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Please indicate how often you experience each of the following. (check one box for each in items a through j) d. Feel unrested during the day, no matter how many hours of sleep you had.

Have you ever had surgery as treatment for your snoring?

Please indicate how often you experience each of the following. (check one box for each in items a through j) b. Wake up during the night and have difficulty getting back to sleep.

Please indicate how often you experience each of the following. (check one box for each in items a through j) c. Wake up too early in the morning and be unable to get back to sleep.

In the past year, how often, on average, have you been awakened with noise in your surroundings?

Please indicate how often you experience each of the following. (check one box for each in items a through j) a. Have trouble falling asleep.

In the past year, how often, on average, have you been awakened with chest pain or tightness?

For how many years have you been snoring? (number of years, up to 2 digits)

Have you ever been told by a doctor that you have a sleep disorder (other than sleep apnea)? 18. What other sleep disorder? (check all that apply) b. Restless legs

In the past year, how often, on average, have you been awakened with sweats or hot flashes?

In the past year, how often, on average, have you been awakened with pain in your joints, muscles, or back?

Please indicate how often you experience each of the following. (check one box for each in items a through j) h. Nasal stuffiness, obstruction or discharge at night.

To answer these questions, please consider both what others have told you AND what you know about yourself. 15. How often do you have times when you stop breathing during your sleep?

In the past year, how often, on average, have you been awakened with the need to go to the bathroom?

In the past year, how often, on average, have you been awakened with heartburn or indigestion?

In the past year, how often, on average, have you been awakened with leg cramps or leg jerks?

Questions 9 through 15 are about snoring and breathing during sleep. To answer these questions, please consider both what others have told you AND what you know about yourself. 9. Have you ever snored (now or at any time in the past)?

Is your snoring: (increasing, decreasing, etc) 1=Increasing over time, 2=Decreasing over time, 3=Staying the same, 8=Don't know

Questions 9 through 15 are about snoring and breathing during sleep. To answer these questions, please consider both what others have told you AND what you know about yourself. 12. Has your snoring been: (check one)

Questions 9 through 15 are about snoring and breathing during sleep. To answer these questions, please consider both what others have told you AND what you know about yourself. 10. How often do you snore now? (check one)

How often do you have times when you stop breathing during your sleep? 1=Rarely-less than 1night/wk, 2=Sometimes-1 or 2nights/wk, 3=Frequently-3 to 5nights/wk, 4=Always or almost always-6 or 7nights/wk, 8=Don't know

In the past year, how often, on average, have you been awakened with shortness of breath?

Questions 9 through 15 are about snoring and breathing during sleep. To answer these questions, please consider both what others have told you AND what you know about yourself. 11. How loud is your snoring? (check one)

How often do you snore? 0=Do not snore any more, 1=Rarely-less than 1 night/wk, 2=Sometimes-1 or 2 nights/wk,3=Frequently-3 to 5nights/wk, 4=Always or almost always-6 or 7nights/wk, 8=Don't know