Berlin Questionnaire - Sleep Apnea

Category 1

1. Do you Snore?  

a. Yes
b. No
c. Don't know

If "no", proceed to question 6. If "yes", please answer questions 2-5 below.

2. Is your snoring:

a. Slightly louder than breathing
b. As loud as talking
c. Louder than talking

3. How often do you snore?

a. Almost every day
b. 3-4 times per week
c. 1-2 times per week
d. 1-2 times per month
e. Rarely or never

4. Has your snoring ever bothered other people?

a. Yes
b. No
c. Don't know

5. Has anyone noticed that you stop breathing during your sleep?

a. Almost every day
b. 3-4 times per week
c. 1-2 times per week
d. 1-2 times per month
e. Rarely or never

Category 2

6. How often do you feel tired or fatiqued after your sleep?  

a. Almost every day
b. 3-4 times per week
c. 1-2 times per week
d. 1-2 times per month
e. Rarely or never

7. During your waking time, do you feel tired, fatigued or not up to par?  

a. Almost every day
b. 3-4 times per week
c. 1-2 times per week
d. 1-2 times per month
e. Rarely or never

8. Have you ever nodded off or fallen asleep while driving a vehicle?  

a. Yes
b. No

If you answered "yes" to question (8) above, please answer question 9 below.

9. How often does this occur?

a. Almost every day
b. 3-4 times per week
c. 1-2 times per week
d. 1-2 times per month
e. Rarely or never

Category 3

10. Do you have high blood pressure?  

Yes
No
Don't know