Patient Sleep Questionnaire

Tick the box if you answer Yes to any of these questions

Do you feel tired or fatigued during the day? Do you doze off during the day while watching TV, sitting down in the afternoon, or stopped in traffic? (at least once a month)? Do you Snore? (louder than your breathing, at least once a month)? Has anyone told you that you stop breathing while you sleep? Have you ever woken up gasping or choking? Do you have morning headaches (more than once a month)? Do you have high blood pressure or Atrial Fibrilation?