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.