Sleep Apnea Consultation Request

Blank Form (#3) (#5)


The Thornton Snoring Scale

If you snore, it doesn’t only affect you, depriving you of comfortable rest. It also affects others. The Thornton Snoring Scale can help you determine how your snoring may be influencing the people around you. Choose the most appropriate number for each situation. (Go to question #4, if you have no bed partner.)

0 Never
1 Infrequently (1 night per week)
2 Frequently (2-3 nights per week)
3 Most of the time (4 or more nights per week)

Dozing Scale

In “recent” times, not necessarily today: How likely are you to doze off or fall asleep in the following situations, in contrast to feeling just 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:

0 No chance of dozing
1 Slight chance of dozing
2 Moderate chance of dozing
3 High chance of dozing