Sleep Questionnaire
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 work out how they would have affected you. Use the following scale to choose the most appropriate number for each situation.
0 = would never dose
1 = slight chance of dozing
2 = moderate chance of dozing
3 = high chance of dozing
| Situation | Chance of Dozing |
|---|---|
| Sitting and Reading | _____ |
| Watching TV | _____ |
| Sitting, inactive in a public place (e.g. theater, or meeting) | _____ |
| As a passenger in a car for an hour without a break | _____ |
| Lying down to rest in the afternoon when circumstances permit | _____ |
| Sitting, talking with someone | _____ |
| Sitting quietly after a lunch without alcohol | _____ |
| In a car, while stopped a few minutes in traffic | _____ |