Berlin (Sleep Apnoea) questionnaire Do you snore? Yes No Don’t know How often do you snore? Every day 3 to 4 times a week 1 to 2 times a week 1 to 2 times a month Rarely or Nearly Never Your snoring is… Slightly louder than breathing As loud as talking Louder than talking Has your snoring ever bothered other people? Every day 3 to 4 times a week 1 to 2 times a week 1 to 2 times a month Rarely or Nearly Never Has anyone noticed that you stop breathing during your sleep? Every day 3 to 4 times a week 1 to 2 times a week 1 to 2 times a month Rarely or Nearly Never How often do you feel tired or fatigued after your sleep? Every day 3 to 4 times a week 1 to 2 times a week 1 to 2 times a month Rarely or Nearly Never During your waking time, do you feel tired, fatigued or not up to par? Every day 3 to 4 times a week 1 to 2 times a week 1 to 2 times a month Rarely or Nearly Never Have you ever nodded off or fallen asleep while driving a vehicle? Yes No How often does it happen? Every day 3 to 4 times a week 1 to 2 times a week 1 to 2 times a month Rarely or Nearly Never Do you have high blood pressure? Yes No Don’t know Submit score to GPName First Last Date of BirthDayDay12345678910111213141516171819202122232425262728293031MonthMonth123456789101112YearYear20262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920PhoneEmail Submit score to GP I confirm that the information provided is accurate to the best of my knowledge
