Participant Identification

First Name *

Last Name *

Phone *

Email *

Demographics & CPAP History

Date of birth

Age (years) *

Sex Assigned at Birth *

Male

Female

Prefer not to say

Race (per US Census format) *

White

Black or African American

Asian

American Indian or Alaska Native

Native Hawaiian or Other Pacific Islander

Height *

Weight (lbs.) *

CPAP Pressure Setting (if known) *

Do you have facial hair? *

Yes

Do you have any respiratory conditions other than obstructive sleep apnea (OSA)? *

Yes

Please specify other respiratory conditions:

CPAP Therapy Experience

How long have you used CPAP therapy? *

Less than 6 months

6 months – 1 year

1 – 3 years

More than 3 years

Current CPAP Mask

What type of CPAP mask do you currently use? *

Nasal mask

Nasal pillows

Full-face mask

What brand and model of CPAP mask do you currently use?

How often do you replace the cushion in your current CPAP mask?

Every 2 weeks

Every month

Every 2 months

Every 3 months

Longer than every 3 months

Comfort Level

Rate the comfort of your current mask: *

Very Uncomfortable

Uncomfortable

Neutral

Comfortable

Very Comfortable

Issues Experienced

Check all issues you've encountered with your current mask: *

Air leaks

Skin irritation

Pressure points

Difficulty adjusting fit

Please specify any additional issues you've had other than what's listed above:

Sleep Quality

How would you rate your sleep quality overall with your current mask? *

Very Poor

Fair

Poor

Good

Excellent

Mask Stability

How often do you need to adjust your current mask during sleep? *

Frequently

Occasionally

Never

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