Epworth Sleepiness Scale
Epworth Sleepiness Scale
Name: ______________________________________________ Today's date: _________________ Your age (Yrs): _______________ Your sex (Male = M, Female = 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 usual way of life in recent times.
Even if you haven't 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
It is important that you answer each question as best you can.
Situation
Chance of Dozing (0-3)
Sitting and reading ________________________________________
___
Watching TV
________________________________________
___
Sitting, inactive in a public place (e.g. a theatre 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 a lunch without alcohol ________________________ ___
In a car, while stopped for a few minutes in the traffic ________________
THANK YOU FOR YOUR COOPERATION
? M.W. Johns 1990-97
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