Adult Sleep Related Impairment Questionnaire

This measure is intended for adults ages 18 and up. Please respond to each item by selecting an option from each dropdown menu.

In the past 7 days...

If you would like a copy of your answers and results emailed to you, please provide your email address here:

1. I had a hard time getting things done because I was sleepy.

2. I felt alert when I woke up.

3. I felt tired.

4. I had problems during the day because of poor sleep.

5. I had a hard time concentrating because of poor sleep.

6. I felt irritable because of poor sleep.

7. I was sleepy during the daytime.

8. I had trouble staying awake during the day.

Lakeview
(312) 508-3645
1438 West Belmont Ave.
Chicago, IL 60657

River North
(312) 584-2144
311 W Superior St., Suite 402
Chicago, IL 60654

Highland Park
(847) 241-1195
1160 Park Avenue W., Suite 6E
Highland Park, IL 60035

Wilmette
(847) 610-6763
3330 Old Glenview Rd., Suite 14
Wilmette, IL 60091