Sleep Disordered Breathing - Self Assessment Questionnaire | Sleep Clinic Services

You are here

Sleep Disordered Breathing - Self Assessment Questionnaire

sleep-disordered-breathing-self-assessmentComplete our online Sleep Assessment Questionnaire to quickly and easily estimate your likelihood of having a serious Sleep Disordered Breathing (SDB) condition.

Our unique questionnaire combines a range of scientifically validated and professionally approved screening systems to quickly provide you with the most accurate estimate of your potential SDB condition. 

Your results will provide a very good indication of whether you have a significant SDB condition – but the results are not conclusive. The only truly accurate and professionally recognised method of diagnosis is via a diagnostic sleep study.

A diagnostic sleep study, or polysomnogram (PSG) is the ‘gold standard’ for the professional diagnosis of SDB. A professional sleep study will monitor your breathing, cardiac activity, brain activity, limb movement, sleeping position, blood oxygen levels and much more; while you sleep.

If you suspect that you, or someone you know, have a potential SDB condition, it is important that you either speak to your doctor and arrange a diagnostic sleep study.  Or click the link below to organise a professional diagnostic sleep study in the comfort, privacy, and convenience of your own home.

CLICK HERE TO BOOK YOUR DIAGNOSTIC SLEEP STUDY NOW. 

If you'd like to discuss your results with a friendly Sleep Therapist, simply click the SUBMIT button below and we'll happily return your call - obligation free. All information provided will remain strictly confidential.

Section 1. What is your Body Mass Index (BMI)?
(e.g. 92)
(eg. 180)

If your BMI total does not display automatically after entering both your weight and height details, check that these values have been entered correctly and please try again (kilograms and centimetres).

Section 2. What is your 'Adjusted Neck Circumference'?
Start with your normally measured neck circumference (i.e., your collar size). Then add the relevant amounts to arrive at your ‘ANC’
(cm)
Enter 3 for YES or 0 for NO.
Enter 3 for YES or 0 for NO.
Enter 4 for YES or 0 for NO.
Section 3. What are your general sleep/waking patterns?
Section 4. Epworth Sleepiness Scale
In the section below, enter the number that best describes your likelihood of dozing in the corresponding situations. 0=Never    1=Sometimes    2=Likely    3=Highly Likely
Section 5. Karolinska Scale
In this section, describe your level of alertness ‘right now’ as you complete this form
Preliminary Assessment
Note: This assessment is not a substitute for a full diagnostic sleep study.
Contact Details
Submit your results for an obligation-free chat with a professional Sleep Therapist now.
CAPTCHA
One last step. Please enter the code in the field below proving you're not a spam robot. Thank you!
Image CAPTCHA
Enter the characters shown in the image.