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Bed Partner Survey
| Question | Yes | No |
|---|---|---|
| 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!
