1. I frequently awaken with a dry mouth.      Yes      No

2. My spouse complains that I snore often during sleep.      Yes      No

3. My snoring is so bad my bed-partner left years ago.      Yes      No

4. I often wake up feeling unrefreshed—like I barely got any sleep at all.      Yes      No

5. Sometimes on long drives I have to pull over and nap—so I don’t fall asleep.      Yes      No

6. Sometimes I fight to stay awake at work—especially if it’s boring.      Yes      No

7. I need more than 2 cups of coffee or tea to make it through the day.      Yes      No

8. I awaken frequently to use the bathroom—more than once a night.      Yes      No

9. I have awakened from sleep gasping for breath more than once.      Yes      No

10. Sometimes I awaken from sleep with my heart pounding. I don’t know why.      Yes      No

11. I have been told that I stop breathing during sleep.      Yes     No

12. On weekends I take naps and “sleep in” to make up for lost sleep during the week.      Yes      No

13. I don’t have as much energy as I used to. I must be “losing a step.”      Yes      No

14. I often get “heartburn” when I sleep.      Yes      No

15. When I drink alcohol, people say that my snoring is horrible.      Yes      No

If you (or someone you know) answered yes to four or more of the above descriptions, or you feel
that you or a loved one may suffer from a sleep disorder, don't waste any time, contact your
primary physician or sleep center to make an appointment for a sleep study.