MMP Sleep Disorders Center - Sleeptest

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Below you will find two quesionnaires that will help in determining your risk for sleep apnea. The results for each will be displayed in the box to the left.

Epworth Sleepiness Scale (Test 1):

Column Descriptions

Sitting and reading:
Watching TV:
Sitting inactive in a public place:
As a passenger in a car for an hour without a break:
Lying down to rest in the afternoon when circumstances permit:
Sitting and talking to someone:
Sitting quietly after a lunch without alcohol:
In a car, while stopped for a few minutes in traffic:

Sleep Apnea Screening (Test 2):

CATEGORY 1

1. Do you snore?

Yes No Don’t know

2. If you snore, your snoring is:

Slightly louder than breathing
As loud as talking
Louder than talking
Very loud – can be heard in adjacent rooms

3. How often do you snore?

Nearly every day
3-4 times a week
1-2 times a week
1-2 times a month
Never or nearly never

4. Has your snoring ever bothered other people?

Yes
No
Don’t Know

5. Has anyone noticed that you quit breathing during your sleep?

Nearly every day
3-4 times a week
1-2 times a week
1-2 times a month
Never or nearly never

CATEGORY 2

6. How often do you feel tired or fatigued after your sleep?

Nearly every day
3-4 times a week
1-2 times a week
1-2 times a month
Never or nearly never

7. During your waking time, do you feel tired, fatigued or not up to par?

Nearly every day
3-4 times a week
1-2 times a week
1-2 times a month
Never or nearly never

8. Have you ever nodded off or fallen asleep while driving a vehicle?

Yes
No

9. If yes, how often does this occur?

Nearly every day
3-4 times a week
1-2 times a week
1-2 times a month
Never or nearly never

CATEGORY 3

10. Do you have high blood pressure?

Yes
No
Don’t know

11. Body Mass Index Calculation (BMI):

Height ie. 5'10" (feet): (inches):
Weight:

If two or more of the categories are positive then you are at high risk for sleep apnea and should consider seeing a specialist.