F D S D

Flagler Diagnostic & Sleep Disorder Centers

Sleep Quiz Form

Patient Name:
1. Which Best Describes Your Sleep?*
*(Choose the option you mostly closely identify with.)
2. Do You Or Your Partner Notice That You Snore Loudly Or Have Pauses In Your Breathing At Night?*
*(Why we ask: A blocked airway is commonly associated with sleep disorders like sleep apnea.)
3. How Often Do You Wake Up Gasping For Air Or Short Of Breath?*
(Why we ask: Gasping is a survival reflex triggered when oxygen levels drop dangerously low, forcing your body to jolt awake and clear obstructed airway.)
4. How Often Do You Feel Tired During The Day?
*(Why we ask: Chronic daytime exhaustion is a major red flag that your nighttime breathing issues are preventing your brain and body from properly recharging.)
5. Do You Have High Blood Pressure, Obesity, Or Diabetes?*
(Why we ask: These conditions are closely linked to sleep apnea. Physical weight can narrow the airway, while oxygen drops cause stress that can spike blood pressure and blood sugar.)
Submit your answers to see what better sleep quality could look like for you.

Contact Info: