Labored, difficult or loud breathing at night?
*
No Occurrence
Occurs Rarely
Occurs 2 to 4 times per week
Occurs 5 to 7 times per week
Interrupted snoring where breathing stops
*
No Occurrence
Occurs Rarely
Occurs 2 to 4 times per week
Occurs 2 to 4 times per week
Do You Snore?
*
No Occurrence
Occurs Rarely
Occurs 2-4 Times Per Week
Occurs 5-7 Times Per Week
Gasping for air or Labored Breathing while sleeping?
*
No Occurrence
Occurs Rarely
Occurs 2 to 4 times per week
Occurs 5 to 7 times per week
Mouth breathes or has lips slightly parted while sleeping?
*
No Occurrence
Occurs Rarely
Occurs 2 to 4 times per week
Occurs 5 to 7 times per week
Mouth breathes or has lips slightly parted during day?
*
No Occurrence
Occurs Rarely
Occurs 2 to 4 times per week
Occurs 5 to 7 times per week
Restless or continuous movement during sleep?
*
No Occurrence
Occurs Rarely
Occurs 2 to 4 times per week
Occurs 5 to 7 times per week
Grinds teeth while sleeping?
*
No Occurrence
Occurs Rarely
Occurs 2 to 4 times per week
Occurs 5 to 7 times per week
Talks in sleep?
*
No Occurrence
Occurs Rarely
Occurs 2 to 4 times per week
Occurs 5 to 7 times per week
Excessive sweating while sleeping?
*
No Occurrence
Occurs Rarely
Occurs 2 to 4 times per week
Occurs 5 to 7 times per week
Wakes up at night?
*
No Occurrence
Occurs Rarely
Occurs 2 to 4 times per week
Occurs 5 to 7 times per week
Feels sleepy and/or irritable during the day?
*
No Occurrence
Occurs Rarely
Occurs 2 to 4 times per week
Occurs 5 to 7 times per week
Seasonal allergies?
*
No Occurrence
Occurs Rarely
Occurs 2 to 4 times per week
Occurs 5 to 7 times per week
Trouble focusing?
*
No Occurrence
Occurs Rarely
Occurs 2 to 4 times per week
Occurs 5 to 7 times per week
ADD/ADHD?
*
Yes
No
Would you like to know the results of this sleep quiz?
Yes
No
Full Name
*
Email
*
Phone
*