Self Test Questionnaire

The Epworth Sleepiness Scale


Name:_________________Age:_______

Today’s Date: ___________Male/Female

How likely are you to doze off or fall asleep in the following situations, in contrast to feeling tired?  This refers to your usual way of life in recent times.  Even if you have not 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
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Situation

 

Sitting & Reading 

Watching TV 

Sitting, inactive in a public place
(E.g. movie 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 lunch
without alcohol

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

Chance of Dozing

 

_____________

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_____________

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If your score is more than 10, you may have a sleep disorder and it is recommended that you seek the advice of a sleep specialist without delay.