Sleep Disorder Questionnaire

If the answer is yes to either of the first two questions you do not need to complete the rest of the questionnaire but return it in the provided envelope. 

If the answer is no to these questions, please continue with the questionnaire.

Please complete the questions below 

The Epworth Sleepiness Scale is used to help diagnose obstructive sleep apnoea (OSA)

How likely are you to doze off or fall asleep in the following situations, in comparison to feeling just tired?

Even if you haven’t done some of these things 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

1= slight chance of dozing

2= moderate chance of dozing

3= high chance of dozing

It’s important you answer each question as best you can.