Screening Questionnaire for Sleep Apnoea

1 - Which statement best describes your sleep?

I generally sleep well and wake rested

I generally sleep well but often wake tired

Not great, but I have more good night’s sleep than bad

It’s not good at all, and I suspect it’s getting worse

I have long-term debilitating sleep issues

2 - If we asked your partner if you snore, what would they say?

Not at all - no issues with breathing that I’m aware of?

Snores occasionally, mostly when tired

Snores more nights than not

Snores pretty much every night, particularly when lying on his/her back

Snores pretty much every night, whether on his/her back or my side

3 - If we asked your partner how loud you snore when you’re having a ‘bad night’, what would they say?

Not really any noise – I wouldn’t call it snoring anyway?

There’s a constant droning noise but I sleep through it.

It’s loud enough to cause issues. If I don’t fall asleep first, I’ll never get to sleep.

It’s loud. It can sometimes be heard from other rooms in the house.

I’m waiting for the day that the neighbours knock on my door to complain about the noise

4 - How often is your sleep loud enough to disturb others?

Never

It happens, but it’s not very often at all

On average, maybe once or twice a week

On average, it’s closer to four or five times a week

It’s (just about) every night

5 - How often do you feel some level of sleepiness during the day (even when you’re getting 6+ hours sleep?)

Never

It happens occasionally, but it’s usually only when I don’t sleep well

I feel some level of sleepiness at least once a week, maybe more

A lot – I feel that I notice the sleepy feeling more often than not

It seems to be with me nearly all the time

6 - Has anyone noticed any disturbances in your breathing while you’re sleeping?

Not that I’m aware of?

I sometimes snort loudly, like I haven’t taken a breath for a long time

I sometimes snort, then desperately gasp for air in my sleep

Snorting and gasping for air has turned into choking on more than one occasion

Snorting, gasping for air, and choking are something reported back to me often

7 - Have you been treated for sleep apnoea or snoring previously?

No, I’ve never been treated before

Yes, I’ve had success with oral appliances previously

Yes, I’ve successfully used other treatments, such as CPAP, surgery, or nasal splints

Yes, but I didn’t have success at that stage

8 - How would your doctor describe your weight?

Definitely below normal

Around average for your height, give or take a few kilos

A bit above average, but nothing to be concerned about

Above average, to the point where it could be affecting your health

Significantly above average, and causing health issues

9 - Are you being treated for any of the following (if none, just click Finish):

High blood pressure

Diabetes

Heart Disease

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Screening Questionnaire for Sleep Apnoea

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