Sleep Apnea Self-Evaluation

Complete this free evaluation to help assess your risk for sleep apnea. This questionnaire includes the Epworth Sleepiness Scale, a widely-used measure of daytime sleepiness. After submission, our team will review your responses and contact you to discuss next steps.

Sleep Apnea Evaluation: Submission Form

Personal Information

Epworth Sleepiness Scale

How likely are you to doze off or fall asleep during the following Situations. Even if you have not been in the situations recently, try to imagine how you would behave.

0 = No chance of dozing
1 = Slight chance of dozing
2 = Moderate chance of dozing
3 = High chance of dozing

General Sleep Apnea Questions

Select the answer that best applies.

Do you snore? (required)
How often do you snore? (required)
Has your snoring ever bothered other people? (required)
Have you ever been told that you stop breathing for periods of time while sleeping? (required)
Do you experience daytime sleepiness? (required)
How often do you feel fatigued after you sleep? (required)
Have you been treated for Sleep Apnea in the past? (required)
Have you had surgical intervention for Sleep Apnea in the past? (required)
Have you been to a sleep Lab or Sleep Disorder Center for an Evaluation? (required)
Have you tried using CPAP? (required)

Physical Measurements