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Berlin Sleep Apnea Questionnaire

Fill out all the information below and someone will contact you to discuss the results of your free home sleep test evaluation:

* denotes required field

What is your height?*
What is your weight?*
Age?*
Do you snore?*
If you snore, your snoring is:*
How often do you snore?*
Has your snoring ever bothered other people?*
Has anyone noticed that you quit breathing during sleep?*
How often do you feel tired or fatigued after your sleep?*
During your waking time, do you feel tired, fatigued or not up to par?*
Have you ever nodded off or fallen asleep while driving a vehicle?*
If yes: How often does this occur?*
Do you have high blood pressure?*
What is the best way to contact you and discuss your results?
If you answered phone, please input the best number to reach you at:
If you answered email, please input your email address.
Enter the code shown:


Please note this questionnaire is for a free evaluation. 1800CPAP.COM is not responsible for any action you take or don't take based on the results of this free evaluation. 1800CPAP.COM has not been made aware of any preexisting conditions when you take this sleep apnea evaluation test.


This questionnaire is just a screening tool. The home sleep testing service we also offer is a complete diagnostic test that gives you accurate results. 1800CPAP.COM strongly encourages you to talk with your physician about your results in addition to talking with one of our specialists.


By submitting this form you agree that 1800CPAP.COM is not liable for your health or your decisions based on the results of the test. The results of this sleep apnea test are for your knowledge only and we are not held accountable for your decision to not act on information you've received from this free test. All information gathered from this test will not be shared and is held on a secure server. The information you provide is completely confidential. By submitting this form you acknowledge that you are willingly giving us this information.


1800CPAP.COM also recognizes that there is a need for a traditional sleep lab in some cases. Home sleep testing is not recommended for heart failure conditions or other known co-morbidities. That being said we also recognize that home sleep testing is a valid form of testing for a large percentage of people that suspect they have sleep apnea. We have found through several years in this industry that the main reason home sleep testing is frowned upon is because sleep centers are revenue generators for the industry. Sleep centers will make patients have a CPAP titration in a lot of cases when it is completely unnecessary. With the technology of the Auto CPAP machine these second sleep studies or CPAP titrations have become less useful and inconvenient.


Why Choose 1800CPAP?