Online Sleep Assessment Test

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Welcome to our Sleep Disorder Assessment Tool

About 5 minutes Confidential

Discover your sleep profile

This short questionnaire is designed to help you better understand the quality of your sleep and to detect possible signs of a sleep disorder. Your answers will allow us to guide you toward the most suitable evaluation or screening options.

There’s no time limit, take a few minutes to answer calmly, according to your situation.

Privacy and Consent

I agree that the Clinique de santé respiratoire des Sommets may use my personal information and my responses to this questionnaire for analysis and recommendations, as well as to send me informational or promotional messages related to its services.

I understand that I can unsubscribe at any time, without it affecting the services offered by the clinic.

Consentement(Required)

I agree

I refuse

Since you did not accept the clinic’s privacy consent policy, we are unable to proceed with the screening test.

Collecting this information is essential to analyze your situation and provide recommendations tailored to your condition.

Do you already have a prescription for a sleep diagnostic test?(Required)

Yes

Select the test indicated on your prescription(Required)

At-Home Sleep Apnea Test

In-Lab Polysomnography (Comprehensive Sleep Study)

Since you already have a prescription for an at-home sleep apnea test, you can book your test right away.

Book an appointment

Since you already have a prescription for an in-lab polysomnography (comprehensive sleep study), you can book your test right away.

Book an appointment

Your Daily Sleep

Do you wake up feeling tired, even after a full night’s sleep?(Required)

Yes, almost every morning

Sometimes

No, I feel rested.

Do you have difficulty falling asleep or staying asleep?(Required)

Yes, often

Sometimes

Do you often take naps or feel the need to sleep during the day?(Required)

Yes, every day

Sometimes

No, never

Your Sleep Habits

What time do you usually go to bed?(Required)

Before 9 p.m.

Between 9 p.m. and 11 p.m.

After 11 p.m.

Is your sleep disturbed by frequent awakenings?(Required)

Yes, several times a night

Sometimes

Rarely or never

How many hours do you sleep on average per night?(Required)

Less than 5 hours

Between 5 and 7 hours

7 hours or more

Physical Signs and Symptoms

Has anyone ever noticed that you snore loudly at night?(Required)

Yes, regularly

Sometimes

No / I don't know

Has anyone ever noticed that you stop breathing during your sleep?(Required)

Yes

I don't know

Do you often wake up with a dry mouth or a sore throat?(Required)

Yes

Sometimes

Do you suffer from morning headaches?(Required)

Yes, frequently

Sometimes

Do you feel sleepy or have trouble concentrating during the day?(Required)

Yes, almost every day

Sometimes

Epworth Sleepiness Scale

What are the chances that I would fall asleep...

In a seated position(Required)

No chance

Low chance

Moderate chance

Strong chance

While watching television(Required)

No chance

Low chance

Moderate chance

Strong chance

While sitting inactive in a public place (meeting rooms, classes, cinema, etc.)(Required)

No chance

Low chance

Moderate chance

Strong chance

While being a passenger for more than an hour in a vehicle(Required)

No chance

Low chance

Moderate chance

Strong chance

While lying down to rest in the afternoon(Required)

No chance

Low chance

Moderate chance

Strong chance

While talking to someone while seated(Required)

No chance

Low chance

Moderate chance

Strong chance

In a seated position after a non-alcoholic dinner(Required)

No chance

Low chance

Moderate chance

Strong chance

Behind the wheel of a car stuck in traffic for a few minutes(Required)

No chance

Low chance

Moderate chance

Strong chance

This field is hidden when viewing the form

Résultat - Test Epworth

General Health

Do you have a medical history of high blood pressure, diabetes, or heart problems?(Required)

Yes

Enter your height(Required)

Centimeters (cm)

Feet/Inches (ft/in)

Centimeters (cm)(Required)

Feet (ft)(Required)

Inches (in)(Required)

Enter your weight(Required)

Pounds (lb)

Kilograms (kg)

Pounds (lb)(Required)

Kilograms (kg)(Required)

What is your gender identity?(Required)

Man

Woman

Other / Prefer not to answer

Contact Information

Date of Birth(Required)

DD dash MM dash YYYY

First name(Required)

Last Name(Required)

Email(Required)

Phone(Required)

Dépistage en ligne - EN

Welcome to our Sleep Disorder Assessment Tool

Discover your sleep profile

Privacy and Consent

Your Daily Sleep

Your Sleep Habits

Physical Signs and Symptoms

Epworth Sleepiness Scale

General Health

Contact Information

Your Path to Restorative Sleep

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