InterSleep Online Questionnaire This online questionnaire can in no way replace a medical examination, consultation, and/or treatment decision. It is purely for informational purposes and does not constitute a medical service. 1. How often do you snore during sleep? Never or almost never--0Rarely--1Frequently--2Very frequently--3I don't know---1 2. How loud is your snoring usually? I don't snore / only very quietly--0Moderately loud--1Loud--2Very loud--3I don't know---1 3. Has it ever been observed that you stop breathing or gasp for air during sleep? No, never--0Rarely--2Sometimes--4Frequently--6I don't know---1 4. How often do you wake up in the morning feeling unrefreshed despite getting enough sleep? Never / almost never--0Rarely--1Frequently--3Very frequently--4I don't know---1 5. How often do you feel unusually tired, sleepy, or lacking energy during the day? Never / almost never--0Rarely--1Frequently--3Very frequently--4I don't know---1 6. Have you ever nodded off or dozed in situations where you intended to stay awake (e.g., while driving, in meetings)? No, never--0Yes, rarely--1Yes, sometimes--3Yes, frequently--4I don't know---1 7. Do you suffer from high blood pressure (hypertension)? No, my blood pressure is consistently normal--0Not sure / borderline--1Yes, but well controlled with medication--2Yes, values often too high despite medication--4I don't know---1 8. Have you been diagnosed with a misalignment of the lower jaw (e.g., a very small or recessed lower jaw)? No, none known--0Possibly a slight one--1Yes, a moderate misalignment--2Yes, a severe jaw anomaly--3I don't know---1 9. Do you often have difficulty breathing through your nose (e.g., due to chronic nasal congestion, allergies, or nasal polyps)? No, I can breathe freely through my nose at night--0Occasionally slight nasal breathing problems--1Yes, often restricted nasal breathing--2Yes, very often; I almost always have to breathe through my mouth--3I don't know---1 10. How often do you wake up during the night (e.g. restless sleep, or urge to urinate)? Rarely or never (almost always sleep through)--0Sometimes--1Frequently--3Very frequently--4I don't know---1 11. Do you ever wake up at night with shortness of breath, gasping, or a feeling of choking? No, never--0Rarely--1Sometimes--3Frequently--4I don't know---1 12. How old are you? Under 40 years--040-55 years--156-65 years--2Over 65 years--3I don't know---1 My height (in cm) My weight (in kg) I agree that the information from this form will be collected and processed to respond to the inquiry. The data will be deleted after processing is completed. Note: You can withdraw your consent at any time for the future by emailing kontakt@intersleep.ch. Detailed information on handling user data can be found in our privacy policy. Note: No online questionnaire can replace a medical examination and consultation. The evaluation is for informational purposes only and is not a medical service. Evaluate Evaluation: → Low risk. There are no or only very few signs of obstructive sleep apnea (OSA). However, disruptive snoring may still affect your own sleep and that of your bed partner. There are therapeutic options available to address this. → Slightly increased risk. There are some indications of possible sleep apnea, but no definitive diagnosis yet. A medical consultation might be advisable, especially if symptoms like daytime sleepiness occur. → Significantly increased risk. Multiple risk factors suggest moderate obstructive sleep apnea. An examination by a sleep specialist is recommended. → High risk. Severe symptoms and significant health risks. Immediate medical evaluation is necessary, as untreated severe sleep apnea may be associated with cardiovascular diseases and other complications. Request a more detailed evaluation via email: Salutation: Mr.Ms.No selection Title: First Name: Last Name: Email: ©Dr. Michael Adler | 2025 privacy policy imprint
