Are You At Risk for Sleep Apnea?

Are You at Risk for Sleep Apnea?

Take This Short Quiz To Find Out!

Are you at risk for sleep apnea? Sleep apnea is more common (and more dangerous) than many realize. This quiz will help you determine your risk level for sleep apnea.

Disclaimer: This questionnaire is not intended to diagnose any disease or condition. This is simply a tool to determine the probability of you having sleep apnea.

Suggestion: It would be more helpful if you fill out this form with your significant other, if applicable.


Conditons

Have you been diagnosed or treated for any of the following conditions? Check only those that apply.

Situations

In the following situations, how likely are you to fall asleep (rather than merely feel tired)? Even if you haven’t done some of these activities recently, try to imagine their likely affect on you.

  1. Sitting and Reading
  2. Watching TV
  3. Sitting, inactive, in a public place
  4. As a car passenger for one hour without break
  5. Lying down to rest in the afternoon (when circumstances permit)
  6. Sitting and talking to someone
  7. Sitting quietly after lunch (without alcohol)
  8. In a car, stopped for a few minutes in traffic

Experience

For the following questions, please answer with the frequency of your experience.

  1. Do you snore, or are you told that you snore? On average, how many times in the last month have either happened?
  2. Do you wake up choking or gasping?
  3. Have you been told that you stop breathing in your sleep, or that you wake up choking or gasping?

Please enter your name, sex, neck size in inches, email address, city where you live and submit to receive results as to your likelihood for sleep apnea.

Name:
Sex:  Male      Female
Neck Size:
Email:
City Where You Live:
x

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