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 _____