The following questionnaire will help you measure your general level of daytime sleepiness. You are to rate the chance that you would doze off or fall asleep during different routine daytime situations. Each item is rated from "No Chance"to "High Chance", meaning the chance that you would doze or fall asleep in that situation.

First Name

Last Name

Phone

Age

Male

Female

How likely are you dozing off or falling asleep in the following situations in contrast to just feeling tired?

Do you Snore Loudly (loud enough to be heard through closed doors or your bed-partner elbows you for snoring at night)?

Yes

Do you often feel Tired, Fatigued, or Sleepy during the daytime (such as falling asleep during driving or talking to someone)?

Yes

Has anyone Observed you Stop Breathing or Choking/Gasping during your sleep?

Yes

Do you have or are being treated for High Blood Pressure?

Yes

Body Mass Index more than 35 kg/m2? Calculate Your Body Mass Index

Yes

Neck size large? (Measured around Adams apple)For male, is your shirt collar 17 inches/43 cm or larger? For female, is your shirt collar 16 inches/41 cm or larger?

Yes

By clicking on "Score" You allow us to calculate the scoring and provide known interpretation of the score based on the literature.
You also allow us to contact You with additional information to help You keeping a good health. The information You provide us will never shared with any 3rd party or used for inappropriate manner.

Note: This scale should not be used to make your own diagnosis. It is intended as a tool to help you identify the level of daytime sleepiness, which is symptom of many sleep disorders. This page is for information purpose only and is not intended to replace the advice of a qualified health professional. Please contact CPAP Clinic or call 1-877-430-CPAP(2727) with any question.

It is important to remember than true excessive daytime sleepiness is almost always caused by an underlying medical condition that can be easily diagnosed and effectively treated.

Property of University Health Network.

Sleep Apnea Self-Assessment - STOP-BANG Questionnaire

How likely are you dozing off or falling asleep in the following situations in contrast to just feeling tired?