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0 = Never     1 = Slight Chance   2 = Moderate Chance   3 = Very Likely
   
How likely are you to Doze off in the Following Situations? Snoring may have a significant impact on you and your family's lives
Sitting and Reading How often are you told you snore?
Watching TV Does your snoring affect your bed partner?
Sitting in a Public Place Does your snoring affect others in the house?
Riding in a Car, Train or Plane
Lying Down in the afternoon
Sitting & Talking
Sitting quietly after drinking alcohol
In a car stopped for traffic

Have you been told you to stop breathing between snores?
Have you been suddenly awakened by your own snoring?
Do you awaken from sleep with a gasping or choking sensation?

 
 
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