1. Do you snore at night? Yes No
2. Do you wake up gasping for air in the middle of the night? Yes No
3. Do you wake up with a headache often? Yes No
4. Do you feel unenergized throughout the day even after a full night's sleep? Yes No
5. Do you have a family history of Sleep Apnea? Yes No
6. Do you have to go to the bathroom frequently at night? Yes No
7. Are you considered overweight or obese? Yes No
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