|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.