Trouble Sleeping?

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* 1. I snore loudly.

Yes

No

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* 2. I have noticed, or others have told me, that I sometimes stop breathing or gasp for breath during sleep.

Yes

No

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* 3. I feel sleepy or doze off while watching TV, reading, driving or engaging in daily activities.

Yes

No

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* 4. I have difficulty sleeping three nights a week or more (have trouble falling asleep, wake frequently during the night, wake too early and cannot get back to sleep, or wake feeling unrefreshed).

Yes

No

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* 5. I have unpleasant, tingling, creeping feelings or feel nervousness in my legs when trying to sleep.

Yes

No

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* 6. I have interruptions to my sleep (nighttime heartburn, bad dreams, pain, discomfort, noise, or light or temperature complaints).

Yes

No