Do You Snore?
Yes
No
I Don't Know
If You Snore: Your Snoring is:
Slightly Louder than Breathing
As Loud as Talking
Louder than Talking
Louder than Talking - Can be heard in adjacent rooms
How often do you Snore?
Nearly Everyday
3-4 time a week
1-2 times a week
Never or nearly Never
Has your Snoring ever bothered people?
Yes
No
I Don't Know
Has anyone ever noticed that you quit breathing in your sleep?
Nearly Everyday
3-4 times a week
1-2 times a week
1-2 times a month
Never or nearly Never
How ofter do you feel fatigued or tired after you sleep?
Nearly Everyday
3-4 time a week
1-2 times a week
1-2 times a month
Never or nearly Never
During your waking time, do you feel tired, fatigued or Not up to Par?
Nearly Everyday
3-4 times a week
1-2 times a week
1-2 times a month
Never o nearly Never
Have you ever fallen asleep or nodded off while driving a vehicle?
Yes
No
If YES, then How often does this Happen?
Nearly Everyday
3-4 time a week
1-2 times a week
1-2 times a month
Never or nearly Never
Do You have High Blood Pressure?
Yes
No
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