Sleep Quiz

1.  Do you snore?
Yes
No (skip to question 6)
Don't know (skip to question 6)

If you snore:

2.  Your snoring is ...
Slightly louder than breathing
As loud as talking
Louder than talking
Very loud - can be heard in adjacent rooms

3.  How often do you snore?
Nearly Every Day
3 to 4 times per week
1 to 2 times per week
1 to 2 times per month
Never or nearly never

4.  Has your snoring bothered other people?
Yes
No
Don't know

5.  Has anyone noticed that you quit breathing during your sleep?
Nearly every day
3 to 4 times per week
1 to 2 times per week
1 to 2 times per month
Never or nearly never

Whether or not you snore:

6.  How often do you feel tired or fatigued after you sleep?
Nearly Every Day
3 to 4 times per week
1 to 2 times per week
1 to 2 times per month
Never or nearly never

7.  During your waking time, do you feel tired or fatigued?
Nearly Every Day
3 to 4 times per week
1 to 2 times per week
1 to 2 times per month
Never or nearly never

8.  Have you ever nodded off or fallen asleep while driving?
Yes
No (skip to question 10)

If yes to question 8:

9.  How often does this occur?
Nearly every day
3 to 4 times per week
1 to 2 times per week
1 to 2 times per month
Never or nearly never

10.  Do you have high blood pressure?
Yes
No
Don't know

Enter Your Height and Weight:
Height: feet  inches
Weight: pounds
 
 

 


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