Sleep Questionnaire Sleep Questionaire Name* Email* Phone*I snore. Yes No Are you tired, fatigue, or sleepy during the day? Yes No I have used a CPAP (Continuous Positive Airway Pressure). Yes No My snoring is loud. Never Infrequently Frequently Most of the time Snoring affects my relationship. Never Infrequently Frequently Most of the time My snoring causes me or my partner to be irritable and/or tired. Never Infrequently Frequently Most of the time My snoring requires me to sleep in a separate room. Never Infrequently Frequently Most of the time My snoring affects other people when I am sleeping away from home (hotel, camping, etc.). Never Infrequently Frequently Most of the time CAPTCHAHiddenUntitled
