> Home > Sedation
Sleep Study Questionnaire
Have you ever had an evaluation at a Sleep Center?
Sleep Center Name
Sleep Study Details
CPAP (Continuous Positive Airway Pressure) Intolerance
If you have attempted treatment with a CPAP device, but could not tolerate it, please fill in this section.
I was unable to get the mask to fit properly
discomfort caused by the straps and headgear
disturbed or interrupted sleep caused by the presence of the device
noise from the device disturbing my sleep and/or bed partner's sleep
CPAP restricted movements during sleep
CPAP does not seem to be effective
pressure on the upper lip causing tooth replacement problems
a latex allergy
an unconscious need to remove the CPAP apparatus at night
Other Therapy Attempts
What other therapies have you had for breathing disorders? (Weight-loss attempts, smoking cessation for at least one month, surgeries, etc.)
Do You Snore?
I don't know
If you snore...
The Epworth Sleepiness Scale
How likely are you to doze off or fall asleep in the following situations?
| Home | Trusted Experience | Advanced Treatment | Snoring / Sleep Apnea | Facial Cosmetics | Sedation Dentistry |
| Smiles and Lives Renewed | Deaf and Hard of Hearing | Available Accessible Caring
| Health and Safety | Colleague
| Practice News | Contact Us | Sitemap |
Kenneth S. Magid, DDS • Sabrina B. Magid, DMD • Advanced Dentistry of Westchester
163 Halstead Avenue • Harrison, NY 10528 • phone: 914-835-0542 • fax: 914-835-0957