Get help for a sleep or tiredness problem

Use this form at any time to get help from your practice. We aim to respond within 2 working hours.

Get help for a sleep or tiredness problem

About the Patient's Problem

If you're not sure, it's helpful to tell us whether it's been days, weeks, months or years.

Please specify the problem(s) you are having: *

Psychological causes of tiredness

Psychological causes of tiredness are much more common than physical causes.

During the last month, have you often been bothered by feeling down, depressed or hopeless?
During the last month, have you often been bothered by having little interest or pleasure in doing things?

Over the last 2 weeks, how often have you been bothered by any of the following problems:

Little interest or pleasure in doing things: *
Feeling down, depressed, or hopeless: *
Trouble falling or staying asleep, or sleeping too much: *
Feeling tired or having little energy: *
Poor appetite or overeating: *
Feeling bad about yourself — or that you are a failure or have let yourself or your family down: *
Trouble concentrating on things, such as reading the newspaper or watching television: *
Moving or speaking so slowly that other people could have noticed? Or the opposite — being so fidgety or restless that you have been moving around a lot more than usual: *
Thoughts that you would be better off dead or of hurting yourself in some way: *

For immediate help

This is not an emergency form. If you require immediate help or are considering self harm, you can seek help and advice today by visiting 111.nhs.uk or calling 111 and selecting option 2.

Do you suffer from anxiety?

Over the last 2 weeks, how often have you been bothered by the following problems?

Feeling nervous, anxious, or on edge *
Not being able to stop or control worrying *
Worrying too much about different things *
Trouble relaxing *
Being so restless that it's hard to sit still *
Becoming easily annoyed or irritable *
Feeling afraid as if something awful might happen *

Do you drink alcohol?

This is one unit of alcohol:

Amount of different types of drink representing one unit of alcohol

And each one of these, is more than one unit:

Amount of different types of drink representing more than one unit of alcoholAmount of different types of drink representing more than one unit of alcohol
How often do you have a drink containing alcohol? *
How many units of alcohol do you drink on a typical day when you are drinking? *
How often have you had 6 or more units if female, or 8 or more if male, on a single occasion in the last year? *
How often during the last year have you found that you were not able to stop drinking once you had started? *
How often during the last year have you failed to do what was normally expected from you because of your drinking? *
How often during the last year have you needed an alcoholic drink in the morning to get yourself going after a heavy drinking session? *
How often during the last year have you had a feeling of guilt or remorse after drinking? *
How often during the last year have you been unable to remember what happened the night before because you had been drinking? *
Have you or somebody else been injured as a result of your drinking? *
Has a relative or friend, doctor or other health worker been concerned about your drinking or suggested that you cut down? *

Do you smoke?

If you do not currently smoke

Have you smoked in the past?
How many cigarettes did you smoke in a day?

If you currently smoke

How many cigarettes do you smoke in a day?
Would you like to give up smoking?

Please contact SmokeFree Norfolk for help quitting (Opens in new tab)

How many drinks containing caffeine do you have in a usual day?

Feeling tired without an obvious cause

Physical causes of tiredness

How did your tiredness start?
Are you regularly using medication that is not prescribed?
Have you had any vaginal bleeding in the last year?
Did you develop any of these symptoms around the time that your tiredness started or later?
Or any of the following symptoms?

Carbon monoxide poisoning can cause tiredness. This is usually caused by incorrectly installed, poorly maintained or poorly ventilated household appliances, such as cookers, heaters and central heating boilers. See NHS: Carbon monoxide poisoning (Opens in a new tab)

Do you think you might be exposed to carbon monoxide at home or work?

Problems with sleeping

How often do you have trouble getting off to sleep?
Do you have an overwhelming urge to move your legs?
How often do you wake in the night?
How long does it usually take to fall asleep again?
Do you feel well rested when you wake up in the morning?

Have you been told that:

You snore loudly?
Your breathing stops and starts during sleep?
You make gasping, snorting or choking noises during sleep?

Do you feel sleepy during the afternoon?
Do you nap during the day?

Please select your chance of dozing in the following situations:

This refers to your usual way of life in recent times. Even if you have not done some of these things recently, try to work out how they would have affected you.

Think about how likely you are to doze off or fall asleep in the following situations, in contrast to feeling just tired.

Sitting and Reading: *
Watching TV: *
Sitting, inactive in a public place (e.g. a theatre or a meeting): *
As a passenger in a car for an hour without a break: *
Lying down to rest in the afternoon when circumstances permit: *
Sitting and talking to someone: *
Sitting quietly after lunch without alcohol: *
In a car, while stopped for a few minutes in traffic: *

Physical Activity

File Upload

Please send photos if you think a photo would help our clinicians.
Drop a file here or click to upload Choose File
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Communication Preferences

How would you like us to deal with the problem? *
Video Consultation

Video consultations require you to have a smartphone, tablet, laptop or any computer with camera and microphone or headset. You will also require access to the internet, preferably over WiFi. If the practice decides on a video consultation you will be sent an email containing a link for the video consultation, so it's best if you can receive your emails on that same device.

How quickly do you think the problem needs to be dealt with? *

If the practice has a mobile number for you, we may send text messages to this number to inform you of an appointment time, or to allow you to book an appointment at a time of your choice.

Terms & Conditions *