Bed Partner Survey

QuestionYesNo
Do you witness the patient snoring?
Do you witness the patient choking or gasping for breath during sleep?
Does the patient pause or stop breathing during sleep?
Does the patient fall asleep easily, if given the opportunity, during the day (normal wakeful hours)?
Do you witness the patient clenching and/or grinding his/her teeth during sleep?
Does the patient still appear tired upon awakening from a normal night’s sleep?
Do the patient’s sleep habits disturb your sleep?
Does the patient sit up in bed, not awake?
Please check those sleep habits of the patient that are disturbing to you:
Snores
Restless
Wakes up often
Loud gasping for breath while sleeping
Stops breathing
Grinds teeth
Becoming very rigid or shaking
Biting tongue
Kicking during sleep
Head rocking or banging
Bed-wetting
Sleep walking
Sleep talking

Scoring results:

The more “Yes” answers given, the more likely it is that your bed partner has the life threatening condition called sleep apnea. If you answered more than 2 or 3 questions with a “yes”, your bed partner should be evaluated for sleep apnea as soon as possible. Contact us now to find out how we can help!