HST Admission Packet (NightOwl)

  • Pre-Sleep Study Questionnaire

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  • Epworth Sleepiness Scale

    According to the following scale, choose the appropriate number value to represent how likely you are to fall asleep during the day in the following situations. Try to be as honest as possible. If possible, have your significant other help you fill this out.

  • 0 - Never          1 - Slight Chance          2 - Moderate          3 - Always

  • Interpretation:

    0-7: It is unlikely that you are abnormally sleepy.

    8-9: You have an average amount of daytime sleepiness.

    10-15: You may be excessively sleepy depending on the situation. You may want to consider seeking medical attention.

    16-24: You are excessively sleepy and should consider seeking medical attention.

  • The U.S. Department of Heath & Human Services Office of Civil Rights

    200 Independence Avenue

    S.W. Washington, D.C. 20201

    (202) 619-0257

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  • ACHC

     139 Weston Oak Ct.

    Cary, N.C. 27513

    (855) 937-2242

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  • Post-Sleep Questionnaire

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  • Should be Empty: