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Screening Draft

What level is your snoring?
Very little
Occasionally
2 - 5 nights a week
6+ nights - particularly if lying on your back
6+ nights - whether on your back or side
My snoring is very loud and can disturb others.
Never
Occasionally
2 - 5 nights a week
Regularly 3 - 5 nights per week
Very frequently - more than 5 nights per week
Do you have some sleepiness during the day, even if you get more than 6 hours sleep?
Never
Occasionally
2 days per week
Regularly 3 - 5 nights per week
Very frequently - more than 5 nights per week
Has anyone noticed any disturbances in your breathing during sleep? (gasping, choking, etc.)
Never
Occasionally
1 - 2 nights per week
Regularly - 3 - 5 nights per week
Very frequently - more than 5 nights per week
Do you wake up unrefreshed, even if you have more than 6 hours sleep?
Never
Occasionally
2 days per week
Regularly - 3 - 5 days per week
Very frequently - more than 5 days per week
Are you being treated for any of the following (if none, just click Finish):
High blood pressure
Diabetes
Heart Disease
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