THE EPWORTH SLEEPINESS SCALE

How likely are you to doze off or fall asleep in the following situations, in contrast to feeling just tired?  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 doze

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 public place

(e.g. theater or meeting)

_____

As a passenger in a car for an hour without a break

_____

Lying down to rest in afternoon when circumstances permit

_____

Sitting and talking to someone

_____

Sitting quietly after lunch without alcohol

_____

In car, while stopped for a few minutes in the traffic

_____

Total Score

_____

THE EPWORTH SLEEPINESS SCALE

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

0 = never during a usual night

1 = less than once a week

2 = once to about half the nights per week

3 = half the nights to almost always

4 = almost always or every night

? = don’t know or haven’t been told

During your usual sleep have you noticed or have been told you do the following:

(0-4,?)

1. Snore loudly

_____

2. Stop breathing

_____

3. Choke, struggle for breath

_____

4. Toss and turn frequently

_____

5. Wake up with a headache

_____

Usual number hours of sleep per night

_____

Number of times your rise to use toilet

_____