1. Are you sleepy during the day, even after your usual number of hours of sleep? *This question is required.
2. Has anyone complained of your loud snoring? *This question is required.
3. Have you had a significant weight gain since age 18? *This question is required.
4. Does your bed partner notice pauses in your breathing as you sleep? *This question is required.
5. Have you ever had broken bones in the nose or mouth area? *This question is required.
6. Have your health care providers described your tonsils as being enlarged? *This question is required.
7. Are you aware of any throat or airway difficulties due to injury or disease? *This question is required.
8. Are you aware of having thyroid disease? *This question is required.
9. Has your ability to concentrate decreased? *This question is required.
10. Do you consistently have headaches upon awakening in the morning? *This question is required.
11. Have people around you noticed that you are easily irritated lately? *This question is required.
12. Are you currently taking any medication for high blood pressure? *This question is required.
13. Does your bed partner complain that you seem restless while you sleep? *This question is required.
14. Is your restlessness confined to your legs? *This question is required.
15. As an adult, have you experienced any sleep walking, sleep talking or other "sleep behavior?" *This question is required.
16. Do you awaken often during the night? *This question is required.
17. Does it usually take you longer than 20 minutes to fall asleep? *This question is required.
18. Do you often awaken at a different time every morning? *This question is required.
19. Have you been experiencing spells of weakness or irresistible sleepiness during the day? *This question is required.