SLEEP APNEA TEST

The Epworth Sleepiness Scale

The Epworth Sleepiness Scale (below) was developed by researchers in Australia, and is widely used by sleep professionals around the word to measure sleep deprivation. The questionnaire assesses how likely you are to doze off or fall asleep in certain situations, as opposed to just feeling tired. It pertains to your normal, day to day life. Even if you have not done some of these activities recently, estimate the most appropriate number for each situation using the scale below.

Situation 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 to rest 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 traffic
0 = no chance of dozing
1 = slight chance of dozing
2 = moderate chance of dozing
3 = high chance of dozing

*Note: We assume no liability for outcomes of this test, and you by using this test, assume all responsibilty contained herein. If you believe you might have sleep apnea you should contact a doctor.

The Berlin Questionnaire

The Berlin Questionnaire is a validated patient survey that helps identify Obstructive Sleep Apnea (OSA) in patients. It was developed in 1998 at a medical conference in Berlin, Germany, by a group of family practice physicians and sleep researchers. The purpose of the questionnaire is two-fold: to identify patients who are at high risk for OSA and to identify snoring patients who have a low risk for OSA.

Complete the Following:



Gender: Male Female

Please answer all questions to the best of your ability to improve the accuracy of the results.

  1. Do you snore?
    Yes
    No
    Don't Know
    If you snore:
  2. Your snoring is:
    Slightly louder than breathing
    As loud as talking
    Louder than talking
    Very loud - can be heard in adjacent rooms
  3. How often do you snore?
    Nearly every day
    3-4 times a week
    1-2 times a week
    1-2 times a month
    Never or nearly never
  4. Has your snoring ever bothered other people?
    Yes
    No
    Don't Know
  5. Has anyone noticed that you quit breathing during your sleep?
    Nearly every day
    3-4 times a week
    1-2 times a week
    1-2 times a month
    Never or nearly never
  6. How often do you feel tired or fatigued after your sleep?
    Nearly every day
    3-4 times a week
    1-2 times a week
    1-2 times a month
    Never or nearly never
  7. During your waking time, do you feel tired, fatigued or not up to par?
    Nearly every day
    3-4 times a week
    1-2 times a week
    1-2 times a month
    Never or nearly never
  8. Have you ever nodded off or fallen asleep while driving a vehicle
    Yes
    No
  9. How often does this occur?
    Nearly every day
    3-4 times a week
    1-2 times a week
    1-2 times a month
    Never or nearly never
  10. Do you have high blood pressure?
    Yes
    No
    Don't Know
BMI: