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Text: (336)447-6559
Email: cheryl@freemandds.com
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Sleep Apnea Risk Assessment

Woman Sleeping  White  TiredBefore you make an appointment with the doctor, you should know your risk for sleep apnea. Answer each question honestly in order to have a thorough understanding of your risk and to enable your doctor to provide you with the best treatment for your circumstances.

1) If you have been told that you snore, how often are you told that it has kept others awake or disturbed their sleep in any way?
a. Never
b. Not often (less frequent than once per week)
c. Sometimes (between 1 and 3 times per week)
d. Often (more frequent than 3 times per week)

2) If you have been told that you stop breathing or struggle to breathe while sleeping, how often does it occur?
a. Never
b. Not often (less frequent than once per week)
c. Sometimes (between 1 and 3 times per week)
d. Often (more frequent than 3 times per week)

3) If you are overweight, how would you describe yourself?
a. You are not overweight
b. Between 10-20 pounds overweight
c. Between 20-40 pounds overweight
d. Over 40 pounds overweight

4) What is your sleepiness score?
a. Lower than 8
b. Between 9 and 13
c. Between 14 and 18
d. Higher than 19

5) Do you have or have you ever had?
a. Blood pressure above normal
b. A stroke
c. A heart attack
d. A problem sleeping through the night (getting up more than 3 times)
e.Trouble with focusing during the day

If you answered C or D for questions 1-4 and circled any of the answers on question 5, you should speak with your doctor immediately about your risk of having sleep apnea. Drs. Freeman could then help you get fitted for the appropriate oral appliance to alleviate you symptoms and help your sleep better at night.



Office Information
Address:
134 Davis Street
Asheboro, NC 27203-5469

Office Hours:
Monday - Wednesday: 8:00am - 5:00pm
Thursday: 7:30am - 3:30pm

Phone: (336) 625-3292
Email: Email Us
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Randolph Center for Dental Excellence | www.freemandds.com | (336) 625-3292
134 Davis Street, Asheboro, NC 27203