Name: SLEEP APNEA MASK QUESTIONAIRE
Brand: STELLAR PHARMACY
Availability: InStock

Full name

Email address

1. Have you been diagnosed with sleep apnoea by a doctor or sleep study?

Yes No Not sure

2. Have you been given CPAP pressure settings?

Yes No Not sure

3. Is this your first time using a CPAP machine?

Yes No Not sure

4. When you sleep, do you mostly breathe through your:

Nose Mouth Not sure

5. Do you often experience a blocked or congested nose at night?

Yes No Sometimes

6. Do you wake up with a dry mouth?

Yes No Sometimes

7. Do you think your mouth opens while you sleep?

Yes No Not sure

8. Which type of mask would you prefer?

Minimal and lightweight Moderate coverage (nose only) Full coverage (nose and mouth) Not sure

9. Do you feel uncomfortable or claustrophobic with something covering your face?

Yes No A little

10. What is your usual sleeping position?

Back Side Stomach I move around a lot

11. Have you used a CPAP mask before?

No Yes Not sure

12. Are you sensitive to strong airflow or pressure?

Yes No Not sure

13. Do you have any implanted medical devices or metal fragments near the head or chest?

Examples: pacemaker, ICD, neurostimulator, insulin pump, cochlear implant, shunt, aneurysm clip, metallic eye fragment.

Yes No Not sure

14. Do you have facial sensitivities, skin concerns, or previous mask-fit issues?

Yes No Not sure

15. Is there anything else you would like us to know to improve your comfort?

SLEEP APNEA MASK QUESTIONAIRE

CPAP Mask & Setup Questionnaire