SLEEP QUIZ
Do you have the symptoms of sleep apnea? Print out
the form below and write in your score.
How often does this
happen:
|
0= Never
|
1= Sometimes
|
2= Frequently
|
3= Always
|
|
|
| You feel sleepy during
the day(* Please see note below) |
|
| You fall asleep in a
public place |
|
| You wake up in the morning
with a dry mouth |
|
| You wake up in the morning
with a headache |
|
| You wake up in the morning
not feeling refreshed |
|
| You wake up during the
night in a sweat |
|
| You wake up during the
night with a choking sensation |
|
| You wake up during the
night feeling startled |
|
| You have to fight sleep
while watching a movie, in a meeting or driving |
|
|
Total for section 1
|
|
|
|
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Have you been told that
you seem to stop breathing or gasp while you sleep?
(* Please see note below) |
|
| Do you often feel exhausted
and have trouble functioning during the day? |
|
| Have you had or come
close to having and accident due to sleepiness? |
|
| Do you have trouble
getting up in the morning? |
|
| Have you been told you
"snort" during the night? |
|
| Do you seem to be loosing
you sex drive? |
|
| Do you have trouble
concentrating or remembering things? |
|
| Do you snore loudly,
to the point of disturbing others? |
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| Do friends or family
members say that you are moody or irritable? |
|
| Are you overweight?
(less than 20% over your ideal weight) |
|
| Are you obese? (more
than 25% over your ideal weight) |
|
| Do you have high blood
pressure? |
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| If you are a man, do
you have a neck circumference greater than 17.5 inches? |
|
| If you are a man, do
you have trouble with impotence? |
|
| If you are a woman,
do you have a neck circumference greater than 16.5 inches? |
|
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Total for section 2
|
|
|
Total for section 1
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+ |
|
TOTAL SCORE
|
= |
| If your TOTAL SCORE is: |
Your risk of sleep apnea is:: |
| Less than 10 |
Low |
| 10-20 |
Mild |
| 20-40 |
Moderate-Warning, you are in a high risk group |
| 40-55 |
Severe-PLEASE CONSULT PHYSICIAN |
| 55-69 |
Excessive-PLEASE CONSULT PHYSICIAN
SOON |
*If you answered yes to either of
these questions, please be advised that these are the main warning
signs of sleep apnea and you should contact your physician as soon
as possible to be evaluated.
IF YOU SCORED HIGHER THAN 10, IT IS HIGHLY
RECOMMENDED THAT YOU SEEK MEDICAL ADVICE FROM YOUR PHYSICIAN AND BE
EVALUATED FOR SLEEP APNEA.
If you scored less than 10, you are at a low risk of having sleep
apnea.
If your snoring bothers
you and you feel that it is NOT related to sleep apnea, you may go
here for a listing
of resources that may help you. If you are having trouble sleeping
in general, here are some helpful
hints to getting a good nights sleep.
