Weight (kg):

Waist Circumference (cm): Measured at narrowest point Enter your waist circumference in centimeters (cm).

On a scale of 1 to 10, where 1 means ‘not at all’ and 10 means ‘very frequently,’ how often have you experienced snoring, gasping for air, along with fatigue or daytime sleepiness?” Please Select 1 2 3 4 5 6 7 8 9 10

“On a scale of 1 to 10, where 1 means ‘not at all’ and 10 means ‘very frequently,’ how often have you experienced problems such as pain, bloating, diarrhea or constipation?” Please Select 1 2 3 4 5 6 7 8 9 10

“On a scale of 1 to 10, where 1 means ‘not at all’ and 10 means ‘very frequently,’ how often have you experienced fatigue or lack of energy along with increased thirst, frequent urination or blurred vision?” Please Select 1 2 3 4 5 6 7 8 9 10

on a scale of 1 to 10, where 1 means ‘very inefficient sleep’ (spent a lot of time awake in bed) and 10 means ‘very efficient sleep’ (fell asleep quickly and slept soundly), how would you rate your overall sleep efficiency?” Please Select 1 2 3 4 5 6 7 8 9 10

On a scale of 1 to 10, where 1 means ‘went to sleep at the same time each day’ and 10 means ‘went to sleep at widely varying times each day,’ how would you describe your sleep consistency?” Please Select 1 2 3 4 5 6 7 8 9 10

On a scale of 1 to 10, where 1 means ‘feeling completely at ease’ (calm, relaxed, peaceful) and 10 means ‘feeling extremely distressed’ (worried, fearful, agitated, uneasy), how would you rate your overall emotional state?” Please Select 1 2 3 4 5 6 7 8 9 10