Have you been told that you snore consistently?

    Do you awaken yourself from sleep?

    Does your sleep partner witness you suddenly gasp out loudly for air at night?

    Are you fatigued during the day?

    Have you been diagnosed with Sleep Apnea?

    Do you currently have a CPAP?

    If you have a CPAP, do you wear it all night?

    Please provide any other relevant details: