Sleep Quiz

1

Have you ever been diagnosed with sleep apnea?

Yes

No

Not sure

2

How would you describe your sleep most nights?

I fall asleep easily, but wake up tired

I wake up several times during the night

My partner says I snore loudly

I sleep fine, but my partner complains about my snoring

3

Do you know your sleep apnea severity?

Mild

Moderate

Severe

Not sure

4

Are you currently using CPAP to treat your sleep apnea?

Yes, regularly

Sometimes

I tried, but stopped

Never have used

5

What’s the biggest issue you experience with CPAP?(select all that apply)

Mask discomfort

Noise

Dry mouth

Travel inconvenience

I remove it during sleep

Other

6

Which symptoms do you experience? (select all that apply)

Snoring

Daytime fatigue

Morning headaches

Brain fog

Partner complains

7

Which statement(s) sounds applicable to you?(select all that apply)

I travel frequently

I want the simplest treatment option

I’d do anything to sleep better

I want to improve my health and energy

I’m often exhausted during the day

I’m mainly trying to stop snoring

8

Have you ever discussed oral appliance therapy with your doctor or dentist?

YESNO

9

If a comfortable alternative to CPAP existed, how interested would you be in that treatment?

Very interested

Maybe

Just exploring

10

Last up: Please enter your information so we can send you your results and next steps.

First name

Last name

Email

Please enter your phone

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