SLEEP SURVEY

Sleep Apnea Questionnaire

These four (yes or no) “STOP” questions can help you determine your risk:

S:  Do you snore loudly (louder than talking or loud enough to be heard through a closed door)?

T:  Do you often feel tired, fatigued or sleepy during the day?

O:  Has anyone observed you not breathing during sleep?

P:  Do you have or have you been treated for high blood pressure?

You have a high risk of sleep apnea if you answered “yes” to two or more of these questions.

This questionnaire has an even higher predictive value when you answer four more questions from the STOP-BANG version:

B:  Is your Body Mass Index more than 35?

A:  Is your age more than 50 years old?

N:  Is your neck circumference greater than 40cm or 17 inches?

G:  Is your gender male?

You have a high risk of sleep apnea if you answered “yes” to three or more of the eight STOP-BANG questions.

The Epworth Sleepiness Scale

How likely are you to doze off or fall asleep in the following situations?  Choose the most appropriate number for each situation:

0=would never doze   1=slight chance of dozing   2=moderate chance of dozing   3=high chance of dozing

Sitting and reading _________

Watching TV _________

Sitting, inactive in a public place (theater, meeting, etc.)  _________

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 lunch without alcohol_________

In a car, while stopped for a few minutes in traffic_________

Total_________        

A score of more than 10 shows a level of excessive daytime sleepiness.  A sleep study may be indicated.

Call Dr. Salonia today at (860) 346-6737 to see if oral appliance therapy is right for you!

Dental Sleep Medicine of Central Connecticut
955 South Main Street
Middletown, CT 06457
Phone: (860) 346-6737
Fax: (860) 704-0239
office@dentalsleepmedct.com