Learn more about Sleep Apnea → This questionnaire tells us how likely you are to doze off or fall asleep in the following situations, in contrast to just feeling tired. Your answers refer to your usual way of life in recent times. Even if you have not experienced some of these things recently, estimate how they would affect you. First Name * Last Name E-mail * Phone Please check the following conditions that apply to you as you have witnessed or been told by a witness: * Frequent heavy snoring Snoring that affects the sleep of others Significant daytime drowsiness I have been told I "stop breathing" when I sleep Difficulty falling asleep Gasping when waking up Night time choking spells Not feeling refreshed/rested in the morning None of these How likely are you to fall asleep in the following situations? Please mark one response in each row: No chance of dozing (0) Slight chance of dozing (1) Moderate chance of dozing (2) High chance of dozing (3) Sitting and reading * Watching TV * Sitting inactive in a public place (e.g. a theatre 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 momentarily in traffic * Your Result Print before you submit Your results will be emailed to you after you submit the form. Analyze Interpretation: 0-7: It is unlikely that you are abnormally sleepy. 8-9: You have an average amount of daytime sleepiness. 10-15: You may be excessively sleepy depending on the situation. You should discuss your responses with your doctor. 16-24: You are excessively sleepy and should consider seeking medical attention. Should be Empty:
