STEP 1 of 5

Tell us about yourself

Let’s find out about the physical characteristics that affect your health.

Your gender
Your weight lbs
Your height ft in
Your neck size in Print measuring tape
Please fill all fields!

STEP 2 of 5

Have you been diagnosed or
treated for:

Select any condition you have been treated for:

STEP 3 of 5

Feeling sleepy?

How likely are you to doze off or fall asleep (more than just feeling tired) in the following situations?
Try to think about how these things would typically affect you.

ACTIVITY NEVER RARELY SOMETIMES OFTEN
Sitting and reading
Watching TV, browsing internet
Sitting, inactive, in a public place (theater, meeting ,etc)
As a passenger in a car for an hour
Please fill all fields!

STEP 4 of 5

Feeling tired?

How likely are you to doze off or fall asleep (more than just feeling tired) in the following situations?
Try to think about how these things would typically affect you.

ACTIVITY NEVER RARELY SOMETIMES OFTEN
Laying down to rest in the afternoon when circumstances permit
Sitting and talking to someone
Sitting quietly after lunch (without alcoholic drinks)
Stopped in a car during a few minutes of traffic
Please fill all fields!

STEP 4 of 5

How do you sleep at night?

How likely are you to doze off or fall asleep (more than just feeling tired) in the following situations?
Try to think about how these things would typically affect you.

ACTIVITY NEVER RARELY SOMETIMES FREQUENTLY ALWAYS
Someone says you snore, or you know you snore
You wake up gasping or choking, or with morning headaches
Someone says you stop breathing in your sleep
At night, you need to move your legs to feel comfortable or have problems keeping your legs still
Please fill all fields!

High risk of potential Sleep Apnea

Obstructive Sleep Apnea has been linked to heart disease, COPD, stroke, diabetes and cancer and its effects range from daytime sleepiness, depression, relationship issues and dementia.

If your score is 6 points or higher contact us, or click here for your secure proprietary ARES™ Sleep Screener.