Please complete the form below and we will contact you with more information:
Name
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Do I have a Sleep Disorder?
Question 1
I have been told that I snore.
Question 2
I have experienced or others have observed that I stop breathing or gasp for air during sleep.
Question 3
I feel sleepy or doze off while watching TV, reading, driving or engaged in daily activities.
Question 4
I have difficulty falling asleep, or wake up frequently or too early and can not go back to sleep.
Question 5
I have non-refreshing sleep, daytime tiredness and fatigue, and low energy level.
Question 6
I have difficulty concentrating, and memory problems.
Question 7
I have unpleasant, tingling, creeping feelings or nervousness and the urge to move my legs when trying to sleep.
Question 8
I have frequent sleep disruptions due to nighttime heartburns, chronic aches and pains, discomfort, bad dreams,
dry mouth and thirst, noise.
Additional Comments or Questions