Take the Sleep and Snoring Questionnaire. Below are some of the most common sleep issues that we can help you or your loved one with: General Sleep IssuesDo you or a loved one suffer from a sleep disorder? Below are some of the most common sleep issues that we can help you or your loved one with: Check all that apply. Excessive daytime sleepiness, which is usually a consequence of too little or very disrupted sleep Insomnia, which is characterized by difficulty initiating and/or maintaining sleep. Low oxygen during sleep. Obstructive sleep apnea, which is often described as Brief cessations of breathing throughout sleep. Poor sleep habits. Preoperative sleep apnea screening. Restless legs syndrome (RLS), which is best described as "creepy crawly" sensations in your legs, but can also occur in the arms. Shift work sleep problems. Shortness of breath during sleep. Snoring Situational Sleep IssuesHave you ever fallen asleep during the following situations? Check all that apply. Sitting and reading Watching TV Sitting inactive in a public place (e.g a theater or a meeting) As a passenger in a car for an hour without a break Lying down to rest in the afternoon when circumstances permit Sitting and talking to someone Sitting quietly after a lunch without alcohol In a car, while stopped for a few minutes in traffic SnoringIs your snoring effecting your quality of life? Check all that apply. You snore loudly (louder than talking or loud enough to be heard through closed doors). You often feel tired, fatigued, or sleepy during daytime. Someone has observed you stop breathing during your sleep. You have or are you being treated for high blood pressure. BMI more than 35 kg/m2. Over 50 yr old. Neck circumference greater than 16 inches. Gender: Male. Name* First Name Last Name Email Phone(###)####### This iframe contains the logic required to handle Ajax powered Gravity Forms. Learn more about the Epworth Sleepiness Scale. *The ESS should be used with a clear understanding of what it measures, and what its strengths and limitations are.