berlin questionnaire - snoremart.com questionnaire.pdf · 1. do you snore? a. yes b. no c. don’t...

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1. Do you snore? a. Yes b. No c. Don’t know 2. If you do snore, your snoring is: a. Slightly louder than breathing b. As loud as talking c. Louder than talking d. Very loud – can be heard in adjacent rooms 3. How often do you snore? a. Nearly every day b. 3-4 times a week c. 1-2 times a week d. 1-2 times a month e. Never or nearly never 4. Has your snoring ever bothered other people? a. Yes b. No c. Don’t know 5. Has anyone noticed that you quit breathing during your sleep? a. Nearly every day b. 3-4 times a week c. 1-2 times a week d. 1-2 times a month e. Never or nearly never 6. How often do you feel tired or fatigued after your sleep? a. Nearly every day b. 3-4 times a week c. 1-2 times a week d. 1-2 times a month e. Never or nearly never 7. During your waking time, do you feel tired, fatigued or not up to par? a. Nearly every day b. 3-4 times a week c. 1-2 times a week d. 1-2 times a month e. Never or nearly never 8. Have you ever nodded off or fallen asleep while driving a vehicle? a. Yes b. No 9. If yes to #8, How often does this occur? a. Nearly every day b. 3-4 times a week c. 1-2 times a week d. 1-2 times a month e. Never or nearly never 10. Do you have high blood pressure? a. Yes b. No c. Don’t know Berlin Questionnaire The Berlin Questionnaire is a simple test that can help determine the likelihood that you have sleep apnea. Answer the below questions to learn if you are at high or low risk for sleep apnea.

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1. Do you snore?

a. Yes

b. No

c. Don’t know

2. If you do snore, your snoring is:

a. Slightly louder than breathing

b. As loud as talking

c. Louder than talking

d. Very loud – can be heard in

adjacent rooms

3. How often do you snore?

a. Nearly every day

b. 3-4 times a week

c. 1-2 times a week

d. 1-2 times a month

e. Never or nearly never

4. Has your snoring ever bothered other

people?

a. Yes

b. No

c. Don’t know

5. Has anyone noticed that you quit

breathing during your sleep?

a. Nearly every day

b. 3-4 times a week

c. 1-2 times a week

d. 1-2 times a month

e. Never or nearly never

6. How often do you feel tired or fatigued

after your sleep?

a. Nearly every day

b. 3-4 times a week

c. 1-2 times a week

d. 1-2 times a month

e. Never or nearly never

7. During your waking time, do you feel

tired, fatigued or not up to par?

a. Nearly every day

b. 3-4 times a week

c. 1-2 times a week

d. 1-2 times a month

e. Never or nearly never

8. Have you ever nodded off or fallen

asleep while driving a vehicle?

a. Yes

b. No

9. If yes to #8, How often does this occur?

a. Nearly every day

b. 3-4 times a week

c. 1-2 times a week

d. 1-2 times a month

e. Never or nearly never

10. Do you have high blood pressure?

a. Yes

b. No

c. Don’t know

Berlin Questionnaire

The Berlin Questionnaire is a simple test that can help determine the likelihood that you have sleep

apnea. Answer the below questions to learn if you are at high or low risk for sleep apnea.

1. Do you snore?

a. Yes

b. No

c. Don’t know

If answered YES, assign 1 point

2. If you do snore, your snoring is:

a. Slightly louder than breathing

b. As loud as talking

c. Louder than talking

d. Very loud – can be heard in

adjacent rooms

If answered C or D, assign 1 point

3. How often do you snore?

a. Nearly every day

b. 3-4 times a week

c. 1-2 times a week

d. 1-2 times a month

e. Never or nearly never

If answered A or B, assign 1 point

4. Has your snoring ever bothered other

people?

a. Yes

b. No

c. Don’t know

If answered A, assign 1 point

5. Has anyone noticed that you quit

breathing during your sleep?

a. Nearly every day

b. 3-4 times a week

c. 1-2 times a week

d. 1-2 times a month

e. Never or nearly never

If answered A or B, assign 1 point

Category 1 overall points: ________

(2 or more points = “Positive”)

6. How often do you feel tired or fatigued

after your sleep?

a. Nearly every day

b. 3-4 times a week

c. 1-2 times a week

d. 1-2 times a month

e. Never or nearly never

If answered A or B, assign 1 point

7. During your waking time, do you feel

tired, fatigued or not up to par?

a. Nearly every day

b. 3-4 times a week

c. 1-2 times a week

d. 1-2 times a month

e. Never or nearly never

If answered A or B, assign 1 point

8. Have you ever nodded off or fallen

asleep while driving a vehicle?

a. Yes

b. No

If answered A, assign 1 point

Category 2 overall points: ________

(2 or more points = “Positive”)

9. If yes to #8, How often does this occur?

a. Nearly every day

b. 3-4 times a week

c. 1-2 times a week

d. 1-2 times a month

e. Never or nearly never

10. Do you have high blood pressure?

a. Yes

b. No

c. Don’t know

Category 3: If answered Yes = “Positive”

Berlin Questionnaire Scoring

The Berlin Questionnaire scoring system allows you to tally your own score based on 3 categories. If you have 2 or more

Categories with a positive score, then you are at High Risk for Sleep Apnea