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Sleep Self-Evaluation   |   ResMed Berlin Questionnaire 1. Do you snore? Yes No Don't know If you snore... 2. Your snoring is... Slightly louder than breathing As loud as talking Louder than talking Very loud 3. How often do you snore? Almost every day 3-4 times a week 1-2 times a week Never or almost never 4. Does your snoring bother other people? Yes No 5. Has anyone noticed that you quit breathing during your sleep? Almost every day 3-4 times a week 1-2 times a week Never or almost never 6. Are you tired after sleeping? Almost every day 3-4 times a week 1-2 times a month Never or almost never 7. Are you tired during waketime? Almost every day 3-4 times a week 1-2 times a month Never or almost never 8. Have you nodded off or fallen asleep while driving? Yes No 9. How often does it occur? Every day 3-4 times a week 1-2 times a week 1-2 times a month Never or almost never 10. Do you have high blood pressure?* Yes No Don't know You score is out of . You have a % risk of sleep-related issues and sleep apnea. Please contact our office if your score is 6 or higher (60% or higher risk). You may print this page and bring it along to your consultation, if you would like. *If your Body Mass Index (BMI) is 30 or over, you may also be at an additional risk. To calculate your BMI, click here. © Copyright Annals of Internal Medicine 1999. The Berlin Questionnaire is reproduced with the permission of American College of Physicians. © 2006 Grant Hensley, D.D.S. • 114 Rand Place, Franklin, TN 37064 • 615-794-1546 • Privacy Policy