Screen Yourself for Sleep Apnoea

Name

How likely are you to doze off or fall asleep during the follow situations, in contrast to just feeling tired?

Even if you have not experienced these situations recently, try to work out how they would have affected you.

Use the following Scale to choose the most appropriate number for each situation.

0 = Would never doze off

1 = Slight change of dozing off

2 = Moderate change of dozing off

3 = High Chance of dozing off

0123
Sitting and reading
Watching television
Sitting inactive in a public place (e.g. theatre/meeting)
As a passenger in a car for an hour with no break
Lying down in the afternoon
Sitting and talking to someone
Sitting quietly after lunch without alcohol
In a car, while stopped for a few minutes in traffic

Is it possible that you have Obstructive Sleep Apnoea (OSA)?

Please answer the following questions below to see if you might be at risk.

YesNo
Do you snore loudly? (loud enough to be heard through closed doors?)
Do you often feel tired, fatigued, or sleepy during the daytime? (or falling asleep while driving or talking to someone)
Has anyone observed you stop breathing or choking/ gasping during your sleep?
Do you have or are being treated for High Blood Pressure?
Do you have a Body Mass Index more than 35kg/m²? (BMI = Weight ÷ Height² )
Age older than 50?
Neck size larger (measured around Adams apple) Male 43cm or larger or Female 41cm or larger
Male Gender?

A Pharmacist will contact you shortly about your results.