Sleep Apnea, Dallas, Rockwall, Texas | Sleep Apnea, Snoring, TMJ, Sleep Disorder | Team Perkins Orthodontics | Ron C. Perkins, DDS

Sleep Apnea in Adults

Name
Phone
E-mail

Do you snore?		Yes No
Have you or anyone observed you stop breathing or gasp during sleep?		Yes No
Do you wake up not refreshed?		Yes No
Do you doze off easily?		Yes No
Do you ever wake up out of breath, gasping or coughing?		Yes No
Are you a restless sleeper?		Yes No
Do you ever have indigestion or acid reflux?		Yes No
Do you have headaches or jaw pain?		Yes No
Do you have or ever had in the past high blood pressure?		Yes No
Do you ever have night sweats?		Yes No


Three (3) or more YES answers to these 10 questions means you child should be further evaluated for SDB. Five (5) or six (6) YES answers means there is a very good possibility that you have SDB.

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Ron C. Perkins, DDS | Team Perkins Orthodontics | Dallas, Rockwall, Texas
Sleep Apnea, Sleep Disordered Breathing, Snoring, TMJ, Sleep Disorder
Orthodontist, Braces, Invisalign, Straight Teeth, Beautiful Smile
301 North Goliad Street, Rockwall, Texas 75087 | 972-722-2200 office
info @ sleepapneasnoringdallas . com

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