Sleep Risk Assessment

Complete both the STOP-Bang and Epworth Sleepiness Scale in one go. Enter your details once, get a combined report, and receive everything in a single email.

1. Your details

2. STOP-Bang

3. Epworth

4. Results

Your details (entered once)

Full name *

Email *

Age *

Gender *

Male Female

Telephone number (optional)

What do you do for a living? *

Does your work involve driving or operating a vehicle as a main part of your job? *

Yes No

For example: bus, taxi, HGV, delivery, train or other professional vehicle operation.

Units:

Height (cm) *

Weight (kg) *

Height *

Weight (lb) *

Calculated BMI (auto-filled – you can override)

Lifestyle & sleep habits

Do you do shift work? *

Yes — nights only Yes — days and nights Yes — days only No

Current medications * Name what you take if you can — leave blank or type None if none.

Measurement units:

Waist circumference (cm)

Hip circumference (cm)

Neck circumference (cm) Measured around the neck, ideally at the level of the larynx.

Waist–hip ratio

Choose your assessment *

Quick / ExpressSTOP-Bang + Epworth only, using your personal details and the measurements needed for STOP-Bang. Full AssessmentAll sleep, lifestyle, symptom and medical history questions.

Do you have nasal obstruction? *

None Right nostril Left nostril Both

Normal bedtime *

Normal wake / out-of-bed time *

Average time in bed

Time it usually takes to fall asleep (minutes) *

Do you take medication to help you sleep? *

Yes No

Which sleep medication(s)?

Night-time symptoms

Have you been told you stop breathing at night? *

Yes No

Have you ever woken up gasping for breath? *

Yes No

Do you experience restless feelings in your legs at night? *

Yes No

Do your legs twitch or jerk while you are asleep? *

Yes No

Evidence of parasomnias? * Parasomnias are unusual behaviours or experiences during sleep — for example sleepwalking, sleep talking, night terrors, acting out dreams, teeth grinding, or other movements/behaviours you (or a bed partner) notice.

Yes No Not sure

Please briefly describe

Do you wake to use the bathroom during the night? How many times? * Enter a number only (0 if you do not wake for this reason).

Do you have a dry throat in the morning? *

Yes No Sometimes

Do you have heartburn / indigestion at night? *

Yes No Sometimes

Do you feel refreshed in the morning? *

Yes No Sometimes

Has your memory or concentration been affected by your sleep problem? *

Yes — memory Yes — concentration Yes — both equally No

Lifestyle habits

Do you consume caffeinated drinks? *

Yes No

Main source of caffeine *

Tea Coffee Soft drinks Energy drinks Mixed / several

Do you drink alcohol regularly? *

Yes No

How many units per week? * A rough guide: a standard glass of wine or pint of beer is often about 2 units.

Other relevant medical conditions

Diabetes mellitus? *

Type I Type II Pre-diabetic No

Heart disease? *

Yes No

What type of heart disease / condition?

Thyroid disease? *

Underactive Overactive No

High cholesterol? *

Yes — on meds Yes — not on meds Borderline No

High blood pressure? *

Yes — on meds Yes — not on meds No

Asthma? *

Yes No

COPD? *

Yes No

Have you suffered from stroke, epilepsy or other neurological problems? *

Yes No

Please give details

Any other relevant information we should know?

STOP-Bang questionnaire (Yes / No)

S Do you snore loudly (louder than talking or loud enough to be heard through closed doors)?

Yes No

T Do you often feel tired, fatigued, or sleepy during the daytime?

Yes No

O Has anyone observed you stop breathing, choke or gasp during your sleep?

Yes No

P Do you have (or are you being treated for) high blood pressure?

Yes No

B Is your BMI more than 35 kg/m²?

Yes No

A Are you older than 50 years?

Yes No

N Is your neck circumference greater than 40 cm (≈ 15.7 inches)?

Yes No

G Are you male?

Yes No

Epworth Sleepiness Scale

How likely are you to doze off or fall asleep in the following situations? (0 = would never doze · 1 = slight chance · 2 = moderate chance · 3 = high chance)

1. Sitting and reading