Take-home Survey for Pediatric/Adult Sleep Apnea

Take-home Survey for Pediatric/Adult Sleep Apnea 2017-11-03T17:21:49+00:00

Take-home Survey for Adult Sleep Apnea

Epworth Sleepiness Scale (ESS)

Click here for a quick self-assessment test for adults you can take to identify whether you may be at risk for Sleep Apnea and the associated health conditions.

Adult Sleep Apnea Survey

Children and Disordered Sleep

Good sleep is critical to the physical and cognitive development of your child. The first symptom associated with a child experiencing sleep issues is grinding of their teeth!

Please review the following questionnaire to help evaluate the current sleep and airway health of your child.

  • While sleeping, does your child snore more than half the time?

  • While sleeping, does your child always snore?

  • While sleeping, does your child snore loudly?

  • While sleeping, does your child have “heavy” or loud breathing?

  • While sleeping, does your child have trouble breathing, or struggle to breathe?

  • Have you ever seen your child stop breathing during sleep?

  • Does your child experience nightmares or bad dreams?

  • Does your child tend to breathe through their mouth during the day?

  • Does your child have dry mouth upon awakening in the morning?

  • Does your child occasionally wet the bed?
  • Does your child wake up tired in the morning?

  • Does your child experience sleepiness during the day?

  • Has a teacher or supervisor commented that your child appears sleepy or sluggish during the day?

  • Is it hard to wake your child in the morning?

  • Does your child wake up with a headache?

  • Did your child ever stop growing at a normal rate?

  • Is your child overweight?

  • Does your child not seem to listen when spoken to directly?

  • Is your child easily distracted?

  • Does your child often have difficulty organizing tasks and activities?

  • Does your child fidget or squirm?

  • Does your child act as if “motor driven” or seem to always be “on the go”?

  • Does your child often interrupt or intrude?

Contact Us

1188 State Route 131, Milford, OH 45150

Phone: 513-831-1446

Hours

Mon-Thurs 8am-5pm
Limited Hours on Friday