Free Sleep Apnea Assessment

STOP-BANG & Epworth Sleepiness Scale

The following two free prescreening assessments are available to help you work with your healthcare provider to better understand your risk for certain sleep disorders.
At the end of these assessments, you will have the option to save a PDF copy of your results to share with your provider and keep for your records. If you would like your name and date of birth to appear in your PDF copy, enter your information in the designated fields. This form is HIPAA compliant.

These assessments are not intended to diagnose or treatment any condition without the assistance of your healthcare provider.
Enter your first and last name here if you would like it added to your copy of this assessment.

First NameLast Name
Enter your date of birth if you would like it added to your copy of this assessment.

MonthDayYear
Date of Birth
Date of assessment.

MonthDayYear
Date
STOP-BANG

An assessment for Obstructive Sleep Apnea Syndrome
Directions: Please click "YES" or "NO" to the following questions to find your STOP-BANG score. A score will be provided at the end of the questionnaire. *Denotes required field.
[1] Have you been told that you SNORE?*

YESNO
[2] Are you often TIRED during the day?*

YESNO
[3] Do you stop breathing or has anyone OBSERVED you stop breathing during sleep?*

YESNO
[4] Do you have or take medication for high blood PRESSURE?*

YESNO
[5] Is your BMI greater than 35?*

YESNO
[6] Is your AGE 50 years old or older?*

YESNO
[7] Is your NECK circumference: more than 17 inches if you are male? more than 16 inches if you are female?*

YESNO
[8] Is your GENDER male?*

YESNO
STOP-BANG Score
What Your STOP-BANG Score Means

Your STOP-BANG score helps you understand if you are at low, moderate or high risk of having Obstructive Sleep Apnea Syndrome.

If your score is 3 or higher, we strongly recommend that you download your PDF copy of these assessments, show them to your provider. and ask about getting a sleep study at Red River Sleep Center.

If you do not have a provider to assist you with been screened further, please contact us at (318) 443-1684 or request an appointment online at www.redriversleep.com.
Epworth Sleepiness Scale

An assessment of your level of sleepiness during waking hours
Directions: Please rate how likely you are to doze or fall asleep in the following situations by selecting the numbered response that best applies to you. *Denotes required field.

If you have not done some of these activities recently, select what would most likely happen if you were in that situation. A score will be provided at the end of the questionnaire.
[1] While Sitting or reading?*

0 - Would never sleep1 - Slight chance of sleeping2 - Moderate chance of sleeping3 - High chance of sleeping
[2] While watching television?*

0 - Would never sleep1 - Slight chance of sleeping2 - Moderate chance of sleeping3 - High chance of sleeping
[3] Sitting and talking with someone?*

0 - Would never sleep1 - Slight chance of sleeping2 - Moderate chance of sleeping3 - High chance of sleeping
[4] Sitting quietly after a lunch without alcohol?*

0 - Would never sleep1 - Slight chance of sleeping2 - Moderate chance of sleeping3 - High chance of sleeping
[5] As a passenger in a car for an hour without a break?*

0 - Would never sleep1 - Slight chance of sleeping2 - Moderate chance of sleeping3 - High chance of sleeping
[6] In a car, while stopped for a few minutes in traffic?*

0 - Would never sleep1 - Slight chance of sleeping2 - Moderate chance of sleeping3 - High chance of sleeping
[7] Lying down to rest in the afternoon when circumstances permit?*

0 - Would never sleep1 - Slight chance of sleeping2 - Moderate chance of sleeping3 - High chance of sleeping
[8] While sitting inactive in a public place? (Example: a theater or a meeting)*

0 - Would never sleep1 - Slight chance of sleeping2 - Moderate chance of sleeping3 - High chance of sleeping
Epworth Sleepiness Score
What Your Epworth Score Means

Your Epworth score helps you and your provider understand how sleepy you are during waking hours.

If your score is 10 or higher, we strongly recommend that you download your PDF copy of these assessments, share them with your provider, and ask about being screened for sleep disorders.

A score greater than 16 is considered severe sleepiness and we recommend that you seek out or provider's assistance at your earliest convenience.

If you do not have a provider to assist you with been screened further, please contact us at (318) 443-1684 or request an appointment online at www.redriversleep.com.
You will be able to download your PDF copy after clicking submit.

By clicking submit you agree to share your information with Red River Sleep Center and its associates. This form submission is HIPAA compliant, and all information submitted to Red River Sleep Center will remain confidential in accordance with HIPAA and AASM and ACHC accreditation standards.
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STOP-BANG & Epworth Sleepiness Scale

STOP-BANG

Epworth Sleepiness Scale