| EPWORTH
SLEEPINESS SCALE
Name:_____________ Date:_______________
The Epworth Sleepiness Scale is a short quiz designed
to help screen whether you have a sleep disorder.
Rate from 0 to 3 your chance of dozing in the
eight listed situations. Add the eight ratings
to get a Total Epworth Sleepiness Score.
|
| Do
you snore? |
Yes
____ No ____ |
| Are
you tired when you wake up? |
Yes
____ No ____ |
| Rating
Guide: |
|
| Would
never dose |
=>0 |
|
Slight chance of dozing |
=>1 |
|
Moderate chance of dozing |
=>2 |
|
High chance of dozing |
=>3 |
| Situation:
Chance of Dozing: |
|
| 1.
|
Sitting
and reading |
____ |
2.
|
Watching
TV |
____ |
3.
|
Sitting,
inactive in public |
____ |
4. |
Car
passenger (for an hour) |
____ |
5. |
Lying
down in the afternoon |
____ |
6. |
Sitting
and talking to someone |
____ |
7. |
Sitting
quietly after lunch (no alcohol) |
____ |
8. |
Stopped
for a few minutes in traffic |
____
|
Total
Epworth Sleepiness |
____ |
| Score:
|
|
| A
total score of 10 or more suggests you may need
further evaluation to determine if you have a sleep
disorder and/or sleep disordered breathing. If you
think you have Sleep Apnea, discuss it with a medical
or dental doctor who is familiar with sleep disorders.
You can even consult directly with a sleep medicine
physician. Do not postpone needed treatment! |
