Is Your Sleep Keeping You Up At Night?
Take the sleep quiz to find out!
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Take The Quiz
Do you snore?
YES
NO
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Do you spend the most time sleeping on your back, side, or stomach?
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Side
Stomach
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Do you have GERD or heartburn regularly at night?
YES
NO
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Have you ever been diagnosed with sleep apnea?
YES
NO
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How long ago was your Sleep Study (either at home or in-lab)
Within the last year
Over a year ago
A long time ago
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Do you have a CPAP Machine?
YES
NO
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How often do you use your CPAP Machine?
All night, every night
A few hours each night
A couple times per week
Once a week
Rarely
Never
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How would you rate your CPAP experience in the following categories?
Rows
Very Negative
Negative
Neutral
Positive
Very Positive
Comfort
Noise
Portability/Travel
Sleep Quality
Ease of Use
Overall
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Do you have (or think you have) TMJ, Chronic Headaches or Jaw Pain?
YES
NO
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Do you have dentures or missing teeth?
YES, Dentures
YES, Missing Teeth
NO
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Do you have braces or any major dental work pending?
YES, Braces
YES, Major Dental Work Pending
NO
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STOP-BANG Questionnaire
This is a questionnaire used by physician to screen for potential sleep apnea.
Please answer to the best of your ability
Rows
YES
NO
Do you snore?
Do you often feel tired, fatigued, or sleepy during the day?
Has anyone observed you stop breathing during your sleep?
Do you have or are you being treated for high blood pressure?
Is your BMI more than 35kg per m2?
Are you older than 50?
Is your neck circumference greater than 40cm?
Are you male?
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Epworth Sleepiness Scale
0 = Would Never Feel Fatigued, 1 = Slight Chance of Fatigue, 2 = Moderate chance of Fatigue, 3 = High Chance of Fatigue
How likely would you be to feel fatigued in the following situations?
Rows
0
1
2
3
Sitting and reading
Watching TV
Sitting in a public place
Sitting in a car as a passenger without a break
Lying down to rest
Sitting and talking with someone
Sitting quietly after lunch without alcohol
In a car while stopped for a few minutes in traffic
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Fantastic! We'll send you your results!
Please add your contact information below. We'll email you your results and one of our team members will reach out to you to review your results.
Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
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