icon formulaire DOWNLOAD THE PRESCRIPTION
REQUEST FORM

The form must be completed by your doctor

CONTACT US NOW!

Gatineau : 819-778-3748

Services

Take the self-assessment test

Self-assessment test #1

STOP-BANG

Please answer the following questions below to determine if you might be at risk.

Evaluate each of the following questions: Yes No
Do you Snore Loudly (loud enough to be heard through closed doors or your bed-partner elbows you for snoring at night)?
Do you often feel Tired, Fatigued, or Sleepy during the daytime (such as falling asleep during driving or talking to someone)?
Has anyone Observed you Stop Breathing or Choking/Gasping during your sleep?
Do you have or are being treated for High Blood Pressure?
Body Mass Index more than 35 kg/m2?
Age older than 50?
Neck size is over 40 cm?
Male?

f you answered YES to three (3) questions or more, you risk of suffering from sleep apnea is high. If you answered YES to fewer than three (3) questions, your risk of suffering from sleep apnea is negligible.


Self-assessment test #2

THE EPWORTH SCALE OF DROWSINESS

What are your chances of falling asleep during these activities:

0 = no chance of dozing | 1 = Slight chance of falling asleep | 2 = moderate chance of falling asleep | 3 = high chance of dozing

Evaluate each of the following questions: Never Slight Moderate High
Sitting and reading
Sitting and watching TV
Sitting inactive in a public place
Sitting and talking to someone
Lying down in the afternoon
Being a passenger in a car for an hour
Stopping for a few minutes in traffic while driving
Sitting quietly after lunch
Your total :

The probability of suffering from a sleep disorder are high if the total of your identified symptoms is greater than or equal to 10, in which case a sleep study is recommended. The more symptoms you have, the greater chances are that you suffer from sleep apnea.


Self-assessment test #3

DO I SUFFER FROM A RESPIRATORY SLEEP DISORDER?

Click on the symptoms that you have.

Problems concentratiing
Memory loss
Irritability
Loss of sexual appetite
Sweating during the night
Restless legs
Agitated sleep
Depression
Snoring
Breathing pauses of more than 10 seconds
Constant fatigue during the day
Frequent need to urinate at night
Choking sensation during the night
Neck circumference of 41 cm (16 in.) in women and 43 cm (17 in.) in men
Hypertension
Headaches when waking up
Non-restorative sleep
Type 2 Diabetes
You have 0 symptom(s) on a total of 18 possible symptoms.

If you have three (3) of more symptoms amng the 18 symptoms listed above, print this self-evaluation, contact your physician and bring these results on your next visit.

Logo Thérapie CPAP Outaouais