Self Assessment Form

Do you snore loudly (louder than talking or loud enough to be heard through closed doors)?

Correct! Wrong!

Do you often feel tired, fatigued, or sleepy during daytime?

Correct! Wrong!

Has anyone observed you stop breathing during your sleep?

Correct! Wrong!

Do you have or are you being treated for high blood pressure?

Correct! Wrong!

Is your BMI more than 35kg/m?

Correct! Wrong!

Is your age over 50 years old?

Correct! Wrong!

Is your neck circumference greater than 40cm?

Correct! Wrong!

Is your gender male?

Correct! Wrong!

Self Assessment
High Risk
You have answered yes to 3 or more questions. You are at HIGH risk of Sleep Apnea.
Low Risk
You have answered yes to less than 3 questions. You are at LOW risk of Sleep Apnea

Who should be evaluated?

If you have any of the following symptoms or medical conditions, a sleep evaluation may be indicated.

Snoring/sleep apnea
Insomnia/interrupted sleep
Restless or jumpy legs
Sleepiness/fatigue
Poor concentration/memory
Trouble with weight loss/diabetes
Hypertension/heart disease

We offer a full range of testing and treatment

Home sleep testing
Laboratory overnight testing
Daytime nap tests
CPAP, Provent and accessories