Do you snore? YesNoDon't Know
If you snore, your snoring is: Slightly louder than breathingAs loud as talkingLouder than talkingVery loud – can be heard in adjacent rooms
How often do you snore? Nearly every day3-4 times a week1-2 times a week1-2 times a monthNever or nearly never
Has your snoring ever bothered other people? YesNoDon’t know
Has anyone noticed that you quit breathing during your sleep? Nearly every day3-4 times a week1-2 times a week1-2 times a monthNever or nearly never
How often do you feel tired or fatigued after your sleep? Nearly every day3-4 times a week1-2 times a monthNever or nearly never
During your waking time, do you feel tired, fatigued or not up to par? Nearly every day3-4 times a week1-2 times a weekNever or nearly never
Have you ever nodded off or fallen asleep while driving a vehicle? YesNo
How often does this occur? Nearly every day3-4 times a week1-2 times a weekNever or nearly never
Do you have high blood pressure? YesNoDon’t know
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