How old are you?
On average, about how many hours a day do you sleep?
How long does it usually take you to fall asleep at night?
How often do you nap?
Do you often have trouble falling or staying asleep?
Do you snore loudly? (louder than talking - could be heard through a closed door)
Has anyone seen you stop breathing during sleep?
Do you have high blood pressure, or are you being treated for high blood pressure?
Do you often feel tired or sleepy during the days?
Have you ever started to fall asleep while driving?
Do you do unusual actions while sleeping? (Such as eating, driving, yelling, acting out dreams, etc.)
When falling asleep or waking up, do you ever feel paralyzed in bed (cannot move your muscles)?
When you try to relax or sleep, do you ever have unpleasant, restless feelings in your legs that can be relieved by moving or walking?
Do your muscles get weak when you feel emotional?
Do you ever see dreamlike images when you are not fully asleep?
What is your gender?
Body Mass Index (BMI)
Weights (in pounds)
Height (in inches)
Neck circumference 15.75 inches or more?