Yes
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No
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The results
of this free on-line evaluation will direct you to
the next step towards determining if you have a sleep
disorder
breathing problem or sleep apnea.
Click on the check
box for each question.
Be sure to answer each question.
After answering each question, click on the
get score button to reveal your score. Below
the
score is a table to compare your results.
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Snoring |
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1.
I have been told I snore?
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2.
I have been told I keep people awake with my snoring.
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3. I have been told that I stop breathing
or hold my breath while I am snoring. |
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4. I have been told that I snore only
when sleeping on my back. |
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Weight |
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1. I am over weight. |
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2. I have recently gained weight. |
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3. My neck size is greater than seventeen
inches. |
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4. I have tried to loose
weight and have tried several diets, with no success |
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A. M. SYMPTONS |
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1. I wake after sleep with headache. |
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2. I wake from sleep with dry mouth. |
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3. I wake from sleep with a sore throat. |
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SLEEPINESS |
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1. Do you nap during the day more than
one day a week? |
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2. Do you require nap during daytime
to stay awake at night? |
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3. Are you sleepy throughout the day
even if you have slept the previous night? |
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4. Have you fallen asleep while driving
a car? |
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5. Have you fallen asleep at a traffic
light while waiting for the light to change? |
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6. Have you fallen asleep while a passenger in a car for less than one hour
although you slept the previous night? |
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7. Have you fallen asleep while at work
or at school, although you slept the
previous night? |
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8. Have you fallen asleep while eating? |
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9. Have you fallen asleep while watching
TV or reading for less than one hour,
even if you try to stay awake ?
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10. Have you fallen asleep while sitting
at a show or theatrical presentation,
although you slept the previous night and you tried to stay awake? |
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DREAMS - DO YOU… |
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1. Dream that someone is chasing
you or I am chasing them
and you wake up short of breath, or gasping for air? |
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2. Dream someone is choking me and I
am suffocating and wake up short of breath,
or gasping for air? |
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3. Dream that you are doing something
that requires great strength or exertion
and wake up short of breath, or gasping for air? |
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ACID INDIGESTION OR REFLUX |
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1. Do you wake up with acid indigestion,
reflux, or upset stomach once you have gone to sleep?
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Hypertension |
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1. Have you been told that I have high
blood pressure? |
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2. Have you taken blood pressure medicine
in the past, but stopped, other than
by order of a physician? |
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STROKE |
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1. Have you ever been told you have had
a stroke? |
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2. Have you ever experienced
stroke symptoms? i.e. examples…
Examples…
• Sudden numbness or weakness of the face,
arm, or legs, especially on
one side of the body.
• Sudden trouble seeing in one or both eyes.
• Sudden confusion,trouble speaking or understanding.
• Sudden trouble walking,dizziness, loss of balance
or coordination.
• Sudden severe headache with no known cause.
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Heart |
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1. Have you ever had a heart attack? |
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2. Have you been told you have Congestive
Heart Failure (CHF)? |
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3. Do you wake up at night or in the
a.m. with sweats and determine the room is not hot? |
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4. Do you notice swelling or puffiness
in my ankles or feet at night? |
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MEDICATION |
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1.
Do you take medication for depression?
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2.
Do you take medication for sleep?
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OTHER
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1. Do you experience Sexual dysfunction
with loss of desire or impaired sexual function? |
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2. Do you feel your Memory has detracted
in the last six months to a year ? |
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Scoring Range
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Review
the table below to understand your score
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0 ~ 15 |
There
is a high probability that you do not have sleep apnea.
If you want to be sure, order our in-home test. |
15
~ 30 |
You
could definitely have sleep apnea, or a sleep disorder
breathing condition. We recommend that you
order our In-Home Sleep Screening System, and obtain
a free analysis report. |
30
or Higher |
We highly recommend
that you take our In-Home
Sleep Screening System. After doing so you
will receive our free five page report and evaluation
letter. You should
take the results to your physician for diagnosis. You
physician is familiar with these reports and will prescribe
proper treatment. |
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THIS QUESTIONER IS INFORMATIONAL
ONLY AND SHOULD NOT, BY ITSELF, BE USED TO CONFIRM
OR ELIMINATE A
DIAGNOSE SLEEP APNEAS. SHOULD YOUR SCORE BE GREATER
THAN THIRTY (30) WE SUGGEST YOU CONTACT US IMMEDIATELY
OR GO DIRECTLY TO THE ORDER PAGE ON THIS WEBSITE
AND ORDER OUR SCREENING
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