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6. Do You Snore


Snoring can sometimes be a symptom of a medical problem known as Sleep Apnea    To determine if you are at risk, complete the following questionnaire.  Circle the number after each statement that applies to you, and then add the total at the bottom for your score

1. I have been told my snoring can be heard:

     In the same room only

2

     Or through a closed door

4

     Or on another floor of the same house

7

2. I snore only when sleeping in one particular position

2

3. There has been an increase in my snoring over time

4

4. I have been told that I have pauses in my breathing when I sleep

7

5. I sometimes awaken suddenly gasping for air or feel like I am chocking

5

6. I have high blood pressure

3

7. I am tired and sleepy: (pick only one)

     Only when I am inactive and relaxed

2

     During mild activity or in situations requiring some attention

4

     Even if active, eating, or driving a car

7

8. I am overweight or have recently gained weight

2

9. I sweat at night

2

10. I awaken with headaches or have a headache shortly after awakening

4

11. My friends and family have told me that my personality has changed or I feel I become more easily irritated than I have in the past

3

12. I have allergies

2

Total:

____

If you scored 7 points or more, it is recommended that you contact your physician for further evaluation of a potentially serious illness

Body Mass Index______________      % Body Fat ___________________
Blood Pressure _______________      % Oxygen ____________________