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.