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Sleep Survey


Take a moment and read the following. Is this you? 


  1. I have been told that I gasp, snort or stop breathing at night    Yes    No

  2. My neck size is 17 inches or more for men, over 16 inches for women   Yes  No

  3. I have night time reflux ( a bad taste in my mouth during the night, mild regurgitation)  Yes  No

  4. I can fall asleep easily during the day, even after 6 or more hours of sleep   Yes  No

  5. I have been told I snore loudly   Yes  No

  6. I have high blood pressure     Yes  No

  7. I have been told I snore less sleeping on my side   Yes  No

  8. I have excessive daytime sleepiness and/or daytime fatigue even though I have slept   Yes  No

  9. I have been awakened with gasping and choking sensation.   Yes  No

  10. I have been depressed and have been told that my personality has changed   Yes  No

  11. I am overweight   Yes  No

  12. I wake up with morning headaches, and I do not grind my teeth at night.     Yes  No


If you answered yes to the majority of these questions, contact your physician and bring a copy of this survey with you.  Sleep apnea or sleep obstruction can prevent that deep, resting sleep that is needed to refresh your energy for the day. Sleep studies are available through St. Thomas More Hospital.

Click here for a printable sleep survey

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