Use the following scale to choose the most appropriate number for each situation:

1. Do you snore?
   Yes
   No
   Don't know
   
   
2. If you snore, is your snoring?
   I don't snore
   Slightly louder than breathing
   As loud as talking
   Louder than talking
   Very loud. Can be heard in adjacent rooms


3. How often do you snore?
   Nearly every day
   3-4 times a week
   1-2 times a week
   1-2 times a month
   Never or nearly never


4. Has your snoring ever bothered other people?
   Yes
   No


5. Has anyone noticed that you quit breathing during your sleep?
   Nearly every day
   3-4 times a week
   1-2 times a week
   1-2 times a month
   Never or nearly never


6. How often do you feel tired or fatigued after you sleep?
   Nearly every day
   3-4 times a week
   1-2 times a week
   1-2 times a month
   Never or nearly never


7. During your waketime, do you feel tired, fatigued or not up to par?
   Nearly every day
   3-4 times a week
   1-2 times a week
   1-2 times a month
   Never or nearly never


8. Have you ever nodded off or fallen asleep while driving a vehicle?
   Yes
   No
   
   
9. If you have nodded off or fallen asleep while driving, how often does it occur?
   Nearly every day
   3-4 times a week
   1-2 times a week
   1-2 times a month
   Never or nearly never


10. Do you have high blood pressure?
    Yes
    No
    Enter your BMI Click here for your Body Mass Index.