My Sleep Apnea LLC | Sleep Quiz

The following questions will help determine if you are suffering from a sleep disorder:

Do you have a hard time falling asleep, staying asleep, or have insomnia?

Yes

Do you suffer excessive daytime sleepiness?

Yes

Has your sleep partner ever complained about you snoring?

Yes

Would you say sleep or a lack of it is a problem for you?

Yes

As bedtime approaches do you anticipate having difficulty sleeping?

Yes

Do you have any unusual behaviors during sleep?

Yes

Do you have uncomfortable sensations in your limbs?

Yes

Are you currently taking any sleep aids, Over-the-Counter or prescription?

Yes

Do you awaken from a night’s sleep with a sore throat, or dry mouth?

Yes

Have you had a sleep study in the past?

Yes

0 = would never doze 1 = slight chance of dozing 2 = moderate chance of dozing 3 = high chance of dozing

How likely are you to doze or fall asleep in the following situations?

Watching TV

Sitting, talking with someone

As a passenger in a car for over an hour without a break

Sitting down reading

Sitting, inactive in a public place (e.g., a movie theater or park)

Resting in the afternoon, lying down

Anytime while your at work, especially after eating

When driving, stopping for a few minutes in traffic

Do you have, or been told you have:

A snoring problem?

Yes

Have a neck size of 17 inches or greater (men), or 16 inches or greater (women) or you are overweight?

Yes

Stopped breathing while sleeping?

Yes

Wake up choking or gasping?

Yes

High Blood Pressure or overweight

Yes

I’d like more information on the in Home Sleep Test

I’d like to make an appointment for a phone consultation with a sleep specialist

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Please provide your complete contact information below if you'd like to be contacted by our staff.

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The following questions will help determine if you are suffering from a sleep disorder:

How likely are you to doze or fall asleep in the following situations?

Do you have, or been told you have:

I’d like more information on the in Home Sleep Test

Please provide your complete contact information below if you'd like to be contacted by our staff.

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