Your Sleep Apnea and Snoring Professionals
#101 -15 Canada Ave
Duncan, BC V9L 1T3

250-597-8958

1255B Cliffe Avenue
Courtenay, BC V9N 2K1

250-334-0789

277 Evergreen Road
Campbell River, BC V9P 2G4

250-914-5050

#3-5144 Metral Drive
Nanaimo, BC V9T 2K8

250-585-6151

Annual PAP Therapy Review Questionnaire

Annual PAP Therapy Review Questionnaire

1. Are you using your PAP machine every night? Yes No
2. Is your mask fitting comfortably and sealing well? Yes No
3. Have you replaced your mask in the past year? Yes No
4. Have you replaced your filters in the past year? Yes No
5. Are you waking feeling refreshed and rejuvenated in the morning? Yes No
6. Are you experiencing any daytime sleepiness? Yes No
7. Are you pleased with the overall effect PAP therapy has had on you and your health? Yes No
8. Do you have any concerns about your PAP therapy that need to be addressed at this time? Yes No
0 = no chance of dozing
2 = moderate chance of dozing
1 = slight chance of dozing
3 = high chance of dozing

Epworth Sleepiness Scale

How likely are you to doze off or fall asleep in the following situations?

This refers to normal daytime activity over the past several weeks or months. Please check the number that applies to you:

Please click correct button 0 1 2 3
Sitting and reading
Watching TV
Sitting inactive in a public place
As a passenger in a car for an hour
Lying down in the afternoon
Sitting and Talking to someone
Sitting quietly after lunch (no alcohol)
In a car and stopped for few minutes
TOTAL

Your continued success on PAP therapy is of great importance to us.
We want to ensure that your needs are met so that you can be guaranteed years of optimized therapy.

Pacific Sleep Care Logo

At Pacific Sleep Care, we are committed to building knowledge of sleep apnea symptoms and the health benefits of various treatments. Our patients’ well-being is our top priority, and our team enjoys working with people to restore healthy sleep patterns and improve their quality of life.

Due to illness and COVID isolation requirements, there may be times when we have to have an unscheduled closure of a local office. Please check our Facebook page for daily updates.

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