Self Evaluation

The Safety First Sleep Apnea Self Evaluation tools are available to help rule out if you may or may not be a candidate for Sleep Apnea. After taking the self evaluation, and you think you have tested positive for sleep apnea, you should contact one of our trained sleep apnea technicians or your physician to further qualify and diagnose and determine the proper treatment for your sleep apnea condition.

Check out our FAQs Page for additional Sleep Apnea information and Health Conditions.

Body Mass Index

Body Mass Index (BMI) is a number calculated from a person's weight and height. BMI provides a reliable indicator of body fatness for most people and is used to screen for weight categories that may lead to health problems.

Click here to view and download the BMI Chart.

Berlin Score

This is a very common screening tool that is used to determine levels of daytime sleepiness and sleep debt. The questionnaire may be completed be either the patient and/or spouse and is designed to give an indication whether further investigations are necessary (i.e. referral to a Sleep Specialist.

You can view your score without submitting the form. However, by submitting the form and including your name and phone number, a trained specialist will be in touch with you for the best recommendations.

1. Body Mass Index Information:
Height (in inches):
Weight (in pounds):

CATEGORY 1 QUESTIONS
2. Do you snore?
Yes
No
I don't know

3. How loud is your snoring?
My snoring is as loud as breathing
My snoring is as loud as talking
My snoring is louder than talking
My snoring is very loud

4. How frequently do you snore?
Almost every day
3 - 4 times per week
1 - 2 times per week
1 - 2 times per month
Never or almost never

5. Does your snoring bother other people?
Yes
No

6. How often have your breathing pauses been noticed?
Almost every day
3 - 4 times per week
1 - 2 times per week
1 - 2 times per month
Never or almost never

CATEGORY 2 QUESTIONS
7. Are you tired after sleeping?
Almost every day
3 - 4 times per week
1 - 2 times per week
1 - 2 times per month
Never or almost never

8. Are you tired during waketime?
Almost every day
3 - 4 times per week
1 - 2 times per week
1 - 2 times per month
Never or almost never

9. How often do you nod off or fall asleep while driving?
Almost every day
3 - 4 times per week
1 - 2 times per week
1 - 2 times per month
Never or almost never

CATEGORY 3 QUESTIONS
10. Do you have high blood pressure?
Yes
No
I don't know


Sleep Apnea Scoring Results:  

Note: You test positive in any category with a score of 2 or more.

2 or more categories indicates a high likelihood of sleep apnea.

Category 1 (Snoring) is positive with 2** or more positive responses
Category 2 (Sleepiness) is positive with 2** or more positive responses
Category 3 (BMI/BP) is positive with 1** or more positive responses and/or a BMI>30 


BMI Rating:
Below 18.5 Underweight
18.5 - 24.9 Normal
25 - 29.9 Overweight
30.0 & Above Obese

** 2 or more positive categories indicates a high likelihood of sleep apnea

Your results are indicated above.

You do not need to click the submit button unless you wish to have a trained specialist contact you. You must enter your name, phone and email address for us to contact you. We also respect your privacy and will only use this information to contact you regarding sleep apnea solutions.

Enter your first and last name:

Enter your phone number:

Enter your email address:


 

Epworth Scale

The Epworth Scale is an eight-question assessment of daytime sleepiness in which the respondent rates how likely one is to fall asleep in a variety of situations. Scores less than 10 are normal, and scores higher than 10 may suggest the need for additional evaluation by a sleep specialist. The total score can range from 0-24, and higher scores are correlated with increased sleepiness. The average score amongst healthy adults is six. In general, scores higher than ten indicate excessive sleepiness.

Epworth Sleep Test
In the following situations...How likely are you to fall asleep?...
Use the following scale:
"0" = Would never doze or sleep.
"1" = Slight chance of dozing or sleeping.
"2" = Moderate chance of dozing or sleeping.
"3" = High chance of dozing or sleeping.
Click on the appropriate answer:
1. Sitting & Reading?
0
1
2
3
2. Watching TV?
0
1
2
3
3. Sitting inactive in a public place?
0
1
2
3
4. Being a passenger in a motor vehicle for an hour or more?
0
1
2
3
5. Lying down in the afternoon?
0
1
2
3
6. Sitting and talking to someone?
0
1
2
3
7. Sitting quietly after lunch (no alcohol)?
0
1
2
3
8. Stopped for a few minutes in traffic while driving?
0
1
2
3

Epworth Scoring Results:  

Note: You test positive if your score is 9 or more
.

Your total Epworth Score


Your results are indicated above.

You do not need to click the submit button unless you wish to have a trained specialist contact you. You must enter your name, phone and email address for us to contact you. We also respect your privacy and will only use this information to contact you regarding sleep apnea solutions.

Enter your first and last name:

Enter your phone number:

Enter your email address: