Sleep Apnea Screening

Are you significantly overweight? Yes No
If male, is your neck size greater than 17 inches? Yes No
If female, is your neck size greater than 16 inches? Yes No
Do you snore on a nightly basis? Yes No
Has your snoring been heard in other rooms or forced your partner into another room? Yes No
Have you been observed gasping or not breathing while you sleep(witnessed apneas)? Yes No
Do you awaken during the night choking or gasping for air? Yes No
In the morning, do you wake with headaches and or nasal congestion? Yes No
Are you frequently sleepy during the day on a regular basis? Yes No
Has your sleepiness interfered with your life? Yes No

If you answered yes to 3 or more questions, you may have a sleep-related breathing disorder. See your Physician and discuss your symptoms.

If you snore, have witnessed apneas and excessive daytime sleepiness, there is a high                probability you may have a sleep disorder. See your Primary Care Physician (PCP) for a referral to a sleep laboratory.