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Sleep apnea can affect more than just the person who suffers from it. Snoring is just one of the indicators that sleep apnea is a problem for the person you sleep with; and they may not even be aware that they have an issue. We invite you to take the bed partner survey below. After you finish the survey, have your partner contact your physician, and call our office for some solutions that can help both of you can enjoy a restful night’s sleep.

#
Question
Yes
No
1.
Do you witness the patient snoring?
2.
Do you witness the patient choking or gasping for breath during sleep?
3.
Does the patient pause or stop breathing during sleep?
4.
Does the patient fall asleep easily, if given the opportunity, during the day (normal wakeful hours)?
5.
Do you witness the patient clenching and/or grinding his/her teeth during sleep?
6.
Does the patient still appear tired upon awakening from a normal night’s sleep?
7.
Do the patient’s sleep habits disturb your sleep?
8.
Does the patient sit up in bed, not awake?
#
Which of the following patient's sleep habits disturb you
Yes
No
9.
Snores
10.
Restless
11.
Wakes up often
12.
Loud gasping for breath while sleeping
13.
Stops breathing
14.
Grinds teeth
15.
Becoming very rigid or shaking
16.
Biting tongue
17.
Kicking during sleep
18.
Head rocking or banging
19.
Bed-wetting
20.
Sleep walking
21.
Sleep talking
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Please make sure ALL fields are filled out correctly.
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Pete Nathe, D.D.S. • 119 North 50th Ave.
Yakima, WA 98908 • 509-941-2957