Have you ever been told you snore?
Yes
No
Have you ever been told you gasp, choke, or stop breathing when sleeping?
Yes
No
Ever catch yourself nodding off when you'd rather stay awake?
Yes
No
Do you often wake up feeling refreshed?
Yes
No
Do you breathe through your mouth or nose while sleeping?
Mouth
Nose
Do you breathe through your mouth during the day?
Yes
No
Do you grind or clinch your teeth while sleeping?
Yes
No
Do you talk in your sleep?
Yes
No
Do you sweat a lot while sleeping?
Yes
No
Do you wake up at night often?
Yes
No
Sometimes
Do you have seasonal alergies?
Yes
No
Do you have trouble focusing?
Yes
No
ADD/ADHD?
Yes
No
High Blood Pressure?
Yes
No
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Email
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