Measuring the loudness:

(Disturbance factor)

Please rate your snoring problem from 1 to 10

No snoring at all

Non-disruptive - slight snoring sometimes

Non-disruptive - slight snoring about half the time

Non-disruptive - snoring most nights

Disrupts partner - sometimes

Disrupts partner - about half the nights

Disrupts partner - every night

Disrupts others - through shut doors some nights

Disrupts others - about half the nights of the week

Disrupts others - every night in other rooms

Partner sleeps in another room often

If your snoring has become disruptive (higher than 3) snore-op could be beneficial

Measuring your tiredness

(Epworth Sleepiness Scale)

How likely are you to doze off in the following situations?
Choose the most appropriate score for each situation, and add the total.

Situation

Chance of Dozing

0

1

2

3

Sitting and reading

Watching TV

Sitting inactive in a public place (e.g. theatre or meeting)

Passenger in a car for an hour without a break

Lying down to rest in the afternoon when circumstance permit

Sitting and talking to someone

Sitting quietly after lunch without alcohol

In a car, stopped for a few minutes in traffic

Total =

If you are more likely to doze in the following situations (higher than 2) snore-op could be beneficial