Airway

1

Do you suffer from headaches?* This field is mandatory.

YesNo

2

Do you suffer from daytime sleepiness?* This field is mandatory.

YesNo

3

Are you tired upon waking?* This field is mandatory.

YesNo

4

Do you have difficulty concentrating during the day?* This field is mandatory.

YesNo

5

Have you experienced loss of libido?* This field is mandatory.

YesNo

6

Have you noticed that you have had poor performance in school, on the job, or in sports?* This field is mandatory.

YesNo

7

Have you noticed increased clumsiness?* This field is mandatory.

YesNo

8

Do you have trouble staying awake during work or class?* This field is mandatory.

YesNo

9

Do you experience loud snoring?* This field is mandatory.

YesNo

10

Have you experienced episodes where you have stopped breathing during sleep?* This field is mandatory.

YesNo

11

Have you ever woken abruptly accompanied by gasping or choking?* This field is mandatory.

YesNo

12

Have you noticed that when you wake your mouth is dry or your throat is sore?* This field is mandatory.

YesNo

13

Positive responses to the above questions may be a sign that you may be suffering from Sleep-Related Breathing Disorders (SRBD) or Airway Compromise. At Aviara Centers, we provide Advanced STO (Sleep, TMJ & Orthodontic) Evaluations to help you find customized solutions to the root causes of your Sleep, TMJ, Orthodontic (teeth or jaw misalignment), or other health issues.* This field is mandatory.

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