The CSRA’s only AADSM Qualified Dentist

SLEEP APNEA EVALUATION

Instructions

  • This questionnaire is to help you determine if you may have Sleep Apnea
  • Select an answer for each of the questions below for how likely you are to fall asleep
  • If you don't participate in some of these activities, use your best guess

Sitting & Reading




Watching TV




Sitting, inactive in a public place




As a passenger in a car for an hour without 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 stopped for a few minutes in traffic (while you are the driver)




Evaluate Responses