Sleep Quiz Have you been told that you snore? Yes No Have you been diagnosed with sleep apnea? Yes No Do you dream? Yes No Not Sure Do you awaken from sleep with chest pain or shortness of breath? Yes No Has anyone said that you seem to stop breathing while sleeping? Yes No Do you ever awaken with a sensation of gasping or choking? Yes No Do you wake up with a dry mouth? Yes No Do you feel tired, fatigued, or sleepy during the day? Yes No How would you describe your sleep? Restful Disruptive Non-Existent Do you have a CPAP? Yes, use every night Yes, use sporadically No Now, the health questions. Do you have / have you had any of the following (select all that apply): Diabetes High blood pressure Shortness of breath Stroke Coronary artery disease Congestive heart failure Atrial fibrillation Send
