Sleep Disorder Quiz

Below you will find a list of questions. Please answer each one. Once you click submit, your information will be securely mailed to Dr. Kleive. Please feel free to add any comments or questions for the doctor at the end of the quiz. He will personally respond to you as soon as possible.



1. Does it take you a half an hour or more to fall asleep at night?

Invalid Input
2. Have you been told you snore or experience breathing interruptions while sleeping?

Invalid Input
3. If you snore, is it amplified while lying on your back?

Invalid Input
4. Do you actively sweat during the night?

Invalid Input
5. Do you have a restless sensation in your legs before and during sleep?

Invalid Input
6. Do you have a history of sleepwalking, talking, kicking, shouting, or striking out in your sleep?

Invalid Input
7. Do you suffer from frequent headaches, especially in the morning?

Invalid Input
8. Are you diabetic, or do you suffer from high blood pressure?

Invalid Input
9. Do you regularly wake up short of breath?

Invalid Input
10. Do you often feel lethargic, without focus, or that you could fall asleep at any time throughout the day?

Invalid Input
Comments:

Invalid Input
Name:

Please enter your name
Phone:

Please leave a number where we can reach you.
Email Address:

Please enter a valid email address.
Contact Preference:

Please select one
I’d like to set up a consultation

Please select one




The above questions are not to be taken as medical advice; they are an initial tool for learning more about your condition. To formally assess and treat your condition, make a no fee consultation. You do not have to spend another night as a victim to your snoring problem. Take the first step by contacting Dr. Mark Kleive , your local sleep apnea dentist, at (651) 730-7645.