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The following questions will help determine if you have a sleeping disorder

1. Do you snore?
	Yes
	No
	Don't Know
2. How Often do you snore?
	Nearly every day
	3-4 times a week
	1-2 times a week
	1-2 times a month
	Never or nearly never
3. Has your snoring ever bothered other people?
	Yes
	No
4. Has anyone notice that you quit breathing during your sleep?
	Nearly every day
	3-4 times a week
	1-2 times a week
	1-2 times a month
	Never or nearly never
5. How often do you feel tired or fatigued after you sleep?
	Nearly every day
	3-4 times a week
	1-2 times a week
	1-2 times a month
	Never or nearly never
6. During your waketime, do you feel tired, fatigued, or not up to par?
	Nearly every day
	3-4 times a week
	1-2 times a week
	1-2 times a month
	Never or nearly never
7. Have you ever nodded off or fallen asleep while driving a vehicle?
	Nearly every day
	3-4 times a week
	1-2 times a week
	1-2 times a month
	Never or nearly never
	If yes, how often does it occur?
8. Do you have high blood pressure?
	Yes
	No
	Don't Know