Sleep Disorder Tests

Sleep Disorder Tests - GBMC Sleep Center

Sleep Questionnaire

Use this brief survey to assess your risk for sleep apnea. The total score of all give sections denotes your "Apnea Risk Score."

1.  Do you have a history of snoring?

a. No (0)
b. Mild / infrequent (0)
c. Moderate / inconsistent (2)
d. Severe / consistent (8)

2.  Have you ever been told that you have "pauses" in breathing during sleep?

a. No (0)
b. Yes, but infrequent (2)
c. Yes, inconsistent but most nights (8)
d. Yes, severely so (10)

3.  Are you overweight?

a. No (0)
b. Yes, but by less than 20 lbs (2)
c. Yes, by 20 - 50 lbs (3)
d. Yes, more than 50 lbs (8)

4.  Evaluate your levels of sleepiness

a. Would never doze (0)
b. Have a slight chance of dozing (1)
c. Have a moderate chance of dozing (6)
d. Have a high chance of dozing (8)

5.  Does your medical history include?

a. High blood pressure (6)
b. Stroke (1)
c. Heart Disease (1)
d. Morning Headaches (1)
e. 3+ awakenings per night (4)
f. Excessive fatigue (1)
g. Depression (1)
h. Diabetes of any level (1)

TOTAL Apnea Risk Score

Based on your "apnea risk score," we suggest the following:

5-9  Discuss concerns with your doctor at your next visit.
10-14  Important to discuss concerns with your doctor as soon as possible, and consider a sleep evaluation.
15-19  Sleep consultation or sleep study
> 20  Schedule sleep study, as significant risk for sleep apnea is present.


Epworth Sleepiness Scale

How likely are you to doze off or fall asleep in the following situations, in contrast to feeling just tired? This refers to your usual way of life in recent times. Even if you have not done some of these things recently, try to work out how they would have affected you.

The Epworth Sleepiness Scale is used to help you identify your own level of day time sleepiness. Use the following scale to choose the most appropriate number for each situation:

         0 = would never doze
         1 = slight chance of dozing
         2 = moderate chance of dozing
         3 = high chance of dozing

         _____ Sitting and reading
         _____ Watching TV
         _____ Sitting, inactive in a public place (e.g. a theater or a meeting)
         _____ As a passenger in a car for an hour without a break
         _____ Lying down 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 the traffic

A total score of 10 or more suggests wake time sleepiness that may require a sleep evaluation to determine whether you are obtaining inadequate sleep or may have an underlying sleep disorder. If your score is 10 or more, please share this information with your physician.

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© 2016  GBMC. This website is for informational purposes only and not intended as medical advice or a substitute for a consultation with a professional healthcare provider.