Sleep Problems

Symptoms

Complaining of Difficulty falling asleep Difficulty staying asleep Tiredness Exhaustion Poor sleep quality Poor concentration Memory problems Racing thoughts

Has No Difficulty falling asleep No Difficulty staying asleep No Tiredness No Exhaustion No Poor sleep quality No Poor concentration No Memory problems No Racing thoughts

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Symptoms

Reports Irregular sleep schedule Waking up frequently during the night Sleepwalking Night terrors Unusual sensations during sleep Working rotating shifts Using electronic devices in bed Sleeping in an uncomfortable environment A change in sleep pattern as they have aged Having recently travelled over more than 3 time zones prior to onset of the symptoms

Reports No Irregular sleep schedule No Waking up frequently during the night No Sleepwalking No Night terrors No Unusual sensations during sleep Not Working rotating shifts Not Using electronic devices in bed Not Sleeping in an uncomfortable environment No Change in sleep pattern as they have aged Not Recently travelled over more than 3 time zones prior to onset of the symptoms

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Symptoms

Reports Worries keeping him/her awake Chronic pain interfering with sleep Consumption of caffeine in the evening Frequently taking alcohol prior to sleeping Using nicotine products within a few hours of bedtime Frequent waking during the night to use the bathroom Having sleep apnea Suffering from restless leg syndrome

Reports No Worries keeping him/her awake No Chronic pain interfering with sleep No Consumption of caffeine in the evening Not Frequently taking alcohol prior to sleeping Not Using nicotine products within a few hours of bedtime Not Frequently waking up during the night to use the bathroom Not Having sleep apnea Not Suffering from restless leg syndrome

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Medical History

Has a history of Anxiety Depression PTSD Sleep-related disorder

Has no history of Anxiety Depression PTSD Sleep-related disorder

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Drug History

Is currently using Stimulants Antidepressants Antihistamines Corticosteroids

Is not currently using Stimulants Antidepressants Antihistamines Corticosteroids

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Details of alcohol use Details of recreational drug use

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Any other relevant details



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