently smoke cigarettes? Yes/No If yes, how many packs per day? Years of smoking? If you quit smoking, when did you quit? Have you ever smoked cigars, a pipe or chewed tobacco? Yes/No Currently? Yes/No yes, what and how often? Did you ever drink alcohol? Yes/No Do you currently drink alcohol? Yes/No If yes, Do you feel that your sleepiness is a result of poor quality of nighttime sleep? Yes/No , describe: Do you have heartburn, gastric reflux
, Annexe 3. Morningness-Eveningness Questionnaire (MEQ) Name: _____________________________ Date: ________________________ For each question, please select the answer that best describes you by circling
, Approximately what time would you get up if you were entirely free to plan your day
, If you usually have to get up at a specific time in the morning, how much do you depend on an alarm clock?
, Seldom or never later
, You have decided to do physical exercise. A friend suggests that you do this for one hour twice a week, and the best time for him is between 7-8 AM (07-08 h). Bearing in mind nothing but your own internal "clock
, Would be in good form
, Would be in reasonable form
, Would find it difficult
, At approximately what time in the evening do you feel tired, and, as a result, vol.20, pp.0-21
, You want to be at your peak performance for a test that you know is going to be mentally exhausting and will last two hours
, AM-1 PM, pp.11-13
, PM-5 PM, pp.15-17
, some reason you have gone to bed several hours later than usual, but there is no need to get up at any particular time the next morning
, Will wake up at usual time, but will not fall back asleep
, Will wake up at usual time and will doze thereafter
, Will wake up at usual time, but will fall asleep again
, Would not go to bed until the watch is over
, You are entirely free to plan your day. Considering only your internal "clock
, AM-1 PM, pp.11-13
, PM-5 PM, pp.15-17
, You have decided to do physical exercise. A friend suggests that you do this for one hour twice a week. The best time for her is between 10-11 PM (22-23 h). Bearing in mind only your internal "clock
, Would be in good form
, Would be in reasonable form
, Would find it difficult
, your job is interesting, and you are paid based on your performance, five-hour day (including breaks)
, 5 hours starting between 8-9 AM (08-09 h)
, 5 hours starting between 9 AM-2 PM, pp.9-14
, 5 hours starting between 2-5 PM (14-17 h)
, 5 hours starting between 5 PM-4 AM, pp.17-21
, At approximately what time of day do you usually feel your best
, AM-5 PM, pp.10-17
, Which one of these types do you consider yourself to be?
, Definitely a morning type
, Definitely an evening type _____ Total points for all 19 questions INTERPRETING AND USING YOUR MORNINGNESS-EVENINGNESS SCORE This questionnaire has 19 questions, each with a number of points. First, add up the points you circled and enter your total morningness-eveningness score here: Scores can range from 16-86. Scores of 41 and below indicate "evening types
-5) «A new method for measuring day time sleepiness: The Epworth Sleepiness Scale, Sleep, vol.14, p.540, 1991. ,
, La somnolence est la propension plus ou moins irrésistible à s'endormir si l'on n'est pas stimulé. (Nb. Ce sentiment est très distinct de la sensation de fatigue qui parfois oblige à se reposer)
qui sert à évaluer la somnolence subjective, est corrélé avec les résultats objectifs recueillis par les enregistrements du sommeil ,
,
, Date du test
,
, Vous arrive-t-il de somnoler ou de vous endormir (dans la journée) dans les situations suivantes
, Notez 0 : si c'est exclu. «Il ne m'arrive jamais de somnoler: aucune chance Notez 1 : si ce n'est pas impossible. «Il y a un petit risque»: faible chance Notez 2 : si c'est probable. «Il pourrait m'arriver de somnoler»: chance moyenne Notez 3 : si c'est systématique. «Je somnolerais à chaque fois» : forte chance. -Pendant que vous êtes occupé à lire un document, Même si vous ne vous êtes pas trouvé récemment dans l'une de ces situations, essayez d'imaginer comment vous réagiriez et quelles seraient vos chances d'assoupissement, vol.1, p.3
0 1 2 3 -Assis inactif dans un lieu public (salle d'attente, théâtre, cours, congrès) 0 1 2 3 -Passager, depuis au moins une heure sans interruptions, d'une voiture ou d'un transport en commun (train, bus, avion, métro, vol.1, p.3 ,
, Échelle de Fatigue Sommeil et Médecine Générale (EFSMG)
, La fatigue est une sensation d'affaiblissement physique, ou psychique, qui impose la mise au repos. On estime que c'est un état pathologique lorsque la personne se sent
, j'ai besoin de m'allonger même si je ne m'endors pas, pp.0-1
ai souvent des douleurs ou des malaises (vertiges) inexpliqués ,
est en fin d'après midi, que je me sens le plus fatigué ,
,
, En l'absence de cause connue, on peut envisager l'hypothèse d'un problème d'efficacité de votre sommeil en rapport avec des perturbations de vos horloges biologiques
, L'établissement d'un Agenda-Veille-Sommeil pendant quelques semaines vous aidera à observer votre rythme de sommeil et d'activité
, Attention, vous devrez garder à l'esprit que la privation de sommeil provoque la somnolence diurne, mais que paradoxalement, l'excès de sommeil peut