Sleep Apnea Dentist » Sleep Questionnaire Sleep Questionnaire Fill out the questionnaire to help determine the quality of your sleep, and we’ll have it ready when you visit our office! Do you know what sleep apnea means?YesNo Have you ever been diagnosed with sleep apnea?YesNo Do you now or have you ever used a CPAP Machine?YesNo Sleep Observations Do you know you snore or have you ever been told you do?YesNo Do you have difficulty breathing while lying on your back?YesNo Do you ever wake up gasping for air?YesNo Do you often feel tired or fatigued after a god nights sleep?YesNo Has anyone ever noticed that you stop breathing during sleep?YesNo Epworth Sleep Scale How likely are you to doze off or fall asleep in the following situations, in contrast to feel just tired? This refers to your usual way of life in recent times. Use the following scale to choose the most appropriate number of each situation. Sitting and reading0123 Watching TV0123 Sitting inactive in a public place0123 As a passenger in a car for an hour without a break0123 Lying down to rest in the afternoon0123 Sitting and talking to someone0123 Sitting quietly after lunch without alcohol0123 In a car while stopped for a few minutes in traffic0123 Score: Learn MoreSleep TestingStop Snoring TonightWhat Is Sleep Apnea and Do I Have It?