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7. Epworth Sleepiness Scale


Name___________________________

Date____________________________                                   Age___________

Sex:  M  F

How likely are you to doze off or fall asleep in the following situations, in contrast to feeling just tired?  This refers to your standard way of life in recent times.  Even if you have 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 a public place, (e.g. theater or a meeting)

______

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

______

Lying down to rest in the afternoon when circumstances permit

______

Sitting and talking to someone

______

Sitting quietly after lunch without alcohol

______

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

______