Sleep Apnea ScreeningIf you have Aetna or Humana, click here for sleep apnea screening!JourneyLite Physicians Sleep Apnea Screening/EpworthStep 1 of 333%Name First Last Date of Birth* Month Day YearHeight (ft)*(for example for 5' 2", enter 5)Inches*(for example for 5' 2", enter 2)Weight (lbs)*BMIHave you been tested for sleep apnea?* I have never been tested for sleep apnea. I have been tested for sleep apnea and it was negative. I have been diagnosed with sleep apnea but was not prescribed a CPAP. I have been diagnosed with sleep apnea and was prescribed a CPAP, but I do not use it. I have been diagnosed with sleep apnea and DO use my CPAP.Epworth Sleep ScreeningHow likely are you to doze off or fall asleep in the following situations, in contrast to just feeling tired? This refers to your usual way of life in recent times. Even if you have not done some of these things recently try to work out how they would have affected you. Use the following scale to choose the most appropriate number for each situation.Sitting and reading*0 - no chance of dozing1 - slight chance of dozing2 - moderate chance of dozing3 - high chance of dozingWatching TV*0 - no chance of dozing1 - slight chance of dozing2 - moderate chance of dozing3 - high chance of dozingSitting inactive in a public place (e.g. a theater or a meeting)*0 - no chance of dozing1 - slight chance of dozing2 - moderate chance of dozing3 - high chance of dozingAs a passenger in a car for an hour without a break*0 - no chance of dozing1 - slight chance of dozing2 - moderate chance of dozing3 - high chance of dozingLying down to rest in the afternoon when circumstances permit*0 - no chance of dozing1 - slight chance of dozing2 - moderate chance of dozing3 - high chance of dozingSitting and talking to someone*0 - no chance of dozing1 - slight chance of dozing2 - moderate chance of dozing3 - high chance of dozingSitting quietly after a lunch (without alcohol)*0 - no chance of dozing1 - slight chance of dozing2 - moderate chance of dozing3 - high chance of dozingIn a car, while stopped for a few minutes in traffic*0 - no chance of dozing1 - slight chance of dozing2 - moderate chance of dozing3 - high chance of dozingSince your BMI is below 45, we do not require you to complete an Epworth Sleep Screening survey. Just click on the "Submit" button below and you're all finished!Since you are already using a CPAP, we do not require you to complete an Epworth Sleep Screening survey. Just click on the "Submit" button below and you're all finished!Thank you for completing your sleep screening! By clicking the "Submit" button I give permission for this information to be transmitted via internet to JourneyLite Physicians.EmailThis field is for validation purposes and should be left unchanged.Δ