Do you snore?:YesNo

Have you or anyone observed you stop breathing or gasp during sleep?:YesNo

Do you wake up tired and unrefreshed?:YesNo

Do you doze off easily?:YesNo

Do you ever wake up out of breath, gasping or coughing?:YesNo

Are you a restless sleeper?:YesNo

Do you ever have indigestion or acid reflux?:YesNo

Do you have headaches or jaw pain?:YesNo

Do you have or ever had in the past high blood pressure?:YesNo

Do you ever have night sweats?:YesNo