John A. Carollo, DMD
General & Family Dentistry
131 Columbia Turnpike, Suite 2A
Florham Park, NJ 07932
Fax: 973 377-4942
Patient Questions & Symptoms:
Do you snore?
Has anyone ever told you that you snore?
Have you been told that you gasp for air when sleeping?
Do you feel tired during the day?
Do you normally wake up feeling refreshed?
Have you spoken with your physician about snoring?
Have you ever been treated for a sleep disorder
Have you ever had a sleep study?
Do you consume alcoholic beverages or take sedatives?
Epworth Sleepiness Scale:
How 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 think through how you might have felt in each setting. Use the following scale to choose the most appropriate number for each situation: 0 = no chance of dozing 1 = slight chance of dozing 2 = moderate chance of dozing 3 = high chance of dozing
Sitting and Reading
Sitting inactive in a public place (e.g. a theater or a meeting)
As a passenger in a car for an hour without a break
Lying down to rest in the afternoon when circumstances permit
Sitting and talking to someone
Sitting quietly after a lunch without alcohol
In a car, while stopped for a few minutes in traffic
Should be Empty: