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Sleep Metrics
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Quiz
See if you qualify
for CPAP Treatment?
Quiz
Name
Phone
(Required)
Email
Do you often SNORE when you sleep?*
(Required)
Yes
No
Do you find yourself overly TIRED throughout the day?
(Required)
Yes
No
Has anyone noticed that you STOPPED BREATHING during sleep?
(Required)
Yes
No
Do you have HIGH BLOOD PRESSURE? Or are you being treated for HYPERTENSION?
(Required)
Yes
No
Are you 50 years old or older?
(Required)
Yes
No
Is your neck circumference greater than 15.75 inches?
(Required)
Yes
No
Are you male or post – menopausal female?
(Required)
Yes
No
What is your Height (in inches)?
(Required)
What is your Weight (in pounds)?
(Required)
Do you have any of the following symptoms? (Check all that apply):
Feeling irritable and not able to concentrate at work
Morning headaches, memory or learning problems
Mood swings or personality changes, perhaps feeling depressed
Dry throat when you awake and/or waking up often to use the bathroom
