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Snoreka Feedback Form
1. Personal Details
Body Mass Index (BMI) calculation
2. Device Usage
Which Snoreka device did you use? (Select all that apply)
Duration of device usage
3. Did you perform Morning Exercises?
If Yes, was it useful?
4. Changes in Sleep Parameters (Before and after MAD usage)
Parameter
Before
After

AHI (Apnea-Hypopnea Index)

REM AHI (Rapid Eye Movement AHI)

Oxygen Desaturation (%)

Arousal Index

Respiratory Disturbance Index (RDI)

5. Symptom Improvement (Rate on a scale of 0-5)
(0 = No improvement, 5 = Significant Improvement)
Snoring or noisy breathing:
Pauses in breathing:
Waking up gasping or choking:
Excessive daytime sleepiness or fatigue:
Waking up with a dry mouth or sore throat:
Morning headaches:
Difficulties with memory & concentration:
Anxiety & depression:
6. Satisfaction & Overall Experience
How satisfied are you after using Snoreka?
Did you or your bed partner notice a decrease in snoring?
Comfort level while using Snoreka (1= Uncomfortable, 10 = Very comfortable)
Scale:
Rate our customer support (0= Poor, 10= Excellent)
Scale:
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Dormirbien Pvt Ltd

Plot No.4, Phase II, Peenya Industrial Area, Peenya, Peenya Small Industries, Bangalore, Bangalore North, Karnataka, India 560058

Email: connect@dormir-bien.com

Support: +91 90190 27649

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