Self Scoring Sleep Questionnaire

We’ve developed this self-scoring questionnaire as a guideline to help identify
sleep-disordered breathing problems, including Obstructive Sleep Apnea (OSA).

Check the appropriate line if you have experienced the symptom(s) on a regular basis

1. _____ I have been told that I snore.
2. _____ I have been told that I stop breathing when I sleep, although I may have no recollection of this.
3. _____ I am always sleepy during the day even if I slept throughout the night.
4. _____ I have high blood pressure.
5. _____ I have been told that I sleep restlessly, I am always “tossing” and “turning” while asleep.
6. _____ I tend to sweat excessively during my sleep.
7. _____ I frequently awaken with headaches in the morning.
8. _____ I tend to fall asleep during inappropriate times.
9. _____ Others and/or I have noticed a recent change in my personality.
10. _____ I am overweight

_____ TOTAL CHECKED

SCORING: If you have marked three or more lines , you show symptoms of Sleep Apnea, a life-threatening disorder which causes you to stop breathing during your sleep, possibly several hundred times a night.

We recommend that you see to your physician or a dentist who is certified in dental sleep medicine for a sleep examination. Likewise, if your partner shows any signs of Sleep Apnea, you should persuade him or her to do the same.

Once diagnosed, sleep apnea and other types of sleep-disordered breathing problems can be treated quickly and easily. Treatment will not only improve your quality of life, but also increase your life expectancy.

For an Adobe PDF of this questionnaire, please click here.