Epworth Sleepiness Scale

Name*

First NameMiddle NameLast NameSuffix

How likely are you to doze off or fall asleep in the following situations, incontrast to just feeling tired? This refers to your usual way of life in recenttimes. Even if you have not done some of these things recently try to workout how they would have affected you. Use the following scale to choose themost 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, in active in a public place (e.g. theater, or meeting)
As a passenger in a car 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

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