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Sleep Questionnaire - Epworth Sleepiness Score Sleepiness Scale



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 have affected you.

Use the following scale to choose the most appropriate number for each situation:

0 = Would never doze
1 = Slight chance of dozing
2 = Moderate chance of dozing
3 = High chance of dozing
Situation Chance of Dozing
1.) Sitting and reading ________________
2.) Watching television ________________
3.) Sitting, inactive, in a public place (i.e. a theater or a meeting place) ________________
4.) As a passenger in a car for an hour without a break ________________
5.) Lying down to rest in the afternoon when circumstances permit ________________
6.) Sitting and talking to someone ________________
7.) Sitting quietly after a lunch without alcohol ________________
8.) In a car, while stopped for a few minutes in traffic ________________
TOTAL ________________

If you or someone you know scored high on this quiz, it may be a sign of a sleep disorder. Please talk with your physician, or call our sleep center for more information.

Idaho Sleep Specialists, 403 South 11th Street Suite 210, Boise, ID 83702
Phone (208) 895-0411   -   Fax (208) 895-0406

OSA Sleep Questionnaire Epworth Sleepiness Score Sleepiness Scale Narcolepsy Sleep Questionnaire
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